Theoretical Foundations of Nursing Unit I: Structure of a Theory A. Definition in Terms 1.

Phenomenon observable / researchable connections or relationships between objects, events or ideas Any natural event that the human senses can perceive; could also be intangible. 2. Ideas - too see An organized thought about origin, nature, boundaries 3. Concepts - to conceive identify, define and establish structure. Names phenomenon; organized building blocks Abstract indirectly observed or intangible ex. Love, care, freedom Concrete directly observed or tangible ex. Nurse, mother, father 4. Propositions - to put forth identifies the direction of a relationship between concepts and defines the nature of 5. Hypothesis - to place under Formal statement that describes an expected relationship between concepts 6. Assumptions - to take assumed truths that influence relational statements. May or may not be constant in a hypothesis but theorists hold true 7. Research - to search Organized & systematic inquiry of investigation , validating, referring. To study a phenomenon, create general knowledge Induction- type of reasoning that uses specific details to form a general conclusion Deduction- type of reasoning wherin general conclusions are dissected to form specific concepts 8. Facts - a doing Observations consistently proven true over time 9. Principle - a beginning a truth, built on facts which is foundations to other truths 10. Law - a thing laid down Absolute truth that guides intellectual thought and behavior. Organized information about related concepts pertaining to phenomena within a particular discipline 11. Theory to speculate organized info that explains facts, principles, and laws 12. Knowledge culmination of the integration of what is known theoretically and experimentally. 13. Nursing Paradigm patterns or models use to show a clear relationship among existing

theoretical works. Embodies the knowledge base, theory, Philosophy, research, practice, educational experience and literature identified with the professions. B. Major Concepts of the Nursing Paradigm 14. Person biopsychosocial being of mind and body that share fundamental human needs. Presents as an integrated whole 15. Health state of wholeness. Ability to function independently regarding ADLs 16. Environment positive or negative way upon the client. Sub component of man and at integrated system related to self-care 17. Nursing focus to help the client to prevent, solve, alleviate or cop with problems. A socially-valued service whose goal is to promote a positive adaptation to the stimulus. Unit II : The Nursing Theory A. The Nursing Theory group of related concepts deriving from nursing models B. Purpose of the Nursing Theory guides knowledge development and directs education, research and practice. C. Level of Abstraction of a Theory 1. Meta psuedo; most abstract level of knowledge. Specifies the main concepts that encompass the subject matter and the scope of a discipline. 2. Grand unitary human beings, broad theories propose something that is true or testable. 3. Mid-range culture care, least abstract level of theoretical knowledge because they include details specific to nursing practice. 4. Practice application of all theories D. Components in the Analysis of Nursing Theories 1. Clarity How clear is the theory? 2. Simplicity How simple in this theory? 3. Generality How general is this theory? 4. Accessibility How accessible is this theory? 5. Imporatance How important is this theory? Unit III: Nursing Paradigm Man A. Man unique individual, passive organism that is the source of all acts and has freedom to choose.

B. Different Approaches to Man 18. Atomistic approach organism with different organ systems 19. Holistic approach all aspects affect behavior that affects others in the their environment C. Types of Motivation 1. motivation makes man achieve something 2. will - not the strength but desire 3. Natural suffer for those whom he loves and wishes to protect them 3. Supernatural transcends pain & suffering rise above D. Man as a Biological Being 1. biological responds to environmental stimuli 2. subordinate cells, organs, and organ systems 3. cell basic unit of building block 4. family community, and society. Framework of relationship influences by behavior. E. Man as a System 1. whole functions interdependence of it's parts. 20. Closed self-sufficient and isolated. Does not allow outside stimuli. 21. Open exchanges matter, energy of info. Living behavioral system. Components : Input 22. Energy Input scolding, blow 23. Matter Input food, microorganism 24. Information Input validated through feedback. Output 25. Energy Output fever 26. Matter Output loose stools 27. Information Output validated through feedback F. Man as a Psychosocial Being 1. unique, irreplaceable individual capable of rational and logical thinking 2. retains a certain amount of immaturity 3. will never completely able to understand another human being while being able to be social and to cope with stress G. Man as a Spiritual Being

1. each human being is created by his own imageness and likeness 2. physical and social needs Intellect look for the truth. Ability to perceive his surroundings Will wishes, desires, and longing. Power of conscious and deliberate action. 3. Courage H. Maslow's Hierarchy of Needs 1. Need Physiological and emotional health and survival. Basis on that absence of needs results in illness. 28. BIOLOGICAL/PHYSIOLOGICAL air, water, sleep, food, sex 29. SAFETY security means satisfied 30. LOVE/BELONGING or SOCIAL overcome feelings of loneliness and alienation; giving and receiving love, affection and the sense of belongingness. Emotionally-based relationships: friendships, intimacy, supportive, and communicative. Sense of belonging and acceptance absent = loneliness , social anxiety, and clinical depression 31. ESTEEM self-consciousness, self concept. Stake firmly based, high level of respect. Feeling that we are valued by those around us. Cognitive knowledge, meaning and self awareness; aesthetic: beauty, balance, form 32. SELF-ACTUALIZATION all for needs are satisfied. Need to reach one's potential Transcendence help others reach to self actualize. Stop thinking about yourself, think about others first. Unit IV: Nursing Paradigm- Health A. Health WHO a state of complete, physical, mental, social being that is not merely the absence of disease or infirmity. Canon, Walter Equilibrium/Homeostasis B. Wellness state of well-being. (subjective) 7 components of wellness: 1. Physical ability to carry out tasks 2. Social ability to interact successfully with people 3. Emotional ability to manage stress and express emotions properly 4. Intellectual ability to learn and use information effectively 5. Spiritual belief in a higher force 6. Occupational ability to achieve a balance between work and leisure

7. Environment ability to promote health measures that improve standard of living C. Disease altercation in body functions resulting in a reduction of capacities or a shortening of the normal life span (objective) D. Illness highly personal state in which the person's physical, emotional, intellectual, social, developmental or spiritual functioning is thought to be diminished. (subjective) E. Models of Health a. Smith's models of health Clinical signs (objective) and symptoms (subjective) Role-performance tasks , duty, what is expected fulfilling societal roles Adaptive adaptation, coping. Disease is a failure in adaptation or maladaptation Eudemonistic based on Maslow's self-actualization b. Health- Illness Continuum grids or graduated scales that can be used to measure a person's perceived level of wellness. Dunn's High-Level Wellness Grid health axis and environmental axis; 4 quadrants 1. high level wellness in a favorable environment 2. emergent high-level wellness in an unfavorable environment 3. protected poor health in a favorable environment 4. poor health in an unfavorable environment c. Travis' Illness-Wellness Continum - ranges from high-level wellness to premature death. Well being awareness, education, growth Levels of death signs, symptoms, disability d. Agent-Host-Environment Model ecological model 1. agent any environmental factor or stressor that by its presence or absence can lead to illness or disease 2. host person(s) who may or may not be at risk of acquiring a disease.

3. environment all factors external to the host that may or may not predispose the person to the development of disease F. Factors Affecting Health and Illness Internal Variables Biological Genetic makeup influences biological characteristics, innate temperament, activity level, and intellectual potential. Gender influences influences the distribution of disease. Age distribution of disease varies with age. Developmental level Psychological Mind-Body interactions emotional responses to stress affect body function Cognitive Lifestyle risk factors Spiritual and religious beliefs External Variables Environment Standards of Living Family and Cultural Beliefs Social Support Networks

 UNIT V: Nursing Paradigm Environment Culture the totality of socially transmitted behavioral patterns, arts, beliefs, values, customs, life-ways, and all other products of human work and thought characteristic of a population or people that guide their world view and decision making. nonphysical traits, such as values, beliefs, attitudes, and customs that are shared by a group of people and passed from one generation to the next. composed of all verbal and behavioral systems that transmit meaning. Learned, shared, universal and is associated with adaptation to the environment. Prejudice negative belief or preference that is generalized about a group and that leads to prejudgment; Discrimination differential treatment of individuals or groups based on categories such as race, ethnicity, gender, or social class. Ethnocentrism perception that one's world view is the only acceptable truth and that one's beliefs, values, and sanctioned behaviors are superior to all others Cultural assimilation adjusting to culture; fitting in by which an individual develops a new cultural identity. Acculturation keeping own culture with being in another culture. People adapt to or borrow traits from another culture. Culture Competence Awareness - deliberate, cognitive process in which the healthcare provider becomes appreciative and sensitive to the values, beliefs, life ways practices and problem-solving strategies of a client's culture Unconscious incompetence not aware one lacks cultural knowledge, not aware cultural differences exist Conscious incompetence aware one lacks knowledge about another culture; aware that cultural differences exist but not knowing what they are or how to communicate effectively with clients from different cultures Conscious competence consciously learning about the client's culture and providing culturally relevant interventions; aware of differences; able to have effective transcultural interactions Unconscious competence able to automatically provide culturally congruent care

to clients from a different culture having much experience with a variety of cultural groups and having an intuitive grasp of how to communicate effectively in transcultural encounters Knowledge process of seeking and obtaining a sound educational foundation concerning the various world views of different cultures Encounter process that allows the healthcare provider to engage directly in face-toface interactions with clients from culturally diverse backgrounds. Skill - ability to collect relevant cultural data regarding the client's health history and presenting problem as well as accurately performing a physical assessment Culture Bound Syndrome (CBS) - is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture Character the things you do when no one is paying attention. Spirituality Religion rituals, practices and experiences involving a search for the sacred that are shared within a group Defining Characteristics: Formal Organized Group oriented Ritualistic Objective (easily measurable)

Spirituality a search for meaning and purpose in love, which seeks to understand life's ultimate questions in relation to the sacred Defining Characteristics: Informal Non-organized Self-reflection Experience Subjective (difficult to consistently measure)

Spiritual Assessment active and ongoing conversation that assesses the spiritual needs of the client.

Defining Characteristics: Formal or informal Respectful Non-biased

Spiritual Care addressing the spiritual needs of the client as they unfold through spiritual assessment Defining Characteristics: Individualistic Client orientated Collaborative

Christian Scientists - frequently rely on prayer alone to heal illnesses, rarely seek mainstream medical care. Also, have a higher rates of mortality Jehovah's Witness refuse blood transfusions due to their belief that the body cannot be sustained by another's blood and accepting a transfusion will bar the reipient from eternal salvation Faith Assembly of Indiana Has negative view on modern health care and have an especially high rate of infant mortality due to limited prenatal care

World Major Religions (see table 10-1 copy) Buddhism Hinduism Islam Christianity Judaism basic unit of persons that are sharing or interacting binded by blood children marriage cohabitation

Family

love

Traditional Family nuclear consists of a father, mother and their children extended family includes the relatives in addition to the nuclear family single parents may never be married, separated divorced or widowed

Single- Parent Family

Alternative Family Cohabitating Families includes individuals who choose to live together for variety of reasons ex. relationships, financial needs, changing values part of a family of origin, usually has a social network with significant others. Physical Function providing a safe, comfortable environment necessary for growth, development, and rest/recuperation Economical providing financial aid for members as well as meeting monetary needs of the society Reproductive met by procreating; birth of children

Functions of Family

Socialization major importance including teaching, transmitting beliefs, values, attitudes and coping mechanisms, providing feedback and guiding problem solving

Family Stages and Tasks Beginning Family (honeymoon stage) Establishing a mutually satisfying relationship Planning to have or not have kids

Family with Children (1-3 years old) Cost of living

Renegotiating marital relationship

Family with Pre-School and Age School Children Cost of education Loss of parental privacy/ energy

Family with Teenagers (identity vs role confusion) Open communication Morals and Values Supportive home base Strengthen marriage

Post- Parental Family Empty nest syndrome Ties with older and younger generation

Aging Family Retirement depression Death of spouse

UNIT : Nursing Paradigm Nursing Nursing Nutrix - to nourish Latin the act of utilizing the environment of the patient to assist him in his/her recover Florence Nightengale the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to the health or its recovery (or to peaceful death) that he will perform unaided if he had the necessary strength, will or knowledge, and to this in such a way as to help me gain independence as rapidly as possible. - Virginia Henderson Nursing as a Profession History of Nursing Nursing Leaders History of Nursing in the Philippines Professionalism

Nursing Ethics Field of Opportunities in Nursing Communication Nursing as an Art Art the application of knowledge and skill to bring about desired results individualized action

Nursing art carried out by the nurse in one-to-one relationship with the patient, and constitutes the nurse's conscious responses to specifics in the patient's immediate situation

Art of Clinical Nursing Understanding of the patient and his/her condition, situation, and need Enhancement of the patient's capability Improvement of his condition or situation within the framework of the medical plan for his care Prevention of the recurrence of his problem or development of a new one which may cause anxiety, disability, or distress

Nursing as a Science It is a systematic and well-defined body of knowledge which utilizes scientific measures and procedures, and applies nursing processes or uses nursing care plans in caring, diagnosing and treating human responses to actual or potential health problems. Nursing as a Social Science Its primordial interest is man, whether well or sick , within the context of his life and environment