Phenomenon: Is a thing, event or activity that we perceive through our senses. The phenomenon represents the subject matter of a discipline. When experience and sensory and intuitive data become coherent as a whole, we have a phenomenon. For example, when a patient, preoperatively, is noted restless in bed, biting fingernails, and sighing, this is a phenomenon. Concept: Is a label used to describe a phenomenon. Therefore, when we put a name to a phenomenon, we are identifying a concept. In the example provided above, the phenomenon may be labelled as ‘anxiety’. As a mental image, a concept is a view of reality tinted colored with our perceptions and experience. Therefore, a phenomenon could be given a different conceptual label by two different nurses. Therefore, a concept is a tool not a reality – it facilitates observation of a real phenomenon. Concepts are also the building blocks of theory. Construct: If the phenomenon is very abstract and the resultant concept is not directly observable or measurable, it is often referred to as a construct (‘selfesteem’).
Nursing Theories Dr Belal M Hijji, RN, PhD 19.09.2010 Learning Outcomes At the end of this lecture, students will be able to: • Define the working terms and theory • Recognise the four metaparadigms for nursing • Discuss some of the selected nursing theories Defining Relevant Working Terms • • Phenomenon: Is a thing, event or activity that we perceive through our senses The phenomenon represents the subject matter of a discipline When experience and sensory and intuitive data become coherent as a whole, we have a phenomenon For example, when a patient, preoperatively, is noted restless in bed, biting fingernails, and sighing, this is a phenomenon Concept: Is a label used to describe a phenomenon Therefore, when we put a name to a phenomenon, we are identifying a concept In the example provided above, the phenomenon may be labelled as ‘anxiety’ – As a mental image, a concept is a view of reality tinted [colored] with our perceptions and experience Therefore, a phenomenon could be given a different conceptual label by two different nurses Therefore, a concept is a tool not a reality – it facilitates observation of a real phenomenon Concepts are also the building blocks of theory • Construct: If the phenomenon is very abstract and the resultant concept is not directly observable or measurable, it is often referred to as a construct (‘self-esteem’) – A construct is a type of highly complex concept whose reality base can only be inferred Therefore, imagining a continuum of concepts from concrete (thermometre) to abstract (caring, compassion), constructs would be placed at the abstract end All constructs are concepts but not all concepts are constructs – The following example illustrates the continuum of abstraction of concepts A cow is a very concrete conceptualisation and we move toward more abstract levels of conceptualisation – Cow - Bessie - livestock - farm asset - wealth – Two things are noted as the concepts become more abstract; more of the characteristics of the concept ‘cow’ are being omitted and the ability to directly observe and measure the concept is becoming more difficult – Constructs could be made measurable by identifying variables For example, if ‘marital status’ is a construct, it could be made measurable by breaking it into the variables ‘single’, ‘widowed’, ‘divorced’, ‘married’ What is a Theory? • • • • ‘Theory’ is often defined in relation to ‘practice’ For example, a teacher describes the process of giving an injection, as opposed to students actually giving the injection to patient Theory in this sense means dealing with a topic (administration of an injection) Theory has several definitions At basic level, theory explains the occurrence of phenomena To this, it has to explain the relationship between variables or concepts For example, ‘an expansion in a bar of metal occurs when it is heated’ The phenomenon of expansion is explained by the relationship between the variable ‘metal’ and the variable ‘heat’ The theory must also predict that each time the variables happen to be in the same relationship, the same results will be obtained Another definition of theory is that it ‘is a set of interrelated constructs (concepts) definitions and propositions that present a systematic view of phenomena by specifying relations among variables, with the purpose of explanation and prediction’ • From the above example on the theory of metal expansion, a number of propositions exist: – Metals are made up of atoms – The structure of atom is changed by heat – Heat causes atoms to expand The Metaparadigm For Nursing • • Paradigm: refers to a pattern of shared understandings and assumptions about reality and the world We become aware of paradigms when realities clash In nursing we refer to qualitative vs quantitative research paradigms Person, environment, health, and nursing are collectively referred to as metaparadigm for nursing Meta means ‘with’, while paradigm means ‘pattern’ These four concepts are central to nursing – Person: The recipient of nursing care – Environment: The internal and external surroundings that affect the person – Health: the degree of wellness or well-being that the person experiences – Nursing: The attributes, characteristics, and actions of the nurse providing care to person • What we need to know about these four major concepts is that their definitions vary from one theorist to another Overview of Selected Nursing Theories • Nightingale Environmental Theory: Nightingale (1860) defined nursing as ‘the act of utilising the environment to assist the patient in his recovery’ She linked health with five environmental factors: “fresh air”, “pure water”, “efficient drainage”, “cleanliness” and “light, especially direct sunlight” – Nightingale concepts about ventilation, cleanliness, quiet, warmth, and diet remain integral parts of nursing and health care today Orem’s General Theory of Nursing • Consists of three related theories collectively referred to as “Orem’s General Theory of Nursing”: Self-care Theory: types of self-care requisites (needs) Self-care Deficit Theory: Methods of Assistance Nursing Systems Theory: types Orem’s Self-care Theory • Based on the concepts of: • • • • SELF-CARE SELF-CARE AGENCY SELF-CARE REQUISITES THERAPEUTIC SELF-CARE DEMAND 10 Orem’s Self-care Deficit Theory • • • • • Is the central focus of Orem’s Grand Theory of Nursing Explains when nursing is needed Describes and explains how people can be helped through nursing Results when the Self-care Agency (patient) can’t meet her/his self-care needs or administer self-care Nursing meets these self-care needs through five methods of helping These are: - Acting or doing for Guiding Teaching Supporting Providing an environment to promote the patient’s ability to meet current or future demands 13 Orem’s Nursing Systems Theory Describes • • • • Nursing responsibilities Roles of the nurse and patient Rationales for the nurse-patient relationship Types of actions needed to meet the patient’s demands Orem’s Nursing Systems Theory • • • Refers to a series of actions a nurse takes to meet a patient’s self-care needs Is determined by the patient’s self-care needs Is composed of THREE types of nursing systems: – Wholly compensatory: a patient’s self-care agency is so limited that s/he depends on others for well-being – Partly compensatory: a patient can meet some self-care requisites but needs a nurse to help meet others – Supportive-educative: a patient can meet self-care requisites but needs help in decision-making, behavior control, or knowledge acquisition 14 Henderson Definition of Nursing “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to this in such a way as to help him gain independence as rapidly as possible.” “It is my contention that the nurse is, and should be legally, an independent practitioner [as long as she is not performing the doctor’s duties.] But the nurse is the authority on basic nursing care Perhaps I should explain that by basic nursing care I mean helping the patient with the following activities…” 14 Fundamental Needs 10 11 12 13 14 Breathing normally Eating and drinking adequately Eliminating body wastes Moving and maintaining a desirable position Sleeping and resting Selecting suitable clothes Maintaining body temperature… by adjusting cothing and modifying the environment Keeping the body clean and well-groomed… Avoiding dangers in the environment and avoiding injuring others Communicating with others in expressing emotions, needs, fears, or opinions Worshipping according to one’s faith Working in such a way that one feels a sense of accomplishment Playing or participating in various forms of recreation Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities Nurse’s Role • • • Substitutive : acting for a person Supplementary : assisting a person Complementary : working with the person “…with the goal of helping the person become as independent as possible.” “Today I see the role of nurses as givers of ‘primary health care,’ as those who diagnose and treat when a doctor is unavailable… Nurses may be the general (medical) practitioners of tomorrow…” 17 Neuman’s Systems Model • Neuman’s model is based on the individual’s relationship to stress, reaction to it, and reconstitution factors Reconstitution is the state of adaptation to stressors • In this model, the client is an open system composed of a central core of energy sources (physiologic, psychologic, sociocultural, developmental, and spiritual) surrounded by two rings referred to as lines of resistance These lines represent internal factors that help the client defend against a stressor; for example an increase in the body white cells count to fight an infection • Outside the lines of resistance are two lines of defense The normal line of defense represents the person’s state of equilibrium or the state of adaptation developed and maintained over time and considered normal for the person The flexible line of defense is dynamic and can be rapidly altered over a short period of time It prevents stressors from penetrating the normal line of defense 18 • Stressors in Neuman’s model are: Intrapersonal: Occur within an individual (infection) Interpersonal: Occur between individuals (Unrealistic role expectation) Extrapersonal: Occur outside the person (financial concerns) • The individual’s reaction to stress depends on the strength of lines of defense When these lines fail, the resulting reaction depends on the lines of resistance • Nursing interventions focus on retaining or maintaining system stability The intervention are carried out on three preventive levels: Primary prevention: Focuses on protecting the normal line of defense and strengthening the flexible line of defense Secondary prevention: Focuses on strengthening internal lines of resistance, reducing the reaction, and increases resistance factors Tertiary prevention: Focuses on readaptation and stability and protects reconstitution or return to wellness after treatment 19