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nutrire

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This word in nursing is derived from latin meaning, "To nourish"

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Nursing in Ancient times

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No formal education for the care of the sick Early caregivers learned their art through oral traditions passed down through the generations. People were closely tied to nature and were mystical in their thinking of what caused illness They used herbs, rituals, and torture to the person of illness.

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Nursing: Primitive Care

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In primitive societies, the decision to be a caregiver was often made long before he or she had the ability to make such a choice. In the Zuni tribe if an infant was born with part of the placenta covering the face it was taken as a sign that he or she had been marked as one who is destined to become a caregiver. In other societies women were assigned the task of care giving while other groups assigned the role to medicine men, shamans, or other male tribesman.

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Nursing: Early christian era

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Nurses or caregivers first formed themselves into organized groups during the early christian era Nursing ideals of charity, service to others, and self-sacrifice were in harmony with the teachings of the early Christian church The first hospitals were also founded by members of religious communities: Nuns and monks who devoted their lives to care for the sick

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Deaconess

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Was created in Kaiserwerth Germany. They were roman matrons or widows with some educational background who were selected by the church to care for the ill in their own homes

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Founded in 651 A.D.

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Hotel-Dieu was founded by the Augustinian sisters in Paris in the year 651 A.D.

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Nursing: Early Christian Era

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Patients were often place two in a bed (with the feet of the patient opposite the face of the other) They often received no diagnosis on admission, so a smallpox or tuberculosis patient could be put in the bed with a leg fracture. Therefore people were exposed to diseases, and they spread very often.

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Nursing: Early Modern Europe

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During the Protestant Reformation monasteries and convents war closed and seized by the government Care of the sick fell to "common women" who often were to old or ill to find any other type of work. "Nurses" often were often sanctioned for fighting, petty theft, extortion of money from patients, used foul language, and lacked little knowledge of actual care of the sick.

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Elizabeth Fry

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founded the protestant sisters of charity in response to the pleas of British Social reformers in 1840. They received only rudimentary education in nursing.

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Indian groups of the americas

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A historic group of people who defined health as a balance among man, nature, and the supernatural

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Florence Nightingale

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reformed nursing and laid the foundation for nursing as a profession Educated in Greek, LAtin, German, French, italian, mathematics, ancient and modern literature, and natural science She comes from a very wealthy British family who chose to dedicate her life to the service of humanity(against her families wishes) While the french had nuns to care for their troops, the british army lacked any kind of nurses. Most troops died from disease rather than their injuries from the battlefield.

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1854

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The crimean war began and Nightingale learned that the mortality rate for british troops was 41 percent.

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Florence Nightingale

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She was the first to study how "dirt" affected healing and thoroughly scrubbed the soldier's barracks and hospital wards. She let sunshine and fresh air in The number of deaths dropped dramatically in the following months This laid the foundation for modern evidence based practice. The cleanliness of the environment affects the health of the individual and their family. She also became known as the "Lady with the lamp" to the soldiers she was caring for in Crimea

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Florence Nightingale

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She created Nightingale School of nursing at St. Thomas Hospital in London for the education of professional nurses in 1860. This was different than any education nurses had received before: they had classes in theory and clinical experiences in hospital wards.

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Nursing: United States

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The civil war was the forum for some memorable nurses to lay the foundation for professional nursing in the United States. Volunteer nurses soon came to realize the value of formal education in the care of the sick and became instrumental in establishing the first nurse training school in the U.S.

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Clara Barton

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Called The angel of the Battlefield Her civil war work began in April of 1861. After the battle of Bull Run, she established an agency to obtain and distribute supplies to wounded soldiers. IN july of 1862 she received permission to travel behind the lines, eventually reaching some of the grimmest battlefields. She delivered aid to soldiers of both the North and South. In 1881 she established the AMERICAN RED CROSS and in 1882 persuaded congress to ratify the treaty so the Red Cross could perform humanitarian efforts in time of peace. She served as the director of Red Cross until her death

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Dorothea Lynde Dix

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Born in Hampden, Maine in 1802 Reformer of mental hospitals Superintendent of Nurses for the Union Army Formed an Army of Nursing Corps Organized hundreds of women volunteers into the corps during the civil war.

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Mary Ann Ball

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She served throughout the war in the West When the Civil War broke out in 1861, at the age 45 went to the soldiers' aid. Cared for soldiers irregardless of their rank, protocol, or allegiance. she pursued fearlessly and with inexhaustible energy her mission to care for the sick and wounded. Rebel, Union, and black soldiers all received the same attention She risked enemy fire, especially through Grant's western campaign and Sherman's Georgia campaign, to rescue suffering men, often going out at night to hunt for the fallen. When the victorious armies of the North were reviewed in Washington at the war's end, "Mother Bickerdyke" road her faithful white horse beside the general and colonels.

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Harriet Tubman "Moses"

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Born 1822 on the plantation of Anthony Thompson, south of Madison in Dorchester County, Maryland. After escaping from enslavement in 1849, Tubman dedicated herself to fighting for freedom and justice for the remainder of her life, earning her name "Moses" Tended to soldiers during the civil war. She was underground railroad operator leading over 300 slaves to freedom, an abolitionist, a civil war spy, and a nurse.

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Mary Mahoney

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Born in 1845 As a student nurse worked 16 hour days/ 7 days washing, ironing, cleaning, and scrubbing floors. Out of 40 students only three graduated in 1879: Mary and two other white students. She was 34 Black students then were accepted to nursing school.

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Kate Cumming

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A nurse for the confederate army Maintained a diary that was later published into a book. Book presented a realistic record of confederate hospitals and nursing.

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Lillian Wald

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Created the henry street settlement Pioneered the concept of public school nursing service to provide medical care to the poor who lived in the tenement houses, By 1940, 300 nurses worked from 20 branches throughout New york Public school nursing service: Henry Street nurses provided care at public schools to increase attendance. Mary Brewster cofounded the henry street settlement

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Mary Adelaide Nutting

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Born in 1858 in Canada Entered nursing school at Joh Hopkins Hospital school of Nursing 1889 Shortly after graduation became the superintendent of John Hopkins As a superintendent she worked for the reform of nursing education-more education less practical training or ward work. 1907 The world's first nursing professor

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Isabel Hampton Robb

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Graduated from Bellevue Hospital training school in 1883. Appointed superintendent of nurses at the Illinois Training school for nurses at cook county hospital in chicago While there, she abolished the practice of a student nurses doing private duty nursing She broadened the curriculum and established affiliations with other hospitals She established the first grading policy in nursing school Wrote the classic text Nursing: It's Principles and Practice published in 1894. The nurses associated the alumni of U.S. canada became american nurse associated

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Isabel Maitland Stewart

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Professor of nursing at teacher's college of columbia university worked tirelessly to establish a standardized nursing curriculum. Insisted on the need for Nursing research to give the profession on a solid scientific base.

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Walt Whitman

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A poet and writer volunteered as a hospital nurse in Washington, DC during the civil war. Memorialized in his poetry the work of wartime nurses in the care of wounded and dying soldiers. Wrote the poem "The wound dresser" The first male nurse IN 1982 men were able to go to nursing school American Assembly for men in Nursing was founded in 1971.

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Curriculum Era

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Efforts to understand the nature of the knowledge needed for the practice of nursing and focused on standardizing curricular content and standardized testing for diploma programs. Oct 1, 1990 Publication of the first nursing journal - The american journal of Nursing

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Research Era

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Research emerged as a driving force Nurses were encouraged to learn how to conduct research and to begin developing a specialized body of knowledge This era saw the development of scholarly activity and publication of the first nursing journal Nursing Research in 1952. Emphasized scholarship and began to develop a specialized body of knowledge

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Graduate Education Era

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Curriculum for master's level preparation were becoming standardized through accreditation by the National League for Nursing Only 3 doctoral programs existed at the beginning of the era. by 1970 21 nursing doctoral programs existed. A series of national conferences exchange ideas and evaluate knowledge began.

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1977

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Chicago sister Glyceroy presented a workshop that illustrated an adaptation conceptual model.

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Theory ERA

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The driving force of the era revolves around the general understanding that a group of related concepts is a theory, and the theory is derived from a conceptual framework. Person, environment, health and nursing in a uniformed structure of knowledge.

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Aesthetics

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Is a branch of philosophy that focuses on the critical analysis of art and beauty

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Ethical Knowing

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is the branch of philosophy that focuses on matters of obligations and morality.

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Empirical Knowing

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What is known is accessible through the 5 senses and is based on knowledge that is considered objective, quantifiable and verifiable.

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Personal Knowing

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the person's inner experience of becoming whole, aware, and genuine.

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metaparadigm

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Comprises the most global and abstract central concepts that identify the phenomena of the discipline

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Nursing is comprised of:

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Person, Health, environment, Nursing

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Framework

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Is a brief explanation of a theory or those portions of a theory to be tested in a study.

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Model

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Is an idea that explains by using symbolic and physical visualization

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What is a Theory?

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A set of concepts, definitions, relationships, and assumptions that project a systematic view of a phenomena It may consist of one or more relatively specific and concrete concepts and propositions that purport to account for, or organize some phenomenon

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What are the components of a theory?

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Concepts, Definitions, Assumptions, Phenomenon

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Concepts

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Ideas and mental images that help to describe a phenomenon

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Definitions

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convey the general meaning of the concepts

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Assumptions

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Statements that describe concepts

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Phenomenon

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Aspect of reality that can be consciously sensed or experienced

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Theory

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1. Providing frameworks by which to study concepts and variables 2. Attempts to describe or explain the phenomenon called nursing

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Newton's law of gravity

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The theory of thrill

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Theory-Phenomena

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Acceleration- any change in the speed or direction of any object not just increase in speed. Inertia- the tendency of an object to keep moving in the direction it is already moving.

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Gravity

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Acceleration Inertia This is not an accident It is science

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Purpose of theory in nursing

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Conceptualization of some aspect of nursing, communicated for the purpose of Describing, Explaining, Predicting, and or Prescribing nursing care.

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What is a paradigm?

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A model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline.

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What is a domain?

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The view or perspective of the discipline it contains the subject, central concepts, values and beliefs, phenomena of interest, and the central problems of the discipline.

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How does domain relate to the nursing theory?

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Nursing has identified its domain in a paradigm that includes four linkages: 1) person/client 2) health 3) environment 4) nursing

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what are the purposes of nursing theories?

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It guides nursing practice and generates knowledge It helps to describe or explain nursing Enables nurses to know WHY they are doing and WHAT they are doing.

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Grand theories

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Broad and complex

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Middle range theories

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Address specific phenomena and reflect practice

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Descriptive theories

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first level of theory development

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Prescriptive theories

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Address nursing interventions and predict their consequences

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Grand theories

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Not intended to provide guidance for specific nursing interventions, but to provide the structural framework for broad, abstract ideas about nursing.

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Middle-range theories

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Narrower in scope than grand theories. They are made up of a limited number of concepts that are written at a relatively concrete and specific level.

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Descriptive Theories

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Are the most basic type of middle range theory. THey describe or classify specific dimensions or characteristics of individuals, groups, situations, or events summarizing the commonalities found in observations. Theories of growth and development describe the maturation process of an individual at various ages. Do NOT direct specific nursing activities, but may help to explain client assessment.

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Prescriptive Theories

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Address Nursing interventions and predict the consequences of a specific nursing intervention Prescriptives are action oriented and they guide nursing research to develop and test specific nursing interventions Mischel's theory of uncertainty: predicts that increasing the coping skills of clients with gynecological cancer assists the ability to deal with the uncertainty of the cancer diagnosis and treatment. This theory provides a framework to design interventions that support and bolster client's coping resources.

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Why on earth do we study nursing theory?

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Everyday practice enriches theory Both practice and theory are guided by values and beliefs Theory helps to reframe our thinking about nursing Theory guides use of ideas and techniques Theory can close the gap between theory and research

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So how do nurses use theory in everyday practice?

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Organize patient data understand patient data analyze patient data Make decisions about nursing interventions Plan patient care Predict outcomes of care Evaluate patient outcomes

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Student Nurse questions

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What is the nature of knowledge needed for the practice of nursing? What does it mean to me to practice nursing?

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Commonly used non-nursing theories

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System theory BAsic human needs theory Health and wellness models stress and adaptation Developmental theories Psychosocial theories

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What is the link between nursing theory and the research process?

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Theory provides direction for nursing research relationships of components in a theory help to drive the research questions for understanding nursing Chinn and Kramer indicate a spiral relationship between the two.

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Current trends that influence nursing theory

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Medical science Nursing education Professional nursing organizations evolving research approaches global concerns consumer demands technologies

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"Thank Heavens for crazy people"

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People to work long hours with frequent mandatory overtime. Few holidays and weekends off. Must be able to keep a massive amounts of paperwork up to date while making split decisions life or death. Must be immune to verbal abuse and able to neutralize the occasional physical assault. Must display patience, kindness, understanding, and caring even when personal life is coming apart at the seams. Salary in no way commensurate with training and ability. The author continued "In case you're thinking no one would ever work at a job like that, you're wrong. Hundreds of people.. are already working under those conditions. They're called nurses

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Philosophy

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Are broad, connected statements about beliefs and values Presents the general meaning of nursing and nursing phenomena through reasoning and logical presentation of ideas usually in the format of belief statements Potential to guide thinking and behavior There is a relationship between the philosophical stance of individual nurse nursing society

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Philosophical traditions that influence the development of knowledge

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Empirical analytic philosophy of science phenomenological hermeneutic philosophy critical social theory

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Empirical analytic philosophy of science

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Based on "Scientific method" as the only way for developing scientific knowledge. Characteristics include facts, descriptions, explanations, or predictions.

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Phenomenological hermeneutic philosophy

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This scientific tradtion views truth as a matter of perspective In that truth is relative and there is no objective reality.

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critical social theory

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refers to the study of differences between people as related to a socially determined status, such as socioeconomics in healthcare, this theory examines groups of people who are predisposed to physical ailments, and deficiencies.

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According to Dilthey

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Human sciences require concepts, methods, and theories that are fundamentally different from those of the physical and biological sciences. The human scientist's approach to knowledge development recognizes the inseparability of human beings from their environment, context, history and background. Human science is concerned with understanding a person's meanings, relations, values, and patterns and themes in relation to their health-illness experience.

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Aesthetics

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Is a branch of philosophy that focuses on the critical analysis of art and beauty

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ethical knowing

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IS the branch of philosophy that focuses on the matters of obligation and morality

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empirical knowing

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what is known is accessible through the 5 senses and is based on knowledge that is considered objective, quantifiable, and verifiable

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personal knowing

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the person's inner experience of becoming whole, aware and genuine

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philosophy of nursing

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seek to understand the truth to provide a description of nursing to propose an understanding of explanation to examine prediction to critically relate theories, models, and scientific systems Components that are not amenable to empirical testing are within the realm of philosophy

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Philosophical statements

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The "This we believe" statements associated with nursing practice contribute to the discipline in nursing. Statements that reflect values, goals, opinions and beliefs contribute to philosophy. Based on opinion, therefore they cannot be tested for their correctness The prevailing philosophy of a discipline is the one shared by the greatest number of members in terms of accepting the beliefs, values, goals, and opinions of the philosophy.

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Car makers philosophy

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we believe that people can travel safely in cars

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Nursings philosophy

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we believe that healthcare should be effective, safe and humanistic.

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4 concepts central to nursing:

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1. person or client: the recipient of nursing care 2. environment: the internal/external surroundings that affect the client 3. Health: the degree of wellness or well being the client experiences 4. Nursing: attributes, characteristics, and actions of the nurse, providing care on behalf or in conjunction with the client.

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Framework

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is a brief explanation of concepts described in a theory and mary also describe portions of a theory to be tested in a study

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model

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is an idea that explains by using symbolic and physical visualization

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What about nursing?

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The science of nursing is recognized as a fundamental pattern of knowing for nurses

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Pure sciences

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physics, chemistry, biology,and sociology

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applied sciences

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nursing, medicine, engineering, aeronautics c

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characteristics of applied sciences

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The "scientists" communicate with their subjects The "scientists" are part of the social world they study.

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nursing process

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the process that nurses use to plan care of the client Hollistic view of the entire person Roadmap for the care of the client Essential to documenting a nurse's role in the provision of comprehensive, quality patient care.

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Nanda's purpose

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Implementation of nursing diagnosis enhances every aspect of nursing practice, from gathering professional respect to assuring consistent documentation representing nurses' professional clinical judgement, and accurate documentation to enable reimbursement

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Medical diagnosis

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deals with disease or medical condition

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nursing diagnosis

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deals with human response to actual or potential health problems and life processes.

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The complementary nursing diagnoses

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A. Impaired verbal communication B. Risk for falls C. interrupted family processes D. powerlessness

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Nursing diagnosis

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allows the nurse to develop a individualized care plan from each patient.

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five steps of the nursing process

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1. Assessment 2. Diagnosis 3. PLanning 4. Implementation 5. Evaluation Nursing process is a systematic organized and comprehensive approach to meeting the needs of the patient or client

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Assessment 1st step

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Consists of the patient history, the physical examination, and pertinent diagnostic studies

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Data collection

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1. Data collection Subjective - pain level/problems objective- nurses assess about the patient (something that can be measured) 2. Data analysis actual- is the patient actually having a problem potential - the symptoms could potentially lead to a problem

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subjective data

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patient ℅ being tired upon minimal exertion

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objective data

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Patient is short of breath after being assisted to bathroom requires oxygen upon minimal exertion

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Nursing diagnosis step 2

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Made after data analysis result of client assessment is a "clinical judgement about individual, family, or community responses to actual or potential health problems or life processes.

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A nursing diagnosis consists of: to be valid

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Problem As related to Etiology Evidence

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PLanning 3rd step part a

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Set goals for the outcome of the client based on each nursing diagnosis for the client the goals must directly match the nursing diagnosis and apply directly to your client's situation

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PLanning part b

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The nurse "WILL" do a certain intervention set goals for the outcome of the patient Based on each nursing diagnosis for the client Care plans give providers of care direction in providing safe, effective client care

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Implementation 4th step

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Put your plan into action It isn't complete until you document each intervention in the client's chart.

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Evaluation 5th step

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Was the goal met? Was the care plan effective? Does the patient have new needs? Does the care plan need to be revised? If you have a good goal the answer should be yes or no The entire healthcare team must be included in the patient outcome

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