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art and science of nursing exam 1
Structural Hierarchy of Contemporary Nursing knowledge (in order of most abstract to most concrete) - Answer-Metaparadigm Philosophies Conceptual models Theories Empirical indicators Nursing's meta-paradigm defines the focus of the discipline's domain and is composed of four concepts which describe the discipline's phenomena of interest. Please name the four concepts/phenomena addressed in Nursing's meta-paradigm. - Answer-1) Person (individuals, families, communities and other groups who participate in nursing)
- Environment (all conditions and relationships that influence the person).
- Health/Healing (person's state of well being; healing refers to endogenous process)
- Nursing (definition of nursing, the goals, and actions taken by nurses on behalf of persons) Newman's three categories of nursing paradigms: - Answer-1) Particulate-deterministic or human needs
- Integrative-interactive
- Unitary-transformative
Integrative-interactive - Answer-humans are viewed as systems with interrelated dimensions interacting with the environment change is probabilistic. Particulate-deterministic or human needs - Answer-humans are known through parts health is the absence of disease predictability and control are essential for its management. Unitary-transformative - Answer-Humans are patterned, self-organizing fields within larger patterned, self organizing fields Change is characterized by fluctuating rhythms of organization-disorganization. Health is a reflection of continuous change. Paradigm - Answer-is a framework that reflects broad shared perspectives held by members of the discipline that influence their "world view" and serves as a significant factor in their contributions to and development of disciplinary knowledge. Theory - Answer-is an organized coherent set of concepts and their relationships to each other that offers descriptions, explanations, and predictions about phenomena. Purports to account or characterize phenomena Philosophy - Answer-is a statement about beliefs and values
- using empathy and active participation to actualize personal relationships. It is validated in response, reflection, and evaluation. -art, meditation, dance, music, stories, expressions of the self Personal Knowing - Answer-"is about striving to actualize personal relationships between the nurse and the patient" "...promotes wholeness and integrity in personal encounters." Esthetic Knowing - Answer--ART of nursing
- expressive, subjective, unique, and experiential includes sensing the meaning of a moment ... relies on perception ... is creative and incorporates empathy and understanding ... it is interpretive, contextual, intuitive and subjective and requires synthesis rather than analysis ... goes beyond what is explained ... creates values and meaning. -connecting with a patient to explore the meaning of a situation about the human experiences of life, health, illness, and death Ethical Knowing - Answer-refers to the moral code for nursing and is based on obligation to service and respect for human life. Ethical Knowing requires rational and deliberate examination and evaluation of what is good, valuable, and desirable as goals, motives, or characteristics."
- emphasizes respect for person, family, community that encourages connectedness, attentiveness, responsiveness, communication, and moral action Phenomena - Answer-are the designation of an aspect of reality; the phenomena of interest become the subject matter that are the primary concerns of a discipline Empirical Indicators - Answer-a very concrete and specific real world proxy for a middle-range theory concept; an actual instrument, experimental condition, or clinical procedure that is used to observe or measure a middle range theory concept.
Examples of practice theories - Answer-1. Standards for Practice
- Intervention Protocols
- Clinical Pathways Philosophical Assumptions clarify & guide > - Answer-Theoretical Concepts guide practice application Theoretical Concepts guide practice application & guide > - Answer-Empirical indicator development Empirical indicator development & testing > - Answer-clarifies & refines Theoretical Concepts & Philosophical Assumptions Consider the ladder of abstraction representing the processes used in putting together a puzzle: See the whole picture you are trying to create = - Answer-Philosophical assumptions Aggregate pieces according to relationships = - Answer-Theoretical concepts Match pieces that "fit together" and assemble = - Answer-Empirical observation, practice applications Examples of empirical indicators - Answer-Assessment tools & outcome metrics Evaluation Criteria & Benchmarks Concepts - Answer-are the elements or components necessary to understand phenomenon. They are abstract and derived from impressions the human mind receives about phenomena through sensing the environment.
Tanner's definition of clinical reasoning - Answer-the processes by which nurses and other clinicians make their judgments, and includes both the deliberate process of generating alternatives, weighing them against the evidence, and choosing the most appropriate Tanner's clinical reasoning patterns - Answer-Analytical Intuitive Narrative Paradigmatic Analytic reasoning - Answer-is characterized by systematic generation of alternatives and the systematic weighing of those alternatives against the clinical data or likelihood of outcome achievement Paradigmatic - Answer-involves making sense of something by seeing it as an instance of a general type ... comparing a situation with a pattern. Intuition - Answer-is characterized by an immediate apprehension of a clinical situation and is a function of experience with similar situations Narrative thinking - Answer-focuses on the particulars in an individual case. this is viewed as human beings' primary way of making sense of experience through an interpretation of human concerns, intents, and motives. 8 elements of thought - Answer-1. Purpose
- Question at issue
- Information
- Interpretation and inference
- Concepts
- Assumptions
- Implications and consequences (reset view)
- Point of view All reasoning contains _____ or _____ by which we draw conclusions and give meaning to data - Answer-Interpretations or inferences
- infer only what the evidence implies
- check references for their consistency with each other
- identify assumptions underlying your inferences Questions to check inferences - Answer-1. what conclusions am i coming to?
- is it logical?
- are there other conclusions to consider?
- does solution follow from data?
- what are you basing reasoning on?
- given all the facts what is the best solution? Standard sources of information - Answer-- published by professional organizations
- Evidence-based guidelines
- Quality Improvement plans, reports, & evaluation criteria
- Institutional policies, procedures, standards, and practice evaluation criteria -Nursing practice models and associated resources.
- Dashboards and scorecards providing performance reports compared with benchmarks.
- Accreditation and regulatory guides.
- EVIDENCE-BASED RESOURCES.
Weidenbach's Prescriptive Theory focused on the situational reality that affects the nursing action, and includes the agent, the recipient, the framework, goal, and means of care. Henderson coined the term "basic care needs" and identified 14 components of basic nursing care. Hall envisioned 3 aspects of nursing, including care, core, and cure. Weidenbach's Prescriptive Theory of Nursing - Answer-States that the situational reality in which nursing actions occur are composed of the agent, recipient, framework, goal, and means. Weidenbach's situational reality included the physical, psychological , emotional, and spiritual action in which nursing occurs. The situation components include: - Answer-1. The agent ( nurse)
- The recipient ( patient)
- The framework ( situational factors)
- The goal ( results of nursing care)
- The means ( actions and devices) Henderson's definition of Nursing - Answer-"Nursing is primarily assisting the individual ( sick or well) in the performance of those activities contributing to health or its recovery (or to a peaceful death), that he would perform unaided if he had the necessary strength, will, or knowledge" Based on her definition, Henderson identified - Answer-14 components of basic nursing care -Breathe normally -Eat and drink adequately -Eliminate bodily wastes -Move and maintain desirable postures -Sleep and rest -Select suitable clothes-dress and undress -Maintain body temperature within normal range by adjusting clothing and modifying the environment -Keep the body clean and well groomed and protect the integument
-Avoid dangers in the environment and avoid injuring others -Communicate with others in expressing emotions, needs, fears or opinions -Worship according to one's faith -Work in such a way that there is a sense of accomplishment -Play or participate in various forms of recreation -Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities. Lydia Hall envisioned Nursing Process as having three aspects: - Answer-Envisioned 3 aspects of nursing process: Care-intimate bodily and personal care exclusive to nursing practice Core-use of relationships for therapeutic effect Cure-assisting with management/recovery from disease Peplau, Travelbee, and Orlando were early theorists who focused on - Answer-these theorists focused on the centrality of relationships in the practice of nursing. Hildegard Peplau - Answer-1st to identify the nurse-patient relationship as central to nursing care and that it is both a process and educative instrument Peplau's definition of nursing - Answer-defined nursing as a significant, therapeutic, interpersonal process that is an educative instrument, a maturing force that aims to promote foreword movement of personality in the direction of creative, productive, personal and community living Joyce Travelbee - Answer-Mid-range theory known as the Human-to Human Relationship Model.
Many Mid-20th Century Nursing Theorists were influenced by the emergence of ______as a paradigm which was being adopted or incorporated into the paradigms across multiple disciplines. - Answer- Systems Theory is most often associated and credited with developing key concepts associated with systems theory - Answer-Ludwig von Bertalanffy Focus of systems theory - Answer-The focus of this theory is to discover how phenomena interact with environment Interactive-integrative nursing theories reflect - Answer-systems theory thinking Fredrick Hagel - Answer--The whole is more than the sum of the parts -The whole determines the sum of the parts -The parts cannot be understood if considered in isolation from the whole -The parts are dynamically interrelated and interdependent Levine's conservation model - Answer-Introduced the Concept of Patient Centered Care Marked a shift in thinking from task oriented, standardized care to patient centered, individualized care. As an organizing framework for nursing practice, the goal of the Conservation Model is to - Answer- promote adaptation and maintain wholeness through the conservation of energy, structure, and personal and social integrity The nurse accomplishes the goals of the Conservation model through - Answer-the conservation of energy, structure, and personal and social integrity
Levine's Conservation Model: Key Concepts - Answer-Adaptation Conservation Wholeness Adaptation - Answer-"the process of change whereby the patient maintains integrity within the realities of the environment" Every individual has a range of adaptive responses influenced by heredity, gender, age, and health status. Adaptation is achieved through effective use of resources by the individual in his/her best interest. Wholeness - Answer-the unceasing interaction of the individual organism with its environment does represent an 'open and fluid' system, and a condition of health, wholeness, exists when the interactions or constant adaptations to the environment, permit ease---the assurance of integrity...in all the dimensions of life Johnson's Behavioral Systems Model - Answer-Model Incorporates Five Core Principles of Systems Thinking Wholeness and Order Stabilization Reorganization, Hierarchic Interaction Dialectical Contradiction. Principles congruent with developmental theory
Orem's Self Care Deficit Nursing Theory - Answer-Grand Theory congruent with the Integrative- Interactive Paradigm: supportive educative, partly compensatory, or wholly compensatory Supportive-educative - Answer-nurse actions are required for support. The patient accomplishes self- care and both the patient and nurse regulate the exercise and development of self-care agency. Partly compensatory - Answer-Nurse performs some self-care measures for patient, compensates for limitations of patient, assists as required Patient performs some self-care measures, regulated self-care agency, and accepts care and assistance from nurse Wholly compensatory: - Answer-only the nurse can or should perform actions that require movement in space and controlled manipulation Nurse accomplishes patient's self care, compensates for inability to engage in self-care, and supports and protects patient Roy's 4 Adaptation Modes - Answer-describes responses to and interactions with the environment and are how adaptation can be observed
- Physiologic-physical mode
- Self-concept-group identity mode
- Role function mode
- Interdependence mode
- Physiologic-physical adaptation mode - Answer-associated with a person's physical needs, such as oxygen, water, rest, etc, and how we interact with the environment. Self-concept-group identity mode - Answer-relates to the need to know who one is or exist with a sense of unity. Role function mode - Answer-Refers to the need to find one's place in society, fulfilling the need for social integrity; it is knowing who one is, in relation to others. Interdependence mode - Answer-focuses on the need to feel secure in loving relationships with others. This mode focuses on the giving and receiving of love, respect, and value. Rogers identified four fundamental postulates that form the basis of the new reality: - Answer-1. energy fields (human and environmental field)
- openness
- pattern (as diverse and unpredictable)
- pandimensionality (no boundaries other than perceptual ones) Old Paradigm Worldview - Answer-- mind and matter separate entities
- change predictable
- closed systems
- 3 dimensional
- cause and effect, adaptation. New Paradigm Worldview - Answer-- mind and matter interconnected energy
- change as diverse, creative, and unpredictable
- energy fields are continuously open, infinite, and integral
reflects the changes characteristic of the human- environmental fields: continuous, innovative, unpredictable and increasing diversity in patterns - Answer-Helicy reflects the nature of the relationship between the human and environmental fields which is a continuous mutual process - Answer-Integrality the fundamental unit of existence-living and non-living. The term energy reflects the dynamic nature, and the term field reflects the unified nature of an energy field, which is in continuous motion and infinitely connected to all other energy fields. - Answer-Energy Field Openness describes the flow between the human and environmental energy field boundaries; this flow moves through semi-porous networks that form the boundaries. t/f - Answer-False - Energy fields are open, without boundaries to impede energy flow between human and environmental fields the pioneering work that laid the foundation for the Unitary-Transformative Paradigm. - Answer-Rogers' Conceptual Framework Rogers' Science of Unitary Human beings (SUHB) - Answer-the foundational conceptual framework for the Unitary-Transformative Paradigm, is based on the premise that humans and environments are patterned, pan-dimensional energy fields in continuous mutual process with each other. Persons participate in their well-being, which is relative and personally defined Margaret Newman's theory of health as expanding consciousness (HEC) - Answer-- derived from Rogers SUHB
- defines health as an evolving unitary pattern of the whole, including patterns of disease.
- Consciousness, or the informational capacity of the whole, is revealed in the evolving pattern.
- Pattern identifies the human-environmental process and is characterized by meaning
Concepts important in HEC include - Answer-expanding consciousness, presence, resonating with the whole, pattern, meaning, insights as choice points, and the mutuality of the nurse patient relationship (215, 236) concept of mutual process - Answer-key concept in both SUHB and HEC theories. Leininger's Sunrise Enabler Model - Answer-specifies three modes of transcultural decisions and actions that nurses can use in assisting and supporting patients and families: A) Culture Care Preservation /Maintenance, B) Culture Care Accommodation /Negotiation, C) Culture Care Repatterning/Restructuring. help people of a designated culture to adapt to or negotiate with others for beneficial or satisfying health outcomes ex: arrange meals based on religious preferences (vegetarian, no pork) while also addressing diet beneficial to health. - Answer-Culture Care Accommodation/Negotiation help people of a particular culture to retain...relevant care values so that they can maintain their well- being, recover from illness, or face handicaps/and or death ex: include notes in the electronic health record about a patient's culture, religion, practices, and prohibitions - Answer-Culture Care Preservation/Maintenance help clients reorder, change or greatly modify their own lifeways for new, different, and beneficial health-care patterns while respecting the client's cultural values and beliefs to provide beneficial and healthy lifeways - Answer-Culture Care Repatterning/Restructuring the major conceptual elements of Jean Watson's Theory of Human Caring - Answer-1. Ten carative factors (evolving toward clinical caritas processes)
- Caring moment/caring occasion
