Chapter1

1. Whatisthedifferencebetweenanoccupationandaprofession? a. Occupationisajoboracareer,whereasaprofessionisalearned vocationoroccupationthathasastatusofsuperiorityandprecedence withinadivisionofwork. 2. Whatarethecharacteristicsofaprofession? a. Adefinedknowledgebase b. Powerandauthorityovertrainingandeducation c. Registration d. Altruisticservice e. Acodeofethics f. Lengthysocialization g. Autonomy h. Ainstitutionalizedgoalorsocialmission 3. Whyisnursingnoteasilycalledaprofession?

a. Itisanextensionofservicesprovidedbywivesandmothers b. Nurseshavedelayedinidentifyingandorganizingprofessionalknowledge c. Educationfornursesisnotyetstandardized d. Autonomyinpracticeisincompletebecausenursingisstilldependenton medicinetodirectmuchofitspractice. 4. Thescientificapproachtounderstandingrealityischaracterizedbywhat? a. observation,verifiability,andexperience

5. Whataretheories? a. Theoriesaremadetodescribe,explain,&predictphenomenainnature, andtoprovideunderstandingofrelationshipsbetweenphenomena. b. Asystematicexplanationofaneventinwhichconstructsandconceptsare identifiedandrelationshipsareproposedandpredictionsmade. c. Acreativeandrigorousstructuringofideasthatprojectatentative, purposefulandsystematicviewofphenomena. d. Asetofinterpretativeassumptions,principles,orpropositionsthathelp explainorguideaction. 6. Whatisanursingphilosophy? a. Statementoffoundational&universalassumptions,beliefs&principlesabout natureofknowledge&thought(epistemology)&aboutnatureofentities representedinthemetaparadigm. 7. Nosingledominantphilosophyhasprevailedinthedisciplineofnursing. a. True 8. Whatisnursingscience? a. Substantive,disciplinespecificknowledgethatfocusesonhuman universehealthprocessarticulatedinnursingframeworks&theories b. Nursingsciencereferstothesystemofrelationshipsofhumanresponsesin health&illnessaddressingbiologic,behavioral,social,andculturaldomains. 9. Itis________thatgivesdirectiontothefuturegenerationofsubstantivenursing knowledge,andprovidestheknowledgeforallaspectsofnursing. a. Nursingscience

10. Whatismoralorethicalknowledge? a. knowledgeofwhatisrightandwrong.Values,socialandculturalnormsof behaviorarecomponentsofethicalknowledge. 11. Nursingisanevolvingprofession,anacademicdiscipline,andascience. a. True

12. WhowasFlorenceNightingale? a. Firstmodernnursingtheorist.Firsttodelineatewhatsheconsidered nursing'sgoalandpracticedomain,andshepostulatedthat"tonurse"meant havingchargeoftheclient"inthebestconditionfornaturetoactuponhim" 13. Nightingaleestablishedaschoolfornurses.AccordingtoNightingale,whywas trainingfornursesnecessary?Whatdidsheteach? a. "toteachnotonlywhatistobedone,buthowtodoit".Shewasthefirstto advocatetheteachingofsymptomsandwhattheyindicate.Shetaughtthe importanceofrationaleforactionsandstressedthesignificanceof"trained powersofobservationandreflection".

14. Whatisaborrowedorsharedtheory? a. Theorydevelopedinanotherdisciplinethatisnotadaptedtotheworldview andpracticeofnursing

15. Whatisaconcept? a. Theelementsofcomponentsofaphenomenonnecessarytounderstand thephenomenon.Theyareabstractandderivedfromimpressionsthe humanmindreceivesaboutphenomenathroughsensingtheenvironment. b. Asymbolicstatementdescribingaphenomenonoraclassofphenomena. c. Conceptsarelabelsforphenomena d. Conceptsarebasiccomponentsofatheory e. Conceptsrepresentsomeaspectofreality f. Conceptsdescribeobjects,properties,orevents g. Conceptarebuildingblocksoftheories,abstractideasormentalimagesof phenomenaorreality(mass,energy,ego,id)

16. Whatismetaparadigm? a. Representstheworldviewofadisciplineglobalperspectivethat includesmorespecificviewsandapproachestocentralconcepts withwhichthedisciplineisconcerned.

Chapter2
Classification of Theories in Nursing

These include classification based on range/scope or abstractness and type or purpose of the theory.

The Scope of Theory

Have to be able to differentiate theories based on scope, which refers to complexity and degree of abstraction. This classification scheme typically uses the terms: o Metatheory (philosophy, or worldview) to describe philosophical basis of the discipline o Grand theory (macrotheory) to describe comprehensive conceptual frameworks o Middle range or midrange theory to describe frameworks that are relatively more focused than the grand theories o Microtheory, situation specific theory, or practice theory to describe those smallest in scope.

Your Different Theories

Metatheory Refers to a theory about theory. Metatheory focuses on broad issues (processes of generating knowledge and theory development) and it is a forum for debate within the discipline. Beginning in the 1960s metatheory discussions involved nursing as an academic discipline and the relationship of nursing to basic sciences. Recent metatheoretical issues relate to the philosophy of nursing and address what levels of theory development are needed for nursing practice, research, and education, and increasing focus on philosophical perspectives of critical theory and feminism. Grand Theories Are 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. Developed through thoughtful and insightful appraisal of existing ideas as opposed to empirical research.

Middle Range Theories Lies between the nursing models and more circumscribed, concrete ideas. They are substantively specific and encompass a limited number of concepts and a limited aspect of the real world. Comprised of relatively concrete concepts that are operationally defined and relatively concrete propositions that may be empirically tested. Fawcett states that a middle range theory may be 1. A description of a particular phenomenon 2. An explanation of the relationship between phenomena or 3. A prediction of the effects of one phenomenon or another.

Practice Theories Also called micro theories, perspective theories, or situation specific theories and are least complex. They are more specific than middle range theories and produce specific directions for practice. Contain the fewest concepts and refer to specific, easily defined phenomena. Narrow in scope, explain a small aspect of reality, and tend to be perspective. Limited to specific populations or fields of practice and often use knowledge from other disciplines.

Partial Theories Are those in the development stage. Some concepts have been identified and some relationships between them have been identified, but the theory is not complete.

Factor Isolating Theories They describe, observe, and name concepts, properties and dimensions. Identifies and describes 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.

Factor Relating Theories Or 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 tell how or why the concepts are related and may deal with cause and effect and correlations or rules that regulate interactions.

Situation Relating Theories 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.

Situation Producing Theories Are those that prescribe activities necessary to reach defined goals. Address nursing therapeutics and consequences of interventions. Include propositions that call for change and predict consequences of nursing interventions. Should describe the prescription, the consequences, they type of client, and conditions. Four kinds of theories described by Dickoff and James are: o Factor isolating theories (descriptive theories), o Factor relating theories (explanatory theories), o Situation related theories (predictive theories or promoting or inhibiting theories), o Situation-producing theories (perspective theories).

-Florence Nightingale
-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.

Metaparadigm is the global perspective of a discipline that identifies the primary phenomena of interest to that discipline.

Nursing Metaparadigm:

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: ability to function independently; successful adaptation to lifes stressors; achievement of ones 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 Requirements for a metaparadigm: 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 Caring as a central construct in the discipline of nursing closest to general nursing phenomena

Chapter3
Whatisaconcept?

Asymbolicstatementdescribingaphenomenonoraclassorphenomena Canbeabstract(hope,love)Concrete(airplane,bodytemperature) Aword(grief,empathy)Twowords(Rolestrain)Phrase(maternalrole attachment) Whentheyareoperationalized,conceptsbecomevariablesusedinhypothesisto betestedinresearch

Conceptshavebeenborrowedorderivedfromotherdisciplinesaswellasderivedfromnursingpractice andresearch WhatisaSummativeconcept

Representanentirecomplexentityofaphenomenon Complex&notmeasurableexnursing,health,andenvironment

WhatarethecharacteristicsofanAbstractconcept?

Notclearlyobservabledirectlyorindirectly(art,socialsupport,personality) Mustbedefinedintermsofobservableconcepts independentoftimeandspace

Concreteconcept

Canbeseenfeltorheard(char,colorred,jazzmusic) Limitedbytimeandspace Observableinreality(observationsofobjects,properties,orevents) Concreteorempirical

Variable(Continuous)concepts

Conceptsthatdescribephenomenaaccordingtosomedimensionsofthe phenomenaaretermedvariables Permitclassificationofdimensionorgraduationofphenomenaorcontinuum(BP, pain,sexroleorientation,levelofwellbeing,anddegreeofculturalidentity)

 Nonvariable(Discrete)concepts

Canbesinglevariablethatmaybeansweredwithyesornoorfitsintoa predefinedcategory(religion,maritalstatus,educationalattainment)

Theoreticallydefinedconcept

Givesmeaningtotermincontextofatheoryandpermitsanyreadertoassessthe validityofthedefinition

Operationallydefinedconcept

Tellshowtheconceptislinkedtoconcretesituations Describesproceduresthatwillbeperformedtoassignavalueoftheconcept Permitsconcepttobemeasuredandhypothesistobetested Bridgebetweentheoryandempiricalworld

3typesofgrandtheories&whatmakesthemdifferent

BasedonHumanNeeds BasedonInteractiveProcess BasedonUnitaryProcess

GRANDTHEORIESMAYBEDERIVEDFROMCONCEPTUALMODELSANDARETHEMOSTCOMPLEXAND WIDESTINSCOPEOFTHELEVELSOFTHEORY;THEYATTEMPTTOEXPLAINBROADISSUESWITHINTHE DISCIPLINE.GRANDTHORIESARECOMPOSEDOFRELATIVELYABSTRACTCONCEPTSANDTYPICALLYLACK OPERATIONALDEFINITIONS;PROPOSITIONSAREABSTRACTANDARENOTDIRECTLYAMENABLETO TESTING. Inhumanneedsbasedtheories,clientsaretypicallyconsideredtobebiopsychosicialbeingswhoarethe sumoftheirpartsandwhoneednursingcare.Further,clientsaremechanisticbeings,andifcorrect informationcanbegathered,causeorsourceoftheirproblemscanbediscernedandmeasured.These theoriesfocusonclientsneedsfornursingcare. GrandtheoriesbasedonInteractiveprocessbelievethathumanareholisticbeingswhointeractwithand adapttosituationsinwhichtheyfindthemselves.Thesetheoristsascribetosystemstheoryandagree thatthereisconstantinteractionbetweenhumansandtheirenvironment.Thefocusistherelationship thatistakingplace.Theinteractionbetweenthenurseandpatientishappeningatalltimes.

 Theunitaryprocessnursingmodeldescribesagroupoftheoriesthatadheredtoaunitaryprocess perceptionofhumanbeings.Thisgroupoftheoristsbelievedthathumansareunitarybeings:energy systemsembeddedintheuniversalenergysystem.Withinthisgroupoftheories,humanbeingsareseen asunitary,whole,openandfreetochoosewaysofbecoming;andhealthisdescribedascontinuous humanenvironmentalinterchanges. Differencebetweengrandandmiddlerangetheories&borrowedtheories

PPTpostedweek1
Theory Development: process used to create, modify, or define a theory. The first step is to define terms.

Levels of Theory: 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.

Theory Analysis: Why do we analyze theories? To find out... What is the origin of the problem? Methods Subject matter Outcomes Testability Usefulness

PPTPostedweek2
1.) Why do we need nursing theory? To prevent chaos in nursing care To improve client/patient care To guide nursing research to support existing knowledge and to gain new knowledge

7.) Why nursing theories are important? 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 believes, 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.

9.) What is Theory? 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 as a way to view phenomena

10.) What is Nursing Theory? What nursing is and what nurses do What are its goals and outcomes By using nursing theory and research, nursing develops nursing practice guidelines.

 Florence Nightingales concepts of Human, Environment, Health, and Nursing. 14.) Concepts Concrete concepts can be measured-can be seen, felt, or heard Concrete concepts can be measured such as in height, weight, or vitals Abstract concepts (consults) are not clear such as personality.

15.) Types of Concrete Concepts 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.

Chapter12:THEORIESFROMTHESOCIOLOGICSCIENCES
I.ExchangeTheories:Basisinutilitarianism(Thegreatestgoodforthegreatestnumber) 1.)SocialExchangePerspective Group:Grouptherapy,groupcounseling,Groupteaching(education),howgroupsinteract:managing groups,managinganursingteam 2.)IndividualisticSocialExchange individuals:Advocateforpatientsthroughtherapeuticcommunication 3.)Societal/CollectivistExchange Societal/Collectivist:Gatheringofsystem,creatingalargesystems.Collaborationwithothersystems. II.InteractionTheories: 1.)RoleTheory:whendefiningexpectationsfornursing:whatthenurseissupposedtodo III.ConflictTheories: Whenadvocatingpatients,conflictarises.Intermsofconflicttheory,weuseitinptadvocacy. Ethicaldilemmas 1.)FeministTheory: doesnotonlydealwithfemaleoppression.

2.)CriticalSocialTheory dealswithinequality

Chapter13
Psychodynamic theories-attempts to explain multidimensional nature of behavior and understand how an individuals personality and behavior interface. Freud-how individuals work psychologically

Id-original system of personality; pleasure principle Ego-mind vs external world; reality principle; cognitive and intellectual functions; controls behavior; balances ID and superego Superego-keeps us in the straight and narrow; inhibits impulses of ID; perfection

Ericksons 8 Stages (psychosocial theory) nursing care based on developmental stage and age; used to help with appropriate nursing care.

Sullivan (Interpersonal)- Peplau based her nursing theory on Sullivans theory.

Skinner-operant condition; positive reinforcement for patients.

Maslow-behavioral plans; must meet most basic needs first

Carl Rogers (person-centered theory)- patient-centered care

Seyle (general adaptation syndrome)- stress and general adaptation; fight and flight response activates sympathetic nervous system Lazarus-stress, coping, adaptation

Health Belief model-predict health behaviors; people fear disease and that health actions were motivated in relation to the degree of fear. Theory of reasoned action-people are rational & make decisions based on information available to them; relationships between beliefs, attitudes, intentions & behaviors

Chapter14
TheoriesfromtheBiomedicalSciences
Theoriesfrombiomedicalsciences(biology,medicine,publichealth,physiology,andpharmacology)have atremendousimpactonnursingpracticeandaresointegraltonursingthattheyareoverlookedand takenforgranted. TheoriesandModelsofDiseaseCausation EvolutionofTheoriesofDiseaseCausation

Today,predominantmodelofdiseasecausationhasevolvedtomulticausal,involving factorssuchasimmuneresponses,genetics,environment,andbehavior.

GermTheoryandPrinciplesofInfection

ApplicationtoNursing:Nursingresearchhasfocusedonpreventionandmanagementof infectionaswellasidentifyingfactorsthatplaceanindividualatriskfordeveloping infections.Examplesofnursingpracticer/tpreventionofinfectionincludeguidelinesfor choosingsterileovernonsterilegloves,techniquesofhairremovalpriortosurgery,and guidelinesforpreventionofinfectionsrelatedtourinarycatheters,centrallines,etc.

TheEpidemiologicTriangle

Thismodelisoftenusedtoillustratetheinterrelationshipsamongthethreeessential componentsofhost,agent,andenvironmentwithregardtodiseasecausation.A changeinanyofthe3componentscanresultinthediseaseprocess. Withinthistriangle,preventionofdiseaseliesinavertingexposuretotheagent, enhancingphysicalattributesofthehosttoresistdisease,andminimizingany environmentalfactorsthataffecthealthcanalsoinfluenceprogressionofdisease process.

TheWebofCausation

Applicationtonursing:Nurseshavedevelopedinterventionsandproposedstrategiesto addresscomplexhealthproblemswithmanydifferentcauses.

Natural History of Disease: Progress of a disease process in an individual over time Three levels of prevention (Leavell and Clark) Definition. o Primary prevention: 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 specic protection (immunization, water purication). o Secondary prevention: Early detection and includes any screening activity (mammography, cholesterol screening) and subsequent efforts to limit disease progression for those identied with a health condition (taking statin meds, lumpectomy with radiation/ chemotherapy). o Tertiary prevention: Limitation of disability and rehabilitation during period of advanced disease and recuperation, where disease has occurred and resulted in a degree of damage. Application to Nursing: Much of nursing practice focuses on efforts to prevent progression of disease at earliest period or phase using appropriate levels of prevention. o Primary- efforts to prevent skin cancer among athletes, primary prevention of cancer through modication of environmental risks, prevention of falls among elders and prevention of cervical cancer through promoting vaccination against HPV o Secondary- 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 o Tertiary- information to help nurses work to prevent reoccurrences and secondary malignancies among long-term survivors of cancer Theories & Principles r/t to Physiology & Physical Functioning Homeostasis Body systems are integrated and are continually adapting to environmental changes (not just organ-based). How principles of homeostasis are applied in nursing practice? o Examples: Physiologic process of homeostasis in 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 physiology and function of sleep in healthy infants and young children Benets 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

Stress Management and Adaptation Walter Canon developed the concept of ght or ight to explain the bodys reaction to emergencies. Fight or ight response prepares the body for muscular activity (running, self-defense) when reacting to a perceived or actual threat Hans Selye built on Canons work by developing a framework to describe how the body responds to stress. o Selye believed that changes in organs occur in 3 stages. (Table 14-1) Stage 1 (the alarm phase) begins with ght or ight response. Stage 2 (resistance)- body starts to react & 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 1. Genetic Theories and Principles 2. Application to Nursing 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 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 specic drugs 3. Nursing Interventions Individual o Educating patients on genetic testing

o Assisting patients to determine need for testing o Genetic counseling o Educating about individualized medication therapy Family o Interpret and share genetic risk and health promotion o Referring to and interfacing with genetic specialists o Explaining risks and benefits of genetic study o Assessing and counseling families Community o Community readiness for genetic screening and intervention o Availability and voluntary access to genetic information, testing, and assurance of follow-up services Population o Coordinating genetically focused research o Collaborative research focusing on ecogenetics, ethics, and psychosocial issues o Ensuring that patients remain the priority of clinical treatment and research 4. Nurses knowledgeable in genetics can ensure that patients and families make informed and voluntary decisions about genetic information. 5. Genetic counseling: is nondirective, voluntary, and personal, and should precede testing to allow informed decision-making. 6. Counseling should include an explanation of risk factors, exploration of the persons perception of the condition, and discussion of childbearing options. 7. Goals of genetic counseling are to help clients and family members comprehend medical genetic information, appreciate genetic contribution to health and illness, understand health options and alternatives, and make informed health choices.

Pain Management Application to nursing - other therapeutic options to relieve pain (oral sucrose solution to infants before giving injection; music; guided imagery, etc)

Chapter10IntroductiontoMiddleRangeNursingTheories
- Purpose o Take overall scale of grand theories and make it applicable and useful in research, lower level abstraction and ease of operationalization o More likely to be practiced (are more specific and concise) o Function of middle range theories: to describe, explain, or predict phenomena, and, unlike grand theory, they must be explicit and testable.

- Characteristics of Middle Range Theories o Straight forward in general o More readable and user friendly and need to be described in practice terms in journals that nurses are more likely to read o Focus primarily on client problems and outcomes o Specific to nursing and specify an area of practice, age, range of client, nursing actions, or interventions o More likely to testable - Concepts and Relationships for Middle Range Theories o Limited number of concepts that are fairly concrete (discrete and observable) and may be operationally defined - Categorizing Middle Range Theories o High-Middle o Middle o Low-middle - Development of Middle Range Theories o Evolved from grand theories, clinical practice, literature review, practice guidelines, or standard of care

Chapter11OverviewofSelectedMiddleRangeNursingTheories
High: most abstract and closest to grand, only thing that doesnt qualify them to be grand theories is the lack of certain qualities Middle: intended for diff purpose from grand theory Low: less abstract Know specifics of these theories: Benners model of skill acquisition: 5 stages: o novice o advanced beginner o competent o proficient o expert nursing implication: continuing education in nursing Leiningers cultural care diversity and universality theory: First to deal with culture as an area of nursing practice Nursing implication: cultural competence Kolcabas Theory: Defined comfort within nursing practice; comfort viewed as an outcome of care Nursing implication: need for comfort Know that these are middle-range theories: Penders health promotion model: The Omaha System: The Synergy Model: Becks postpartum depression theory: Mercers conceptualization of maternal role attainment