PROFESSIONAL NURSING CONCEPTS AND PRACTICES SUNIL .M.

B CONCEPTUAL & THEORETICAL MODELS OF NURSING PRACTICE

 Introduction Modern nursing involves the application of knowledge from nursing science, basic social sciences, physical sciences, behavioral sciences, ethics. This broad knowledge base applies to nursing because it is a unique profession., addressing the many responses individuals and families experience with their health problems

 One form of knowledge that can be very useful to nurses as they design and implement knowledge that can be very useful to nurses as they design and implement nursing interventions to meet the needs of their clients is nursing theory

The domain of nursing

The domain contains the subject, central concepts, values and beliefs, phenomenon of interest , and the central problems of the discipline The domain of medicine is the diagnosis and treatment of disease. Nursing domain is the identification and treatment of clients health care needs at all levels of health and in all health care settings.

 Nursing has a model or paradigm that explains the linkages of science, philosophy , and theory accepted and applied by the discipline

 The elements of nursing paradigm direct the activity of the nursing profession, including knowledge development, philosophy, theory, educational experience, research, practice, and literature identified with the profession

Nursing identified its domain in a paradigm that includes 4 linkages

METAPARADIGMS IN NURSING Person Recipient of care, including physical, spiritual, psychological, and socio-cultural components. Individual, family, or community The person is central to the care being providedbecause the person needs are multidimensional, it is important that nursing provides care that is individualised to the clients needs

 Health Is defined in different ways by the client, the clinical setting, and the health care profession It is the goal of nursing care Degree of wellness or illness experienced by the person ANA Definition: a dynamic state of being in which the developmental and behavioral potential of the individual is realized to the fullest extent possible

Environment / situation: Includes all possible conditions affecting the client and the setting in which health care needs occur. All internal and external conditions, circumstances, and influences affecting the person Ex: A clients level of health and health care needs can be influenced by factors in the home, school, workplace, or community There is a continuous interaction between the client and the environment. This interaction can have positive and negative effects on the persons level of health and health care needs Nursing has a unique focus in helping clients within all situations achieve a stable or improved level of health.

 Nursing Is the diagnosis and treatment of human responses to actual or potential health problems ( ANA ) Actions, characteristics and attributes of person giving care. Ex: Heart condition

 Theories are a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory & predictive in nature. Theories are composed of concepts, definitions, models, propositions & are based on assumptions.

Theory in modern English is a concept which originally derives from classical Greek Philosophy The word theory is derived from ancient Greek theoria, which originally meant "a looking at, viewing, beholding. Group of related concepts that propose actions that guide practice

THEORIES ARE NOT DISCOVERED IN NATURE BUT ARE HUMAN INVENTIONS

THEORY A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing.

Example..
Orems self care deficit theory defines nursing as a helping service, a creative effort to help people In addition , orem,s self care theory suggests that the goal of nursing is to help people to meet their own self-care demands. From this theoretical view , nursing assists clients by acting for , doing , or guiding physical and / or psychological support.

Definitions of theory
Nursing theory is the term given to the body of knowledge that is used to support nursing practice. Nursing theory is a framework designed to organize knowledge and explain phenomena in nursing, at a more concrete and specific level. Conceptualization of some aspect of nursing communicated for the purpose of describing phenomena explaining relationships between phenomena predicting consequences or prescribing nursing care.

 Nursing is a professional discipline (Donaldson & Crowley, 1978). Almost 90% of all Nursing theories are generated in the last 20 years. Nursing models are conceptual constructed of theories and concepts models,

A paradigm is a model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline.

CHARACTERISTICS OF A THEORY 1) Interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. 2) Must be logical in nature 3) Should be relatively simple yet generalizable 4) The bases for hypothesis that can be tested or for theory to be expanded ...continued..

6)Contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them. 7) Used by practitioners to guide and improve their practice. 8)Consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated. 9) Creative structuring of ideas mental images of ones experiences and create different ways of looking at a particular event or object.

Uses of theory 1. Theory guides and improve nursing practice 2. Theory guides research according to Meleis, primary use of theory is to guide research. It validates and modifies the theory. 3. Theory contributes to the development of the disciplines body of knowledge 4. Theory enhances communication

COMPONENTS OF A NURSING THEORY Concepts

Phenomenon

Definitions

Assumptions or Propositions

Theory a set of related statements that describes or explains phenomena in a systematic way. the doctrine or the principles underlying an art as distinguished from the practice of that particular art. a formulated hypothesis or, loosely speaking, any hypothesis or opinion not based upon actual knowledge. a provisional statement or set of explanatory propositions that purports to account for or characterize some phenomenon.

CONCEPTS Theory consists of inter related concepts Concepts are ideas, mental images They help to describe or label phenomena They are mental formulations of an object or event that come from individual perceptual experience

 DEFINITIONS
Convey the general meaning of the concepts in a manner that fits the theory. theory. Describe the activity necessary to measure the constructs, relationships or variables within a theory. theory.

CONSTRUCT
Constructs are concepts developed or adopted for use in a particular theory. The key concepts of a given theory are its theory. constructs. constructs.

ASSUMPTIONS A statement of relationship between concepts Statements that describe concepts or connect two concepts They are the taken for granted statements that determine the nature of the concepts, definitions, purpose, relationships and structure of the theory. PHENOMENON A phenomena that cannot be observed and must be inferred An aspect of reality that can be consciously sensed or experienced Nursing theories focus on the phenomena of nursing In nursing, phenomena reflect the domain of practice nursing

TYPES OF THEORY (I) LEVEL OF ABSTRACTION

Grand Theory Middle Range Theory

Situation specific Theory

II GOAL ORIENTATION

Descriptive

Prescriptive

Factor isolating

Explanatory theory

GRAND THEORIES  Systematic constructions of the nature of nursing, the mission of nursing and the goals of nursing care.  Broad in scope and complex  Require further specification through research before they can be fully tested.  Concepts are abstract  Not easily empirically tested.

MIDDLE RANGE THEORIES  Limited scope  Less abstract concepts  Address specific phenomena or concepts  Reflect practice (Administration, clinical or teaching)  Increased theory-based research and nursing practice strategies

SITUATION SPECIFIC THEORIES  Focus on specific nursing phenomena that reflect clinical practice.  Limited to specific populations or to a particular field of practice.  Limited scope  More direct impact on nursing practice  Predict outcomes and the impact of nursing practice  Called as prescriptive theory  Day-to-day experience of nurses is a major source to situation specific theory

DESCRIPTIVE THEORIES  Describe a phenomenon, an event, a situation or a relationship Needed when very little is known about a phenomena  Describe phenomena, speculate on why phenomena occur and the consequences of a phenomena.  Have explanatory, relating and predicting utility  They are complete and have the potential for guiding research.

PRESCRIPTIVE THEORIES  Prescriptive theory designates the prescription (intervention), the conditions under which the prescription should occur, and the consequences.  They are action oriented which tests the validity and predictability of a nursing intervention.  Guide nursing research to develop and test specific nursing interventions.

PHILOSOPHIES
THEORIST PHILOSOPHIES
Florence Nightingale An Environmental Adaptation Theory Ernestine Widenbach The helping Art of Clinical Nursing Virginia Henderson Faye Abdellah Lydia E. Hall Basic Needs of the Patient Need Theory Care, Core, Cure Concept

Jean Watson Patricia Benner Kari Martinsen

Philosophy and Science of Caring Excellence and power in clinical Nursing Practice Philosophy of caring

CONCEPTUAL MODELS
THEORIST Dorothy Johnson Myra Levin Martha Rogers Betty Neuman Sister Callista Roy MODEL Behaviour System Model Conservation Model Science of Human beings Systems Model Adaptation Model

GRAND THEORIES THEORIST Imogene King Leninger Margaret A. Newman Dorothea Orem Parse Ida Jean Orlando Hildegard E.Peplau THEORY Theory of Goal Attainment Theory of Culture Care and Universality Health as Expanding Consciousness Self-Care Deficit Theory SelfTheory of Human Becoming Nursing Process Theory Inter personal relationship Theory

MIDDLE RANGE THEORIES THEORIST Ramona T. Mercer Merle H. Mishel Pamela G. Reed Phil Barker THEORY Maternal role attainment Uncertainty in Illness Theory

Self Transcendence Theory Tidal Model of Mental Health Recovery Katharine Kolkaba Theory of Comfort Cheryl Tatano Beck Post partum Depression Theory Kristen M. Swanson Theory of Caring

 A model is a mental image of the phenomena using terms (or images) with which we are familiar.

For example, in the planetary model of the atom scientists visualize the atom as a nucleus with electrons orbiting around it in a manner similar to the way that planets revolve around the Sun.

 While the model is useful in understanding the atom, it is an over-simplified description of a real atom and does not describe/predict all of its attributes.

 Conceptual model Made up of concepts and propositions They represent ways of thinking about a problem or ways of representing how complex things work the way that they do. Different Frameworks will emphasize different variables and outcomes and their interrelatedness.( Bordage, 2009) Models may draw on a number of theories to help understand a particular problem in a certain setting or context. They are not always as specified as theory.

CONCEPTUAL MODEL A set of relatively abstract and general concepts and the propositions that describe or link those concepts.

CONCEPTUAL MODELS OF NURSING Sets of concepts and propositions that provide perspectives on the major concepts of the metaparadigm of nursing Reflect values and beliefs of the discipline Reflect research and practice approaches Provide direction for research Less abstract than philosophy More abstract than theory

THEORETICAL MODELS
A theoretical model refers to global ideas about theindividuals

Theoretical Models Organize care Strengthen nursing focus of care Provide consistency Advance the discipline Advance the professional practice

 CONCLUSION The conceptual and theoretical nursing models help to provide knowledge to improve practice, guide research and curriculum and identify the goals of nursing practice. Nursing knowledge is the inclusive total of the philosophies, theories, research, and practice wisdom of the discipline.As a professional discipline this knowledge is important for guiding practice.(Smith & Liehr, 2008).

 If theory is expected to benefit practice, it must be developed co- operatively with people who practice nursing. People who do research and develop theories think differently about theory when they perceive the reality of practice. Theories do not provide the same type of procedural guidelines for practice as do situation- specific principles and procedures or rules. Procedural rules or principles help to standardize nursing practice and can also be useful in achieving minimum goals of quality of care.