Nurse 340 Theory – Flashcards
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T/F All professions are occupations but not all occupations are professions.
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TRUE
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What is the difference between an occupation and a profession?
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Occupation is a job or a career, whereas a profession is a learned vocation or occupation that has a status of superiority and precedence within a division of work.
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What are the 7 characteristics of a profession?
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1. a defined knowledge base 2. power and authority over training and education 3. registration 4. altruistic service 5. a code of ethics 6. lengthy socialization 7. autonomy A profession must also have an INSTITUTIONALIZED GOAL OR SOCIAL MISSION as well as a group of scholars, investigators, or researchers who work to continually advance the knowledge of the profession with the goal of improving practice.
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Why is nursing not easily called a profession?
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1. extension of services provided by wives and mothers 2. nurses have delayed in identifying and organizing professional knowledge 3. education for nurses is not yet standardized 4. Autonomy in practice is incomplete because nursing is still dependent on medicine to direct much of its practice.
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The scientific approach to understanding reality is characterized by what?
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observation, verifiability, and experience
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_________ are made to describe, explain, and predict phenomena in nature and to provide understanding of relationships between phenomena.
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Theories
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What is nursing philosophy?
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a statement of foundational and universal assumptions, beliefs and principles about the nature of knowledge and thought (epistemology) and about the nature of the entities represented in the metaparadigm.
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T/F No single dominant philosophy has prevailed in the discipline of nursing.
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True
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What is nursing science?
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the substantive, DISCIPLINE-SPECIFIC KNOWLEDGE that focuses on the HUMAN-UNIVERSE-HEALTH PROCESS ARTICULATED IN THE NURSING frameworks and theories. In general, nursing science refers to the system of relationships of human responses in health and illness addressing biologic, behavioral, social, and cultural domains.
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It is ________ that gives direction to the future generation of substantive nursing knowledge, and provides the knowledge fora all aspects of nursing.
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nursing science
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definitions of theory
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a systematic explanation of an event in which constructs and concepts are identified and relationships are proposed and predictions made a creative and rigorous structuring of ideas that project a tentative, purposeful and systematic view of phenomena a set of interpretative assumptions, principles, or propositions that help explain or guide action.
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What is moral or ethical knowledge?
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Knowledge of what is right and wrong. Values and social and cultural norms of behavior are components of ethical knowledge.
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Florence Nightingale
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The first modern nursing theorist. The first to delineate what she considered nursing's goal and practice domain, and she postulated that "to nurse" meant having charge of the client "in the best condition for nature to act upon him"
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Nightingale established a school for nurses. According to Nightingale, why was training for nurses necessary? What did she teach?
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"to teach not only what is to be done, but how to do it". She was the first to advocate the teaching of symptoms and what they indicate. She taught the importance of rationale for actions and stressed the significance of "trained powers of observation and reflection".
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Borrowed or shared theory
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a theory developed in another discipline that is not adapted to the worldview and practice of nursing
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Concept
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The elements or components of a phenomenon necessary to understand the phenomenon. They are abstract and derived from impressions the human mind receives about phenomena through sensing the environment. A symbolic statement describing a phenomenon or a class of phenomena
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Construct
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the most complex type of concept. They are comprised of more than once concept and typically built or constructed by the theorist or philosopher to fit a purpose.
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Metaparadigm
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represents the worldview of a discipline- the global perspective that subsumes more specific views and approaches to the central concepts with which the discipline is concerned.
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Middle range theory
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refers to a part of a discipline's concerns related to particular topics. The scope is narrower than that of broad-range or grand theories.
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Paradigm
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an organizing framework that contains concepts, theories, assumptions, beliefs, values, and principles that form the way a discipline interprets the subject matter with which it is concerned. It describes the work to be done and frames an orientation within which the work will be accomplished.
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Phenomena
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the designation of an aspect of reality; the phenomena of interest become the subject matter that are the primary concerns of a discipline
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Philosophy
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a statement of beliefs and values about human beings and their world
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Relationship statements
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indicate specific relationships between two or more concepts. They may be classified as propositions, hypotheses, laws, axioms, or theorems.
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Theory
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A set of logically interrelated concepts, statements, propositions, and definitions, which have been derived from philosophical beliefs of scientific data and from which questions or hypotheses can be deduced, tested, and verified. A theory purports to account for or characterize some phenomenon.
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Worldview
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the philosophical frame of reference used by a social or cultural group to describe that group's outlook on and beliefs about reality
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What are the five stages in the development of nursing theory?
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silent knowledge received knowledge subjective knowledge procedural knowledge constructed knowledge
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Silent knowledge: Source of knowledge Impact on theory and research
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Blind obedience to medical authority Little attempt to develop theory. Research was limited to collection of epidemiological data
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Received knowledge Source of knowledge Impact on theory and research
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learning through listening to others theories were borrowed from other disciplines. As nurses acquired non-nursing doctoral degrees, they relied on the authority of educators, sociologists, psychologists, physiologists, and anthropologists to provide answers to nursing problems.
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Subjective knowledge Source of knowledge Impact on theory and research
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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.
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Procedural knowledge Source of knowledge Impact on theory and research
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Includes both separate and connected knowledge Proliferation of approaches to theory development. Application of theory in practice was frequently underemphasized. Emphasis was placed on the procedures used to acquire knowledge, with over-attention to the appropriateness of methodology, the criteria for evolution, and statistical procedures for data analysis.
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Constructed knowledge Source of knowledge Impact on theory and research
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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, and the nurse scholar's intuition or related knowledge about the phenomenon of concern.
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The scope of a theory includes its level of _______ and the concreteness of its ____ and ______.
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specificity; concepts; propositions.
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Classification of theories in nursing typically uses the terms metatheory, philosophy, or worldview to describe the __________ basis of the discipline, grand theory or macrotheory to describe the _________ conceptual frameworks.
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philosophical; comprehensive
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List the theories from most abstract to least abstract: Grand theories Practice theories Metatheory Middle range theories
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Methatheory Grand theories Middle range theories Practice theories
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Metatheory refers to a theory about _____.
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theory
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_________ theories are the most complex and the broadest in scope.
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Grand
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Grand theories
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attempt to explain broad areas within a discipline and may incorporate numerous other theories. (macro theories)
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________ theories are nonspecific and comprised of relatively abstract concepts that lack operational definitions.
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Grand
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________ theory lies between the nursing models and more circumscribed, concrete ideas (practice theories). They are substantively specific and encompass a limited number of concepts and al limited aspect of the real world.
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Middle range
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Middle range theories are comprised of relatively _____ concepts and are operationally defined and relatively concrete propositions that may be ______ tested.
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concrete; empirically
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Fawcett (2000) states that a middle range theory may be one of what three things?
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1. a description of a particular phenomenon 2. an explanation of the relationship between phenomena 3. a prediction of the effects of one phenomenon or another
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_______ theories are also called microtheories, prescriptive theories, or situation-specific theories and are the least complex.
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Practice
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T/F Practice theories are more specific than middle range theories and produce specific directions for practice.
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True
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Which kind of theories contain the fewest concepts and refer to specific, easily defined phenomena.
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practice theories
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T/F Practice theories are usually limited to specific populations or fields of practice and often use knowledge from other disciplines.
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True
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Partial theories
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those in the development stage. Theories derived from the social sciences, including nursing, are probably exclusively partial theories because there are few, if any, phenomena that have been totally and completely explained.
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The most abstract and general component of the structural hierarchy of nursing knowledge is what Kuhn (1977) called the _______.
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metaparadigm
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What is a metaparadigm?
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the global perspective of a discipline that identifies the primary phenomena of interest to that discipline and explains how the discipline deals with those phenomena in a unique manner.
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What is the purpose or function of the metaparadigm?
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to summarize the intellectual and social missions of the discipline and place boundaries on the subject matter of that discipline.
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Requirements for a metaparadigm
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box 2-1 pg 39
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Person
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a being composed of physical, intellectual, biochemical, and psychosocial needs; a human energy field; a holistic being in the world; an open system; an integrated whole; an adaptive system; and a being who is greater than the sum of his parts.
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Health
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the ability to function independently; successful adaptation to life's stressors; achievement of one's full ife potential; and unity of mind, body and soul (Wagner, 1986) A pattern of evolving, expanding consciousness regardless of the form or direction it takes. Unity and harmony within the mind, body, and soul.
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Environment
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refers to the external elements that affect the person; internal and external conditions that influence the organism; significant others with whom the person interacts; and an open system with boundaries that permit the exchange of matter, energy, and information with human beings (Wagner, 1986) The totality of an event, situation, or particular experience that gives meaning to human expressions, interpretations, and social interactions in particular physical, ecologic, sociopolitical, and cultural settings.
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Nursing
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a science, an art, and a practice discipline, and involves caring. Goals in nursing include care of the well, care of the sick, assisting with self-car activities, helping individuals attain their human potential, and discovering and using nature's laws of health.
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What is the purpose of nursing care?
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placing the client in the best condition for nature to restore health, promoting the adaptation of the individual, facilitating the development of an interaction between the nurse and the client in which jointly set goals are met, and promoting harmony between the individual and the environment.
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Concepts may be _______ (hope, love, desire) or relatively ________ (airplane, body temperature, pain.
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abstract; concrete
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T/F A concept may be a word, two, words, or a phrase
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True. grief, job satisfaction, maternal role attachment
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T/F Concepts can be defined once and for all.
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False. Because conceptual meanings are dynamic, they should be defined for each specific use the writer or researcher makes of the term.
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What are the types of concepts
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Enumerative concepts-always present and universal. Associative concepts-exist only in some conditions. Relational concepts- can be understood only through the combination or interaction of two or more enumerative or associative concepts. Statistical concepts-relates the property of one thing in terms of its distribution in the population rate. Summative concepts- complex and not measurable.
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Abstract vs Concrete concepts
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concrete (specific) concepts have simple, directly observable empirical referents,that can be seen, felt, or heard (chair, the color red, jazz music. They are limited by time and space and are observable in reality. abstract (general) (art, social support, personality, role). These are not clearly observable directly or indirectly and must be defined in terms of observable concepts. They are independent of space and time.
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Relatively concrete o "empirical" concepts are formed from direct observations of what?
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objects, properties, or events
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Naturalistic concepts
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concepts seen in nature or in nursing practice such as body weight, thermoregulation, hematologic complications, depression, pain, spirituality. These may be on a continuum from concrete to abstract and some may be measurable in fact (body weight and temperature) and others (pain or spirituality) measurable only indirectly and only in principle.
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Research-based concepts
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the result of conceptual development that is grounded in research process. The theorist/researcher studies the realm of interest and identifies themes. Developed through a qualitative research process. Often relate to a nursing specialty. (Hope, grief, cultural competence, chronic pain)
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Existing concepts
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Borrowed from other disciplines. Developed for nursing practice, but are useful in research and theory. Job satisfaction, quality of life, abuse, adaptation, stress
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What is the purpose of concept development or concept analysis?
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clarifying, recognizing, and defining concepts that describe phenomena
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How are theories classified in nursing?
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based on range/scope or abstractness and type or purpose of the theory.
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The scope of a theory refers to...
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complexity and degree of abstraction
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The "scope" classification of a theory typically uses terms ______, ________, or ________ to describe the philosophical basis of the discipline or theory.
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metatheory, philosophy, or worldview.
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What is the scope of a grand theory or macrotheory?
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comprehensive conceptual frameworks
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What is the scope of a middle range theory?
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frameworks that are relatively more focused than grand theories
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What is the scope of micro theories?
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situation specific theory, or practice theory
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What is a metatheory?
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a theory about theory. Focuses on broad issues such as the processes of generating knowledge and theory development and it is a forum for debate within the discipline.
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What are the recent metatheoretical issues?
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relate to the philosophy of nursing and address what levels of theory development are needed for nursing practice, research, and education and the increasing focus on the philosophical perspectives of critical theory and feminism.
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What are grand theories?
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the most complex and broadest in scope.They attempt to explain broad areas within a discipline and may incorporate numerous other theories. They are nonspecific and comprised of relatively abstract concepts that lack operational definitions. Their propositions are also abstract and are not generally amenable to testing.
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How are grand theories developed?
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Through thoughtful and insightful appraisal of existing ideas as opposed to empirical research.
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What are middle range theories?
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They are substantively specific and encompass a limited number of concepts and a limited aspect of the real world. Comprised or relatively concrete concepts that are operationally defined and relatively concrete propositions that may be empirically tested.
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Fawcett states that a middle ranch theory may be what three things?
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1. A description of a particular phenomenon 2. An explanation of the relationship between phenomena or 3. A prediction of the effects of one phenomena or another
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What are practice theories?
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Also called micro theories, perspective theories, or situation specific theories. They are the least complex. They are more specific than middle range theories and produce specific directions for practice. They contain the fewest concepts and refer to specific, easily defined phenomena. They are narrow in scope, explain a small aspect of reality, and tend to be perspective. They are limited to specific populations or fields of practice and often use knowledge from other disciplines.
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What are partial theories?
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They are in the development stage. Some concepts have been identified and some relationships between them have been identified, but the theory is not complete.
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*? Four kinds of [partial] theories are described by Dickoff and James. What are they?
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factor isolating theories (descriptive theories) factor relating theories (explanatory theories) Situation related theories (predictive theories or promoting or inhibiting theories) situation-producing theories (perspective theories).
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What are Factor isolating theories?
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they describe, observe, and name concepts, properties, and dimensions. They identify and describe the major concepts of phenomena but does not explain how or why the concepts are related. The purpose is to provide observation and meaning regarding the phenomena. It is generated and tested by descriptive research techniques.
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What are factor relating theories?
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explanatory theories are those that relate concepts to one another, describe the interrelationships among concepts or propositions, and specify the associations or relationships among some concepts. They attempt to describe how or why the concepts are related and may deal with cause and effect and correlations or rules that regulate interactions.
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What are situation relating theories?
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they are achieved when the conditions under which concepts are related are stated and the relational statements are able to describe future outcomes consistently. They move to prediction of precise relationships between concepts.
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What are situation producing theories?
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Those that prescribe activities necessary to reach defined goals. They address nursing therapeutics and consequences of interventions. They include propositions that call fro change and predict consequences of nursing interventions. THey should describe the prescription, the consequences, the type of client, and conditions.
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Theory has been described as a ________ explanation of an event in which constructs and __________ are identified and relationships are proposed and _________ made.
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systematic; concepts; predictions.
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The initial work of theorists was aimed at what?
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clarifying the complex intellectual and interactional domains that distinguished expert nursing from mere doing of tasks.
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How did theories make nursing practice more overly purposeful?
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by stating not only the focus of practice, but specific goals and outcomes.
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Some nursing scholars believe that nursing theory is practically _______.
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nonexistent.
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Who was Florence Nightingale?
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First modern nursing theorist. First to delineate nursing goals and practice. Believed the role of the nurse was seen as placing the client in the best condition for nature to act upon him. Believed that formal training for nurses was necessary.
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What are the stages of theory development in nursing?
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1. Silent knowledge stage 2. Received knowledge stage 3. Subjective knowledge stage 4. Procedural knowledge stage 5. Constructed knowledge stage
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What is the silent knowledge stage of theory development?
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the source of knowledge was a blind obedience to medical authority. There was little attempt to develop theory and research was limited to collection of epidemiologic data.
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What is the received knowledge stage of theory development?
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The source of knowledge was learning through listening to others. Theories were borrowed from other disciplines. As nurses acquired non-nursing doctoral degrees, they relied on the authority of educators, sociologists, psychologists, physiologists, and anthropologists to provide answers to nursing problems. Research was educational and sociologic.
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What is the subjective knowledge stage of theory development?
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the source of 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 the clients and clinical situations.
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What is the procedural knowledge stage of theory development?
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the source of knowledge includes both separate and connected knowledge. Proliferation of approaches to theory development. Application of theory in practice was frequently underemphasized. Emphasis was placed on the procedures used to acquire knowledge, with over attention to the appropriateness of methodology, the criteria for evolution and statistical procedures for data analysis.
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What is the Constructed knowledge stage of theory development?
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source of knowledge was 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 feel ins, and the nurse scholar's intuition or related knowledge about the phenomenon of concern.
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What is metaparadigm?
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the global perspective of a discipline that identifies the primary phenomena of interest to that discipline.
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What is the nursing metaparadigm?
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- Person: refers to being composed of physical, intellectual, biochemical, and psychosocial needs; a human energy field; a holistic being in the world; an open system; an integrated whole; an adaptive system; and a being who is greater than the sum of his parts - Health: the ability to function independently; successful adaptation to life's stressors; achievement of one's full life potential; and unity of mind, body, and soul - Environment: refers to the external elements that affect the person; internal and external conditions that influence the organism; significant others with whom the person interacts; and an open system with boundaries that permit the exchange of matter, energy, and information with human beings - Nursing: a science, an art, and a practice discipline, and involves caring
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What are the requirements for a metaparadigm?
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1. Must identify a domain that is distinctive 2. Must encompass all phenomena of interest to the discipline 3. Must be perspective-neutral 4. Must be international in scope
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What is the closest thing to a general nursing phenomena?
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caring as a central construct in the discipline of nursing.
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What is a concept?
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A symbolic statement describing a phenomenon or a class of phenomena. Can be abstract (hope, love, Concrete (airplane, body temperature), A word (grief, empathy), two words (role strain), phrase (maternal role attachment).
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When they are operationalized, _________ become variables used in hypotheses to be tested in research.
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concepts
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Concepts have been borrowed or derived from other disciplines as well as derived from _____ and ____.
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nursing practice; research
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What is a summative concept?
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Represent an entire complex entity of phenomenon; are complex and not measurable (ex. nursing, health and environment).
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What are the characteristics of an Abstract concept?
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Not clearly observable directly or indirectly (art, social support, personality). Must be defined in terms of observable concepts. Independent of time and space.
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What are the characteristics of a concrete concept?
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can be seen felt or heard (car, color red, jazz music). Limited by time and space. Observable in reality (observations of objects, properties, or events). "empirical".
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What are Variable (Continuous) concepts?
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Concepts that describe phenomena according to some dimensions of the phenomena are termed variables. Permit classification of dimension or graduation of phenomena or continuum (BP, pain, sex role orientation, level of well being, and degree of cultural identity)
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What are Nonvariable (Discrete) concepts?
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Can be single variable that may be answered with yes or no or fits into a predefined category (religion, marital status, educational attainment).
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What is a theoretically defined concept?
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Gives meaning to term in context of a theory and permits any reader to assess the validity of the definition.
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What is an Operationally defined concept?
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Tells how the concept is linked to concrete situations. Describes procedures that will be performed to assign a value of the concept. Permits concept to be measured and hypothesis to be tested. Bridge between theory and empirical world.
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What are the three types of grand theories and what makes them different?
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...
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What is the difference between grand, middle range, and borrowed theories?
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...
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What is theory development?
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the process to create, modify, or define a theory. The first step is to define terms.
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What are the levels of a theory?
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meta theory- a philosophical discussion of the foundations. A philosophy. Clarifies methodology and roles of other theories. Grand theory- Human experience, abstract. Middle range- variable. Can be proven and tested.
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Why do we analyze theories?
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To find out... What is the origin of the problem? Methods Subject matter Outcomes Testability Usefulness
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Why do we need nursing theory?
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To prevent chaos in nursing care To improve client/patient care To guide nursing research to support existing knowledge and to gain new knowledge.
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Why are nursing theories iportant?
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Provides us with a logical and systematic way of examining situations. Provides guidelines for communication between nurses and other members of the healthcare team. Helps nurses know who we are, our beliefs, values, and goals. Shows how we contribute to healthcare. Helps nurses to control some of our aspects of care- Nursing protocols We need it to continue to develop and evolve as the discipline of nursing.
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What is a theory?
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A group of ideas regarded as correct that can be used to explain and predict phenomenon. A proposed explanation which is still in conjecture- many nursing theories due to their abstract quality. A way to use ideas in an orderly fashion asa way to view phenomena.
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What is nursing theory?
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What nursing is and what nurses do. What are its goals and outcomes By using nursing theory and research, nursing develops nursing practice guidelines.
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What is Florence Nightingale's concepts of Human, Environment, Health, and Nursing?
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...
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What are concepts? (concrete and abstract)
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Concrete concepts can be measured- can be seen, felt or heard. Concrete concepts can be measured such as height, weight, or vitals Abstract concepts are not clear such as personality.
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What are the four types of concrete concepts?
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Enumerative- always present and constant, such as gender. Associative- must be in combination such as elderly-age and longevity. Statistical- one property of one thing in distribution in the population rate, such as the average blood pressure, or disease prevalence. SUMMATIVE- REPRESENT AN ENTIRE COMPLEX PHENOMENA, SUCH AS THE WHOLE CONCEPT OF NURSING.
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Discreet vs Continuous concepts
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Discreet- can be answered with a yes or no, such as gender, ethnic background, etc. Continuous- can change such as well, being, vitals, or faith.
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Concept development
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Once we have down the concepts, we nee to put them together. concept development is the framework so we can begin to identify an assumption then look at its implication for research, theory, and practice. First name the problem Start a collection about the phenomena See the similarities and differences Context in where the concept occurs.
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NURSING USES ________ = PHYSIOLOGY, MATH, PSYCH, HX RELIGION= ________
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SCIENCE; APPLIED SCIENCE
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NURSING AS ACADEMIC DISCIPLINE=
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PROSPECTIVE/SYNTAX, METHOD STUDY, EVIDENCE AS PROOF, PHENOMENA
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PROFESSION=
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KNOWLEDGE, POWER TRAINING/EDU, CODE OF ETHICS, AUTONOMY, AND REGISTRATION.
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What are EXCHANGE THEORIES?
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basis on utilitarianism (the greatest good for the greatest number)
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What are the three types of exchange theories?
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Social exchange perspective Individualistic Social Exchange Societal/Collectivist Exchange
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What is Social Exchange Perspective?
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Group: Group therapy, group counseling, Group teaching (education), how groups interact: managing groups, managing a nursing team.
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What is Individualistic Social Exchange?
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Individuals: Advocate for patients through therapeutic communication.
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What is Societal/Collectivist Exchange?
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Gathering of system, creating a large systems. Collaboration with other systems.
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What is an example of INTERACTION THEORIES?
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Role theory: when defining expectations for nursing: what the nurse is supposed to do.
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What are CONFLICT THEORIES?
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When advocating patients, conflict arises. In terms of conflict theory, we use it in advocacy. Ethical dilemmas: 1. Feminist Theory: does not only deal with female oppression. 2. Critical Social Theory: deals with inequality.
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What are psychodynamic theories?
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attempts to explain multidimensional nature of behavior and understand how an individual's personality and behavior interface.
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Freud
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how individuals work psychologically. Id, Ego, Superego
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Id
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original system of personality; pleasure principle
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Ego
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Mind vs external world; reality principle; cognitive and intellectual functions; controls behavior; balances the ID and superego.
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Superego
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keeps us in the straight and narrow; inhibits impulses of ID; perfection
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Erickson (psychosocial theory)
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8 Stages (psychosocial theory) Nursing care based on developmental stage and age; used to help with appropriate nursing care.
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Sullivan (interpersonal)
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(Interpersonal)- Peplau based her nursing theory on Sullivan's theory
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Skinner
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operant condition; positive reinforcement for patients.
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Maslow
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behavior plans; must meet most basic needs first
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Carl Rogers (person-centered theory)
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patient-centered care
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Seyle (general adaptation syndrome)
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stress and general adaptation; fight and flight response activates sympathetic nervous system
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Lazarus
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stress, coping, adaptation
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Health belief model
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predict health behaviors; people fear disease and that health actions were motivated in relation to the degree of fear
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Theory of reasoned action
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people are rational and make decisions based on the information available to them; relationships between beliefs, attitudes, intentions, and behaviors.
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Theories form ________ sciences have a tremendous impact on nursing practice and are so integral to nursing that they are overlooked and taken for granted.
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biomedical sciences (biology, medicine, public health, physiology, and pharmacology)
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Evolution of Theories of Disease Causation
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today, the predominant model of disease causation has evolved to multicausal, involving factors such as immune responses, genetics, environment, and behavior.
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Germ Theory and Principles of Infection
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Application to Nursing: nursing research has focused on prevention and management of infection as well as identifying factors that place an individual at risk for developing infections. Examples of nursing practice related to prevention of infection include guidelines for choosing sterile over non-sterile gloves, techniques of hair removal prior to surgery,and guidelines for prevention of infections related to urinary catheters, central lines, etc .
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The Epidemiologic Triangle
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This model is often used to illustrate the interrelationships among the three essential components of host, agent, and environment with regard to disease causation. A change in any of the three components can result in the disease process. Within this triangle, prevention of disease lies in averting exposure to the agent, enhancing the physical attributes of the host to resist the disease, and minimizing any environmental factors that affect health can also influence progression of the disease process.
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The Web of Causation
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Application to nursing: nurses have developed interventions and proposed strategies to address complex health problems with many different causes.
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What three levels of prevention are there?
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Primary Prevention Secondary Prevention Tertiary Prevention
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What is primary prevention?
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Activities that are directed at preventing a problem before it occurs. Primary prevention consists of 2 categories: GENERAL HEALTH PROMOTION (good nutrition, adequate shelter, rest exercise) and SPECIFIC PROTECTION (immunization, water purification)
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What is secondary prevention?
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Early detection and includes any screening activity (mammography, cholesterol screening) and subsequent efforts to limit disease progression for those identified with a health condition (taking statin meds, lumpectomy with radiation/chemotherapy)
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What is tertiary prevention?
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Limitation of disability and rehabilitation during period of advanced disease and recuperation, where disease has occurred and resulted in a degree of damage.
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How does the Progress of disease apply to nursing?
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much of nursing practice focuses on efforts to prevent progression of disease at the earliest period or phase using appropriate levels of prevention.
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How does primary prevention apply to nursing?
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efforts to prevent skin cancer among athletes, primary prevention of cancer through modification of environmental risks, prevention of falls among elders and prevention of cervical cancer through promoting vaccination against HPV
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How does secondary prevention apply to nursing?
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program to promote screening for alcohol use and misuse among elders, lead screening for pregnant women and children, and counseling and testing for BRCA gene mutations among at risk women.
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How does tertiary prevention apply to nursing?
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information to help nurses work to prevent reoccurrences and secondary malignancies among long-term survivors of cancer.
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How are principles of homeostasis applied to nursing practice?
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Physiologic process of homeostasis in the human body, focusing on role of albumin in F&E balance. Importance of maintaining homeostasis and blood glucose levels in patients in ICU Use of principles of homeostasis to describe the physiology and function of sleep in healthy infants and young children Benefits in maintaining calcium homeostasis to promote bone health in infants. (in research) concept of homeostasis served as a theoretical framework in a study to determine effect of soothing music on neonatal behavioral states in the hospital newborn nursery.
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Walter Canon developed what concept to explain the body's reaction to emergencies?
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fight or flight
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What is the purpose of fight or flight response?
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prepares the body for muscular activity (running, self-defense) when reacting to a perceived or actual threat.
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How did Hans Selye build on Canon's work on stress?
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by developing a framework to describe how the body responds to stress. He believed that changes in organs occur in three stages.
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What are Selye's three stages?
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Stage 1 (the alarm phase) begins wit fight or flight response Stage 2 (resistance) the body starts to react and return to homeostasis. Stage 3 (exhaustion) occurs when stressor persists and body cannot continue to produce hormones as in stage 1, or when damage has occurred to other organs.
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How does genetic theories and principles apply to nursing?
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genetics will greatly affect the way health care is practiced in the future, and nurses will need to INCORPORATE GENETIC TECHNOLOGY and discovery into practice and RESEARCH AT THE INDIVIDUAL, FAMILY, AND COMMUNITY LEVELS. Nurses familiar with genetics and who are able to "think genetically" can ask appropriate questions of patients to assess genetic risk factors, communicate with patients and their families about inherited risks, make referrals to genetic counselors, reinforce counseling, and administer gene therapy or genetically specific drugs.
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What are the nursing interventions for genetic theories and principles?
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individual: educating patients on genetic testing assisting patients to determine need for testing genetic counseling educating about individualized medication therapy Family interpret and share genetic risk and health promotion referring to and interfacing with genetic specialists explaining risks and benefits of genetic study Assessing and counseling families Community Community readiness for genetic screeing and intervention Availability and voluntary access to genetic information, testing, and assurance of follow-up services Population Coordinating genetically focused research Collaborative research focusing on ecogenetics, ethics, and psychosocial issues. Ensuring that patients remain the priority of clinical treatment and research.
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Nurses knowledgeable in genetics can ensure that patients and families do what?
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make informed and voluntary decisions about genetic information.
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What is genetic counseling?
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nondirective, voluntary, and personal, and should precede testing to allow informed decision making.
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What should genetic counseling include?
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an explanation of risk factors, exploration of the person's perception of the condition, and discussion of childbearing options.
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What are the goals of genetic counseling?
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to help clients and family members comprehend the medical genetic information, appreciate the genetic contribution to health and illness, understand health options and alternatives, and make informed health choices.
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How does pain management apply to nursing?
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other therapeutic options to relieve pain (oral sucrose solution to infants before giving injection; music; guided imagery)
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What is the purpose of middle range nursing theories?
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take overall scale of grand theories and make it applicable and useful in research, lower level of abstraction and ease of operationalization. Also more likely to be practiced because they are more specific and concise.
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What are the characteristics of middle ranch theories?
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straight forward in general more readable and user friendly and need to be described in practice terms in journals that nurses are more likely to read Focus primarily on client problems and outcomes Specific to nursing and specify an area of practice, age, range of client, nursing actions, or interventions More likely to testable
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Concepts and relationships for middle range theories
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limit number of concepts that are fairly concrete (discrete and observable) and may be operationally defined.
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How are middle range theories categorized?
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High middle Middle Low middle
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How do middle range theories develop?
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Evolved from grand theories, clinical practice, literature review, practice guidelines, or standard of care.
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What is a high middle range theory?
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most abstract and closest to grand, only thing that doesn't qualify them to be grand theories is the lack of certain qualities
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What is a middle middle range theory?
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intended for different purpose from grand theory
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what is a low middle range theory?
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less abstract
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Banner's model of skill acquisition
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5 stages -novice -advanced beginner -competent -proficient -expert nursing implication: continuing education in nursing
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Leininger's cultural care diversity and universality theory:
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First to deal with culture as an area of nursing practice. Nursing implication: cultural competence
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Kolcaba's theory
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Defined comfort within nursing practice; comfort viewed as an outcome of care. Nursing implication: need for comfort
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What kind of theories are these? Pender's health promotion model The Omaha System The Synergy Model Beck's postpartum depression theory Mercer's conceptualization of maternal role attainment
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middle range
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What is the difference between a profession and an occupation?
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Profession has regulation over the education. Oversee the kind of education that takes place. Ethics. Autonomy of practice. Advocacy requirements. Occupation=job Profession=career
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Which of the following do science and philosophy have in common? A. Hypothesis testing B. Nature of being C. Goal of increasing knowledge D. Verifiability of information
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C. Goal of increasing knowledge Rational: Science and philosophy share the common goal of increasing knowledge. Science is tied to the philosophy of the disciple, with a shared goal increase the knowledge of the discipline.
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text p9 table 103
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...
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Phenomenology
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study of phenomena and the appearance of things.
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Nursing philosophy refers to:
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the belief system of the profession and provides perspectives for practice, scholarship, and research. There is no one dominant philosophy of nursing.
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What is nursing science?
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the system of relationships of human responses in health and illness addressing biologic, behavioral, social, and cultural domains.
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What is the goal for nursing science?
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Goal of nursing science is to represent the nature of nursing, to understand, to explain, and use it for mankind.
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T/F The only true way of knowledge development is through empirics and science.
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False. There are multiple ways of knowing and knowledge development. There are many theories on knowledge and learning.
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What is nursing epistemology?
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the study of the origins of nursing knowledge and encompasses much more than empirics.
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Quantitative
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numerical relationships
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Qualitative
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Quality (description, elaboration, more opportunity to follow the info that you are getting instead of following a very prescribed procedure as you would in quantitative)
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Theories and models are there to help us _____.
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communicate
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T/F Some nursing scholars believe that theory is practically nonexistent.
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True Rational: Some nursing scholars believe that nursing theory is practically nonexistent. Many nurses and often even nursing faculty admit they see theory as too "theoretical"; difficult to understand.
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T/F The initial goal of nursing theory, by some scholars, was to design a single, unified model of nursing
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True Rational: Some nursing scholars supported the idea of a single theory to represent nursing, a worldview of the discipline. Nursing theory has not evolved in this direction of one single theory.
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Watson- the overarching idea is about...
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caring. Almost everyone can agree on that.
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______ shows up in almost every nursing grand theory.
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Caring
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Who brought the mortality rate down from 40% to 2%?
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Florence Nightingale
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Random facts on Florence Nightingale
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Gathered measureable data (doing quantitative research). She also did some qualitative research (quality of care). She was able to prove that her ideas are accurate with her research. She made a huge difference in mortality rates. She was big on education. She created the first nursing school. She thought that the nurses should know how to keep things clean. She thought nurses should know signs and symptoms. She also talked about respectfulness and hopeful ness in treating people.
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See table 2-2
answer
...
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Borrowed theory:
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take a theory form another area and incorporate it into your nursing theory.
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T/F Nursing theories use only knowledge from nursing.
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False Rational: Nursing theories incorporate concepts and theories shared with other disciplines to guide theory development, research, and practice.
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See table 2-5
answer
...
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Abstract: Concrete:
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Abstract: thinking about thinking Concrete: what is there
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T/F Once a concept is defined, the concept is used with the same definition in all theories.
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False. Rational: The theorist may adjust and re-define concepts and conceptual meaning based on the context of the concept for theory.
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Concepts in nursing theory can be derived from which of the following? A. Nature B. Research C. Other Disciplines D. All of the above
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D. All of the above Rational: Concepts in nursing theory can be adapted from multiple sources, such as nature, research, and other disciplines.
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Rodgers
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Identifies concept f interest setting and sample collecting and managing data analyzing the data identifying an exemplar interpreting the results identifying implications
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See table 2-9 pg 63
answer
...
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T/F Even today, at times, nursing science is based in the positivist era with its focus on disease causality and a desire to produce measurable outcome data.
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True. Nursing scholars are designing and developing new theory in efforts to define the uniqueness of nursing. At times, nursing continues to be focuses on positive paradigms and measurable outcomes from earlier eras of practice.
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What do middle range theories generally want to focus on?
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a particular focus in nursing (a certain area or way of working with patients). may look at particular clusters of health problems or areas of health.
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What is the purpose of middle range theories?
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-More useful in research, lower level of abstraction, and ease of operationalization -Tend to support predictions, circumscribed range, and specificity of the concepts -More likely to be adopted in practice, relative simplicity eases the process of developing interventions for identified health problems
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The support for use of middle range theories includes all of the following except one. Which one is not support for use of middle range theories in nursing? A. Generating testable hypotheses B. Addressing specific client populations C. Applying to general discipline of nursing D. Using as frameworks for investigation.
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C. Applying to general discipline of nursing. Rationale: Middle range theories are more specific. Grand theories are more appropriate for use with the general discipline of nursing.
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What are the characteristics of middle range theory?
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• Principal ideas are relatively simple, straightforward, and general • Limited number of variable or concepts • Receptive to empirical testing • Focus primarily on client problems and likely outcomes • Specific to nursing and may specify an area of practice, age range of client, nursing actions, or interventions
question
Empirical testing=
answer
evidence based. Capable of being verified. Based on experiment.
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Concepts and relationships for middle range theory
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• Consists of two or more concepts and a specified relationship between the concepts • Address phenomena • Concepts should be discrete, observable, and sufficiently abstract to be applied Identifiable but have enough abstract idea that is worth while exploring.
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Categorizing middle range theory
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Not clear how to categorize, more specific than grand theory but abstract enough to support both generalization and operationalization across a range of populations
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Development of middle range theory
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• Theory Derived From: - Research and/or Practice - A Grand Theory - Combining Existing Nursing and Non-Nursing Theories - Non-Nursing Disciplines - Practice Guidelines or Standard of Care • You start with a Grand theory (generally I believe.....I will focus on Watsons theory.....and then I will focus in) • The Grand theory is more overarching and considering more ideas. The middle range will be more specific. But they have to agree and they cant have a lot of conflict. The middle range will follow the Grand's idea but just make it more specific. • You may pull from non nursing disciplines or go can go with a concept that you saw in a grand theory but go farther with it.
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Don't create a theory that conflicts with your own _______ unless you find that they are no longer ______.
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standards of care; viable
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The relationship of concepts in middle range theory include which of the following? A. Multiple concepts in schema B. Discrete, observable concepts C. Independent concepts with limited relationships D. Concepts implicitly stated
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B. Discrete, observable concepts Rational: Concepts in middle range theory are discrete and observable yet general enough to apply to multiple patient population; the number of concepts is limited and the relationships are defined and explicitly stated
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T/F Middle range theories are more user-friendly in language and style.
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True. Rationale: Middle range theories are more readable and needs to be described in practice terms in journals that nurses are more likely to read.
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Theory of unpleasant symptoms
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Symptom management. Provide pain medication, most medications that we give have to do with symptom management. We do a lot of symptom management in psych.
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Reed's Self-Transcendence Theory
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Self-transcendence is like getting over yourself. The importance of "who are the other theorists that are working with this model"
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T/F The term "sociological imagination" refers to the thoughts of individuals in society
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False Rationale: The term "sociological imagination," coined by Mills, refers to the process of looking at social phenomena to discover the unseen and repetitive patterns that govern individuals' social existence.
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Utilitarianism
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the greatest usefulness for the greatest number of people
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social exchange
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we do many things in groups, teaching, therapy, etc
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Individualistic social exchange
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we advocate for our patients
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Which of the following is considered an exchange theory?A. General Systems Theory B. Social Networks C. Rational Choice Theory D. All of the above
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D. All of the above
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Role theory
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"how do nurse's function" Legal expectations of the nursing role. We use role theory when defining role expectations for nurses.
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Ethics can cause ______. The patients belief system is _____ than ours.
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conflicts; higher
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Conflict theory
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we use in advocacy
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Domination/subjugation
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when you are dealing with a person that doesn't have a college education, who has more power? The nurse. The patient with a college degree and the nurse has college degree, who has a higher power? The nurse. If you want to resolve a conflict, do you want the power differential to be big or small? There might be times when subjugation is what we want, but not for long term. Only for short term, like in crisis or dangerous situations.
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Psychodynamic theories
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Attempt to explain the multidimensional nature of behavior and to understand the interaction between personality and behavior Examples: - Psychoanalytic Theory: Freud - Developmental Theory: Erickson - Interpersonal Theory: Sullivan
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Psychoanalytic theory: Freud
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Based theories on scientific view of the late 19th century Behavior product of interactions among 3 systems: Id: original system of personality Ego: controls overall cognitive and intellectual functions Superego: focus is the moral issue of right versus wrong
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Developmental Theory: Erikson
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Emerged as an expansion of Freud Specific stages from birth to death Chronological in order but may vary for each person Eight total stages - First four in infancy/childhood - Fifth in adolescence - Last three in adult years
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Interpersonal Theory: Sullivan
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• Based theory on the premise that individuals cannot exist apart from relations with other individuals • From first day of life, infant is dependent on interactions with individuals • The phenomenon of dynamism, or pattern of energy transformation, is important aspect • Peplau based her nursing theory on this developmental theory • People are dependent on interactions. She did work on nurse patient relationship.
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Skinner Beck RET
answer
Skinner- dog salivating Beck- depression scale? RET- Ellis Focus is on thinking and behavior rather than on feelings • Salivating dog= has to do with behavioral work. Has to do with trying to reinforce with something that they like to do. The importance is for children or developmentally delayed. (sometimes for ourselves too- when we finish one chapter I can get up and watch some tv)
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Selye
answer
stress (fight or flight)
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T/F The health belief model is based on the idea of the individual's fear of disease as a motivational factor for behavioral changes.
answer
True. Rationale: The health belief model is based on the idea that individuals will be motivated to change health behaviors by fear of the disease process; the degree of change is correlated to the degree of fear of the disease.
question
Which theorist developed the idea that behavior is an interactoin among three systems: the id, ego, and superego?
answer
Freud
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Peplau based her nursing theory, Interpersonal Relations in Nursing, on which of the following theorist's works? A. Freud B. Erikson C. Sullivan D. Skinner
answer
C. Sullivan Rationale: Sullivan developed the Interpersonal Theory based on the human interactions and that individuals cannot exist apart from their relationships with other individuals.
question
Germ Theory and Principles of infection
answer
• Louis Pasteur • Theorizes that a specific organism is capable of causing infection • Critical to development of medical care • Applied to prevent infection • Intervention: hand washing • Important because: we are trying to prevent transmission of infection • PPE: to prevent transmission of infection.
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The Epidemiologic Triangle
answer
• Useful in depiction of communicable disease • Model used to illustrate the interrelationships among the three essential components regarding disease causation: - Host - Agent - Environment • Environment meant to reduce the spread of infection- the sterile field • Where do we intervene when we are giving antibiotics? We are impacting the host and trying to kill the agent. • When we wash our hand, we are intervening, we are trying to keep a clean environment as to not spread infection to host.
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Examples of theories that will be used when we are talking about patient advocacy?
answer
conflict management Feminism
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A herd environment
answer
the whole group is protected or affected
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Patricial Bennert
answer
Middle range theorist
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Grand theory/theorist
answer
an over arching way to look at nursing. Watson—caring is the most important thing about nursing. If all else fails, caring is the most important. Then she has 10 caring factors.
question
Stages of the nurse/patient relationship
answer
The pre-initiation phase of nursing is important because we have to figure out what our beliefs are and put them aside for your patient -When we walk into a hospital setting and we have anxiety, our patients can sense that and may give them anxiety and they already aren't having a good day because they are in the hospital. -We need to know what our theory/philosophy is so that we can look at it more objectively.
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What is a theory?
answer
...
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What is a philosophy?
answer
...
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How do we determine how good a theory is?
answer
...
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How do we determine if we can use a certain theory?
answer
...
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What are some grand theories in nursing?
answer
...
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What is your favorite theorist?
answer
...
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Why do you like that theory?
answer
...
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How does that theory fit with your philosophy?
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