Nursing Hallmarks of 20th Century Nursing Theoretical development Theories shared with other disciplines
Success in Nursing Science
Continued research Global focus Profession vs. academic discipline
Use of conceptual models
Contemporary Perspectives of Nursing Where are we going? In order to advance nursing, Fawcett believes: Use of conceptual models to guide practice Establish formal linkages between nursing education and nursing service Recognition of clinical scholars
Assess new knowledge for suitability to practice
Contemporary Perspectives of Nursing Just because research is conducted by nurses, does that make it nursing research? Most studies do not use a nursing framework Contemporary Perspectives of Nursing Current trends Nursing has become more sophisticated Our most talented RNs choose advanced practice Many nurses are often told by physicians that they are too smart to stay on the floor Talk occurs every so often about bringing another type of provider to the bedside Contemporary Perspectives of Nursing Physicians are much less threatened by Physicians Assistants because of the different philosophy they are taught in PA school Nurses tend to cherish their autonomy vs. grown up in the mind set that MD stands for minor deity Contemporary Perspectives of Nursing Many job advertisements are written as Wanted: ARNP or PA-C Are we interchangeable? What do we bring to the table that is unique and different when time is money and quantity is desired over quality patient interactions? Contemporary Perspectives of Nursing When we ask for equal billing, prescriptive authority, etc. are we infringing on the doctors turf? When the media portrays ARNPs, how is it usually approached? Is changing our entry to practice preparation considered a threat? Contemporary Perspectives of Nursing Human Science Understanding life experiences Subjectivity is fundamental
Objectivity is a human creation
Current theorists incorporate human
science Do any other disciplines look at human science the way we do? Contemporary Perspectives of Nursing How does free will play into the equation? Are we charged with monitoring patient choices and determining if they are appropriate? How do you handle a perceived poor choice by your patient? Theory Based Advanced Nursing Practice All nurses use knowledge they acquired during their formal education to guide their practice Most are unaware of existing theories and how to apply them Most are greatly influenced by the medical model Theory Based Advanced Nursing Practice Practitioner programs base themselves heavily on the medical model Junior Doctors vs. Senior Nurses Theories improve the quality of care by clearly defining the boundaries and goals of nursing assessment, diagnosis, and interventions. Theory Based Advanced Nursing Practice Theories help us to maintain consistency and congruency of care Theories may improve efficiency and effectiveness Theories enhance professional autonomy and accountability Theory Based Advanced Nursing Practice Theory can be used to Collect, organize, and classify client data Understand, analyze, and interpret clients health situations Guide formulation of diagnosis Plan, implement and evaluate care strategies Explain actions and interactions with clients Describe and explain client responses Achieve desired outcomes for clients Theory Based Advanced Nursing Practice Issues related to theory based nursing practice Enthusiasm for using theories in advanced practice is low due to the theory-practice gap Most see little correlation between the philosophical concerns of nursing models and the relevance to clinical practice Theories are not routinely used to guide practice Theory Based Advanced Nursing Practice Nurses do not use Nursing Theories because they do not know them, understand them, know how to apply them, or believe in them. (McKenna, 1977) Martha Rogers (1989) said Nursing knowledgeis often seen as being unscientific, intuitive, and highly subjective Theory Based Advanced Nursing Practice Are most conceptual models too abstract to apply to clinical practice? If a theory is not useful in practice, then its value is questionable Nursing often uses theories from other disciplines (Erickson, Selye, Kubler-Ross) Nurses tend to blend them with medical model theory to base their practice Theory Based Advanced Nursing Practice Do you think that combining theories from other disciplines with nursing theories and picking and choosing your beliefs compromises nursing theory? Nurses often study other disciplines to better understand human behavior We are able to bring a unique perspective by blending social science and nursing theories Theory Based Advanced Nursing Practice Should we use one theory consistently or blend the concepts we like from multiple theories? Do nursing models that fragment the patient into elementary parts that respond in a predictable way to stressors lead to fragmented, non- holistic care? Theory Based Advanced Nursing Practice Can we blend the metaparadigm concepts of nursing theory with clinical practice? First we must understand and be able to use the theoretical model most closely aligned with our chosen practice area Then we must use it as the lens by which we view the client and their world This helps you move from the what is to the what could be Theory Based Advanced Nursing Practice Perspective transformation Moving from one frame of reference to another Medical model to nursing model Many steps are involved in this transformation Stability upset when new framework introduced Dissonance challenge of change Confusion the struggle to learn the new way Leads to anxiety, anger, and grieving for the old ways Dwelling with uncertainty the revelation that the confusion is not based on their personal inadequacy Theory Based Advanced Nursing Practice Many steps are involved in this transformation (cont.) Synthesis the first step in pulling it together Model becomes clearer, and insight begins Resolution comfort level increases dramatically Reconceptualization the permanent shift from the old way of thinking to the new one Return to stability once the practice is firmly based on the new model or theory Theory Based Advanced Nursing Practice Examples of models used in practice Peplaus Interpersonal Model used in psychiatric nursing because of its goal directed, nurse-patient interpersonal process to promote clients personality and living Orlandos Model is used as an approach to understand the communication process Theory Based Advanced Nursing Practice Orems Self care model identifies requisites for client self care and identifies means specific nursing systems to deliver the care Ambulatory surgery centers Outpatient care centers Parses Man-living-health theory assists us to explore the past life experiences to predict future behaviors Newman used systems theory to describe stressors and interventions based on the levels of protection Theory Based Advanced Nursing Practice Guidelines for selecting models and theories for nursing practice Consider your personal values and beliefs about nursing, clients, health, and environment Examine the underlying assumptions, values, and beliefs of various nursing models, and how the major concepts are defined Identify several models that are congruent with your personal beliefs and values about nursing, client, and health Theory Based Advanced Nursing Practice Guidelines for selecting models and theories for nursing practice Identify the similarities and differences in clients focus, nursing actions, and client outcomes of these models Practice applying the models and theories to clients with different health concerns to determine which ones best fit specific situations and guide nursing actions that will achieve desired client outcomes Theory Based Advanced Nursing Practice Contemporary Perspectives of Nursing II Humanistic Nursing Paterson and Zderad (1976) Phenomenological methodology Phenomenology is the study of human experience and its influence on behavior Nursing is concerned with human experiences Guilt Anger Hopelessness fear Contemporary Perspectives of Nursing II Phenomenologic nursology Phase I Preparation for the nurse (knower) for coming to know (the patient) Phase II Nurse knowing the other (patient) intuitively Phase III Nurse knowing the other scientifically Phase IV Nurse complementarily synthesizing known others Phase V Succession within the nurse from the many to the paradoxical one (conclusion) Contemporary Perspectives of Nursing II Contemporary Perspectives of Nursing II Phenomenologic Framework Does not offer guidelines for administering patient care Does not offer a means of evaluating the effectiveness of care Does not hold the nurse accountable for quality of care Bases interactions on lived human experiences Contemporary Perspectives of Nursing II Phenomenologic Framework
Can empathy for the human situation be
taught?
Can we predict how clients behave based
solely from the context of their life experiences? Contemporary Perspectives of Nursing II Phenomenological theories have become popular in psychiatric nursing They offer a broader base to evaluate from They do not offer treatment advise They seek to inform the nurse that lived experiences can influence thought and action processes Contemporary Perspectives of Nursing II Planning in the phenomenologic framework is complex The patient is guided to make responsible choices The nurse guides the patient through the use of therapeutic communication Validation of fears and concerns is problematic (can be viewed as enabling) Contemporary Perspectives of Nursing II As the patients progress through their problems, they are able to see the irrationality of their fears and anxiety Active planning on the part of the patients causes an awakening within them Health belief model Maintenance within the comfort environment is important Contemporary Perspectives of Nursing II Theory of Humanistic Nursing begins to take us out of the measurable, empiric world and into a more philosophical one It is important that clients are not encouraged to forget the past, because they will be doomed to repeat it Contemporary Perspectives of Nursing II Multiparadigm approaches to healing Many of our patients practice a variety of healing methods Herbals
Acupuncture
Visualization
These vary from the western tradition of
allopathic medicine Contemporary Perspectives of Nursing II Contemporary Perspectives of Nursing II Contemporary Perspectives of Nursing II The multiparadigm model is holistic and avoids the medicine-nursing and practice-academia dichotomies It speaks to the domain of healing which is an integral part of the domain of nursing It may yield referrals to non traditional providers for advanced practice nurses Contemporary Perspectives of Nursing II What are the potential research applications of the multiparadigm model? Do you think it is time to bridge the gap between holistic nursing and biomedical nursing practice? How does it influence the metaparadigms of nursing?