NUR 3846 Broward Community College Nursing Philosophy Discussion

NUR 3846 Broward Community College Nursing Philosophy Discussion NUR 3846 Broward Community College Nursing Philosophy Discussion Consider one of the nursing theories, conceptual frameworks, or mid-range theories presented in the textbook and class. Which philosophy/conceptual framework/theory/middle-range theory describes nursing the way you think about it? What is your rationale for selecting this theory/framework? Discuss how you could utilize the philosophy/conceptual framework/theory/middle-range theory to organize your thoughts for critical thinking and decision making in nursing practice. i attached a file below. please read it and answer the questions plagiarism free references nursing_theory.docx ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Nursing Theory The Basis for Professional Nursing LEARNING OUTCOMES After studying this chapter, students will be able to: • Define philosophy, conceptual frameworks, theory, and middle-range theory. • Consider how selected nursing theoretical works guide the practice of nursing. • Understand how nursing philosophy or theory shapes the curriculum in schools of nursing. • Delineate the role of nursing theory for different levels of nursing education. • Describe the function of nursing theory in research and practice. To enhance your understanding of this chapter, try the Student Exercises on the Evolve site at Chapter opening photo used with permission from “Theory” is a word that is used often in daily language, such as “I have a theory about that” or “In theory, this should work.” The word “theory” in this context means that the person has some idea about a phenomenon and the way this phenomenon works in the world. When people say, “I have a theory…” about a certain phenomenon or situation, they are demonstrating something about their own distinct orientation or way of seeing the world. “Theory” comes from the Latin and Greek word for “a viewing” or “contemplating.” Nursing as a profession has a distinct theoretical orientation to practice. This means that the practice of nursing is based on a specific body of knowledge that is built on theory. This body of knowledge shapes and is shaped by how nurses see the world. Parsons (1949) described theory as important because it makes a distinction between what we know and what we need to know. The word theory has many definitions, but generally it refers to a group of related concepts, definitions, and statements that describe a certain view of nursing phenomena (observable occurrences) from which to describe, explain, or predict outcomes (Chinn and Kramer, 1998). Theories represent abstract ideas rather than concrete facts. New theories are always being generated, although some theories are useful for many years. When new knowledge becomes available, theories that are no longer useful are modified or discarded. You will be reading about Sister Callista Roy’s adaptation model, one that has “stood the test of time” since the 1970s; its use expanded from its origins as a curriculum framework for bachelor of science in nursing (BSN) education to its current use as an organizing framework for nurses (Alligood, 2011). So why is theory important? First, nursing as a profession is strengthened when nursing knowledge is built on sound theory. As seen in Chapter 3, one criterion for a profession is a distinct body of knowledge as the basis for practice. Nursing began its transition from a vocation to a profession and academic discipline in the 1950s (Bond, Eshah, Bani-Kaled, et al., 2011). Nursing has knowledge that is distinct from, although related to, other disciplines such as medicine, social work, sociology, and physiology, among others. The development of nursing knowledge is the work of nurse researchers and scholars. The evolution of the profession of nursing 177depends on continued recognition of nursing as a scholarly academic discipline that contributes to society. In today’s research environment where theory is developed and tested, interdisciplinary collaboration is now considered to be a critical approach to the development of knowledge. Use of nursing theory in other disciplines is not yet common, however (March and McCormack, 2009). NUR 3846 Broward Community College Nursing Philosophy Discussion Even in our own discipline, unfortunately, nursing theory is underused in supporting research. A recent study demonstrated that nursing theory was used infrequently in research published in nursing journals between 2002 and 2006: only 460 of 2184 (21%) research articles published in seven top nursing research journals used nursing theory (Bond et al., 2011). Second, theory is a useful tool for reasoning, critical thinking, and decision making (Tomey and Alligood, 2010). The ultimate goal of nursing theory is to support excellence in practice. Nursing practice settings are complex, and a large amount of information (data) about each patient is available to nurses. Nurses must analyze this information to make sound clinical judgments and to generate effective interventions. From organization of patient data to the development and evaluation of interventions, theory provides a guide for nurses in developing effective care. Box 9-1 shows how theory guides nursing practice. Several words are used to describe abstract thoughts and their linkages. From the most to least abstract, these include metaparadigm, philosophy, conceptual model or framework, and theory. Metaparadigm refers to the most abstract aspect of the structure of nursing knowledge (March and McCormack, 2009). The metaparadigm of nursing consists of the major concepts of the discipline—person, environment, health, and nursing—that were discussed in Chapter 8 and will be addressed again in Chapter 11. In the past two decades, caring has been added as a major concept of the discipline central to nursing knowledge development and practice. Simply stated, these five concepts comprise the metaparadigm of nursing; that is, these are the concepts (abstract notions or ideas) of most importance to nursing practice and research. Nursing philosophies, models, and theories contain most or all of these concepts. BOX 9-1 Nursing Theory and the Professional Nurse Theory guides the professional nurse in: 1. Making sound clinical judgments based on evidence by a. Determining which data are important b. Organizing, analyzing, and understanding connections in patient data 2. Planning appropriate nursing interventions 3. Evaluating outcomes of interventions A philosophy is a set of beliefs about the nature of how the world works. A nursing philosophy begins to put together some or all concepts of the metaparadigm. For instance, Florence Nightingale, whose work will be considered in more detail later in this chapter, wrote Notes on Nursing: What It Is and What It Is Not, in which her basic philosophy of nursing is described in detail. A conceptual model or framework is a more specific organization of nursing phenomena than philosophies. As the words “model” or “framework” imply, models provide an organizational structure that makes clearer connections between concepts. Theories are more concrete descriptions of concepts that are embedded in propositions. Propositions are statements that describe linkages between concepts and are more prescriptive; that is, they propose an outcome that is testable in practice and research. For example, Peplau’s (1952/1988) book Interpersonal Relations in Nursing contains a theory that describes very specific elements of effective interaction between the nurse and patient. Using concepts from nursing’s metaparadigm, Peplau created a theory delineating elements of excellent and effective practice in psychiatric nursing. She linked abstract concepts such as health and nursing to create a concrete, useful theory for practice. Peplau’s theory will be described later in this chapter.NUR 3846 Broward Community College Nursing Philosophy Discussion The primary source—the original writings of the theorist—is the best source for in-depth understanding of the theory. In the original writings, the theorist will describe exactly what he or she is thinking and how the concepts go together. Articles written by other scholars can be helpful in explaining and interpreting primary sources. Explanatory or interpretive articles introduce students to the historical development of the philosophy, model, or theory and specify criteria (standards) by which to analyze, critique, and evaluate them. Articles such as these were first published in the early 1980s with a completely different purpose than the theorists’ original articles. Explanatory or interpretive articles are written to contribute to the general understanding of nursing theory and theoretical developments in nursing in a unique but complementary way. Undergraduate and graduate students, faculty, and practicing nurses have found that these explanatory and interpretive articles on nursing theory make a significant contribution to their knowledge and understanding of nursing science in its own right. Many of the articles and books cited in this chapter were texts written to clarify, describe, and interpret theorists’ work. In this chapter, four types of nursing theoretical works will be presented: philosophies, conceptual models, 178theories, and middle-range theories. Selected works from each of these four types provide a broad overview of theory within the discipline of nursing. This introduction is designed to help you develop a beginning understanding of nursing theory on which to build as you pursue your nursing education and career in the profession of nursing. Philosophies of Nursing Chapter 8 introduced nursing philosophy and discussed its function in nursing practice and educational institutions. A philosophy provides a broad, general view of nursing that clarifies values and answers broad disciplinary questions such as the following: “What is nursing?” “What is the profession of nursing?” “What do nurses do?” “What is the nature of human caring?” “What is the nature of nursing practice and the development of practice expertise?” Three philosophies representing different positions in the development of nursing theory are presented here. Table 9-1 contains questions that represent the different views of the same patient situation among nurses who subscribe to the philosophies of Florence Nightingale, Virginia Henderson, and Jean Watson, whose work is presented here. Nightingale’s Philosophy Florence Nightingale was born in 1820, in Florence, Italy. She was the daughter of a wealthy English landowner and his wife, Fanny, whose goal in life was to find suitable husbands for her daughters. Florence was very close to her father, and he undertook the responsibility for her education, teaching her a classical curriculum of Greek, Latin, French, German, Italian, history, philosophy, and mathematics. At 25 years of age, after deciding to remain unmarried, Florence announced her decision to go to Kaiserswerth, Germany, to study nursing, over the strong objections of her parents. At that time, nursing was considered the pursuit of working-class women. Her persistence in the face of her parents’ opposition proved to be a sustained characteristic over the course of her life. This trait enabled her to accomplish work that most women of the time would not have had the education or willingness to achieve. TABLE 9-1 Three Philosophies of Nursing: NUR 3846 Broward Community College Nursing Philosophy Discussion Three Different Responses to the Same Patient Situation Florence Nightingale What needs to be adjusted in this environment to protect the patient? Virginia Henderson What can I help this patient do that he would do for himself if he could? Jean Watson How can I create an environment of trust, understanding, and openness so that the patient and I can work together in meeting his or her needs? Nightingale’s work represents the beginning of professional nursing as we know it today. In Notes on Nursing: What It Is and What It Is Not (1969; originally published in 1859), Nightingale explained her philosophy of health, illness, and the nurse’s role in caring for patients. Importantly, she made a distinction between the work of nursing and the work of physicians by identifying health rather than illness as the major concern of nursing. Her writing about nursing reflected the sociohistorical context in which she lived, making a distinction between the work of nursing and the work of household servants, who were common in her day and often cared for the sick. Nightingale’s unique perspective on nursing practice focused on the relationship of patients to their surroundings. She set forth principles that were foundational to nursing and remain relevant to nursing practice today. For example, her description of the importance of observing the patient and accurately recording information and her principles of cleanliness still shape hospital-based nursing practice today. Nightingale focused the profession on what has become known as the metaparadigm of nursing: person (patient), health (as opposed to illness), environment (how the environment affects health and recovery from illness), and nursing (as opposed to medicine). Using Nightingale’s Philosophy in Practice Nightingale believed that the health of patients was related to their environment. She recognized the importance of clean air and water and of adequate ventilation and sunlight and encouraged the arrangement of patients’ beds so that they were in direct sunlight. In her writing, she described both the necessity of a balanced diet and the nurse’s responsibility to observe and record what was eaten. Cleanliness of the patient, the bed linens, and the room itself were essential. Nightingale recognized the problem of noise in hospital rooms and halls, which foreshadowed the attention given to excess noise in inpatient settings in recent years. Rest is important in the restoration of health; Nightingale believed that sudden disruption of sleep was a serious problem. The relationship of health to the environment seems obvious today, but for nursing in the second half of the 19th century, Nightingale’s work was radically different. Nightingale recognized nursing’s role in protecting patients. Nurses were newly responsible for shielding patients from possible harm by well-meaning visitors 179who may provide false hope, discuss upsetting news, or tire the patient with social conversation. Nightingale even suggested that the nurse’s responsibility for patients did not end when the nurse was off duty. This view underpins the system of primary nursing found in some settings today. Interestingly, Nightingale suggested that patients might benefit from visits by small pets, an idea that has been incorporated in both long-term and some acute care settings. The nurse whose practice is guided by Nightingale’s philosophy is sensitive to the effect of the environment on the patient’s health or recovery from illness. This philosophy provided the foundational work for theory development that proposed changing patients’ environments to effect positive changes in their health. NUR 3846 Broward Community College Nursing Philosophy Discussion Nightingale promoted the view that nurses’ primary responsibility was to protect patients by careful management of their surroundings. Henderson’s Philosophy Virginia Henderson, whose photo is featured on the title page of this chapter, was born in 1897 in Kansas City, Missouri, and was named for her mother’s home state to which her family returned when Henderson was 4 years old. Although she received an excellent education from a family friend who was a schoolmaster and from her father who was a former teacher, Henderson did not receive a traditional education that awarded a diploma, which delayed her entry into nursing school. During World War II, she studied under Annie Goodrich at Teachers College, Columbia University, where, after numerous interruptions, she received her bachelor’s and master’s degrees. By the time she died in 1996, Virginia Henderson was internationally known and regarded by many as “the Florence Nightingale of the 20th century.” One hundred years after Nightingale, Virginia Henderson’s work first was published, emerging at a time when efforts to clarify nursing as a profession emphasized the need to define nursing. Henderson’s philosophical approach to nursing is contained in her comprehensive definition: 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 a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” (Henderson, 1966, p. 15). Although Henderson was recognized for many contributions to nursing throughout her long career, her early work remains particularly noteworthy and relevant, defining nursing and specifying the role of the nurse in relation to the patient. Henderson’s relationship with one of her former students, who recognizes the ongoing contributions of Henderson’s work to nursing, is described in Professional Profile Box 9-1. Henderson’s philosophy linked her definition of nursing that emphasized the functions of the nurse with a list of basic patient needs that are the focus of nursing care. She proposed an answer to questions similar to those addressed by Nightingale a century earlier: “What is the nursing profession?” and “What do nurses do?” Henderson described the nurse’s role as that of a substitute for the patient, a helper to the patient, or a partner with the patient. Henderson identified 14 basic needs (Box 9-2) as a general focus for patient care. She proposed that these needs shaped the fundamental elements of nursing care. The function of nurses was to assist patients if they were unable to perform any of these 14 functions themselves. Although these needs can be categorized as physical, psychological, emotional, sociologic, spiritual, or developmental, thoughtful analysis reveals a holistic view of human development and health. NUR 3846 Broward Community College Nursing Philosophy Discussion The first nine needs emphasize the importance of care of the physical body: breathing, eating and drinking, elimination, movement and positioning, sleep and rest, suitable clothing, maintenance of suitable environment for the body temperature, cleanliness, and avoidance of danger or harm. Next she included psychosocial needs such as communication and spirituality, including worship and faith. She concluded with three developmental needs: the need for work and the sense of accomplishment; the need for play and recreation; and the need to learn, discover, and satisfy curiosity. Henderson believed that all 14 basic needs are amenable to nursing care. They continue to be used today in philosophical statements of schools and departments of nursing. Using Henderson’s Philosophy in Practice Nurses whose practice is consistent with Henderson’s philosophy adopt an orientation to care from the perspective of the 14 basic needs. Henderson’s clarity about the role and function of the nurse is a strength of her work. This philosophy is easily applied to a variety of patient care settings, from brief outpatient encounters in which a limited number of needs are addressed to a complex setting such as intensive care where patients are extremely vulnerable. Henderson used her definition of nursing and the basic needs approach in her well-known case study of a young patient who had undergone a leg amputation. Using this case, Henderson (1966) demonstrated how the nurse’s role changes on a day-to-day, week-to-week, and month-tomonth basis in relation to the patient’s changing needs and the contributions of other health care providers. PROFESSIONAL PROFILE BOX 9 -1 Edward J. Halloran, PhD, RN, FAAN Remembering Virginia Henderson Although I had known Virginia Henderson from the time I was a graduate student at Yale, geography later brought us more closely together. Knowing her family lived in Virginia (mine was in Connecticut), whenever I traveled by car from North Carolina to Connecticut I called and asked if she wanted a ride back home with me, because I could drop her off in Virginia en route to North Carolina. Six times we made the 8-hour ride together. Our conversations were wide-ranging because we were both world travelers. We talked much about politics; most about nurses—“see a nurse before you go to a doctor” as a solution to health care cost, quality, and access problems; some about patients—“give them their records” as a most important patient education tool; and some about our large extended families. 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