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Topic 2 - basic concept theory of nursing.pptx
- 1. Fundamentals of Nursing I Dr. Kusrini Kadar
- 2. Instructor Dr. Kusrini Kadar FUNDAMENTALS OF NURSING I Topic 2: Basic concept of nursing – Theory-based Nursing Care 18th Jan 2024
- 3. Corresponding PLO and CLO • PLO 1: Integrate core scientific knowledge to provide therapeutic, holistic care that is culturally appropriate, safe and tailored to the needs of the individual patient. • CLO1: Utilize knowledge of basic concept in nursing care for delivery of nursing care for client across life span. 3
- 4. Learning Outcomes 1. Describe the definition of nursing 2. Differentiate among the functions and roles of nurses. 3. Summarize nursing theories. 4. Examine non-nursing theories that influence nursing practice. 5. Articulate the criteria of a profession as applied to nursing. 6. Consider standards of practice and nurse practice acts. 7. Analyze the socialization and transformation process of a nurse. 8. Explore the levels of educational preparation in nursing and differentiate among the nurse's roles depending on education. 9. Investigate possible certifications in various arenas of nursing and professional organizations in nursing. 4
- 5. Definition of Nursing • In 1860, Florence Nightingale in her Notes on Nursing stated that nursing's role was “to put the patient in the best condition for nature to act upon him” • … nurses work tirelessly to identify and protect the needs of the individual. Beyond the time-honored reputation for compassion and dedication lies a highly specialized profession, which is constantly evolving to address the needs of society. From ensuring the most accurate diagnoses to the ongoing education of the public about critical health issues; nurses are indispensable in safeguarding public health. (American Nurses Association (ANA) (2018)) 5
- 6. Cont’d • Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. • Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. (ICN, 2002) 6
- 7. In summary • Nursing is seen as a holistic (physical, mental, emotional, spiritual, and social) • A profession is an occupation that requires a specialized body of knowledge and training. • The all-encompassing nature of the nursing profession sets it apart from the medical profession • Nurses build on their broad education and understanding of illness to promote wellness and health maintenance. • Nurses include the patient and family in their care while collaborating with all members of the health care team. • Caring, is a fundamental value for nurses in both their personal and professional lives. 7
- 8. Primary Roles and Functions of the Nurse 1. Care Provider 2. Educator 3. Advocate 4. Leader 5. Change agent 6. Manager 7. Researcher 8. Collaborator 9. Delegator 8
- 9. Theory-Based Nursing Practice • Four concepts common in nursing theory that influence and determine nursing practice are (1) the person (patient), (2) the environment, (3) health, and (4) nursing – metaparadigm in nursing • Nursing knowledge is derived from basic and nursing sciences, experience, aesthetics, nurses’ attitudes, and standards of practice. • Florence Nightingale emphasized that the “nature of nursing as a profession that requires knowledge distinct from medical knowledge” (Nightingale, 1860). • The overall goal of nursing knowledge is to explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines. • The integration of theory into practice leads to coordinated care delivery and therefore serves as the basis for nursing (McEwen and Wills, 2019) 9
- 10. Nursing theories Care Deficit Theory of Nursing—Dorothea Orem • Self-care is a purposeful learned behavior in response to a need. • Four concepts: self-care; self-care agency; therapeutic self-care demand; self-care requisites • Nursing implications: a. Promotes nursing care, such as acting, doing for, guiding, teaching, supporting, and providing a supportive environment that increases patients’ self-care abilities. b. Increases patients’ self-care activities to maintain life, health, and well- being. 10
- 11. Cont’d Cultural Care Diversity and Universality Theory— Madeleine Leininger • Transcultural care is a central and uniting feature of nursing. • Focuses on cultural care that addresses: preservation, accommodation, repatterning • Nursing implications: a. Requires nurses to view nursing as a transcultural care profession. b. Requires nurses to provide culture-specific care that assists patients to achieve and maintain health. 11
- 12. Cont’d Human Caring Theory—Jean Watson • Care should be based on values of concern, kindness, love of self and others, and respect for the spiritual domain • Explains that nursing is an interpersonal process. • Ten factors: The first three factors relate to the science of caring, and the rest relate to a focus of nursing practice. • Nursing implications: a. Supports caring as the basis of all nursing interventions and differentiates nursing from medicine, which is more concerned with curing. b. Encourages nurses to treat patients with care, respect, and dignity so that patients feel accepted, supported, and protected. 12
- 13. Cont’d Adaptation Model—Sister Callista Roy • A biopsychosocial adaptive system. • Pronounces that a person modifies and integrates human and environmental components to achieve adaptation that supports survival, continuity, and growth. • Holds that people respond in four modes: physiologic, self-concept, role function, interdependence • Nursing implications: a. Promotes patient adaptations in each of the four modes. b. Supports teaching about ways to alter internal and external environments to facilitate c. adaptations. d. Supports specific nursing care when adaptations are ineffective. 13
- 14. Cont’d Need theory – Virginia Henderson • The patient is a person who requires help to reach independence. • Nursing practice is independent and autonomous • The nurse is expected to carry out a physician’s therapeutic plan, but individualized care results from the nurse’s creativity in planning for care. • Nursing implications: a. The nurse should be an independent practitioner able to make an independent judgment. b. The nurse is responsible for assessing the patient’s needs, helping them meet health needs, and providing an environment in which the patient can perform activity unaided. 14
- 15. 14 Components of the Need Theory 15
- 16. Shared theory • Maslow's Hierarchy of Needs • Erikson's Psychosocial Theory • Lewin's Change Theory • Paul's Critical-Thinking Theory • Rosenstock's Health Belief Model (Potter & Perry – Chapter 4) 16
- 17. Criteria for Profession 1. Altruism 2. Body of Knowledge and Research 3. Accountability 4. Higher education 5. Autonomy 6. Code of Ethics 7. Professional organization 8. Licensure 9. Diversity 17
- 18. Standards of practice in Nursing • Nursing profession is guided by standards of practice • The standards pf Professional Practice published by the American Nursing Association (ANA) • Has two parts: (1) Standards pf practice include six responsibilities in nursing process; (2) Standards of professional nursing practice focuses on professional performance • It is essential that nurses understand and incorporate basic concepts of ethics into their practice. 18
- 19. Nursing Practice Licensure and Graduate Specialties • Each countries has different regulation • Each nurse must have license to be able to work/practice • General Type of Nurses in UAE: • HAAD/DOH, DHA, MOHAP Registered Nurse – considered as General Nurse/ Staff Nurse. • Critical Care Nurse/ ICU Nurse • Pediatric Nurse • Mental Health Nurse • Community Health Nurse • Homecare Nurse • School Nurse 19
- 20. Level of Education in Nursing • Diploma in Nursing (1-3 years) • Bachelor in Nursing (3-5 years) • Masters in Nursing (1-2 years) • Doctorate in Nursing (3-4 years) Certifications: short course (3 months to 1 year) – non-degree education 20
- 21. 21 Q&A Session
- 22. Practice questions Which of the statement below is correct a. Nurses provide care fragmentary b. Nursing is an occupation that not does require a specialized body of knowledge and training. c. The all-encompassing nature of the nursing profession sets it part of the medical profession d. Some theories used in nursing is a borrowed theory 22
- 23. Practice question When a nurse helps a patient make an informed decision about his/her own health and life, which of the following nurse’s roles has been performed? a. Advocate b. Counselor c. Caregiver d. Communicator 23
- 24. What specific aspect of a profession does the development of theories provide? a. Altruism b. Body of knowledge c. Autonomy d. Accountability 24
- 25. Health care workers are discussing a diverse group of patients respectfully and are being responsive to the health beliefs and practices of these patients. What important aspect of nursing professional practice are they exhibiting? a. Autonomy b. Accountability c. Cultural competence d. Autocratic leadership 25
- 26. • A nurse makes a medication error, immediately assesses the patient, and reports the error to the nurse manager and the primary care provider (PCP). Which characteristic of a professional is the nurse demonstrating? a. Autonomy b. Collaboration c. Accountability d. Altruism 26
Editor's Notes
- Nursing is seen as a holistic (physical, mental, emotional, spiritual, and social) profession that addresses many dimensions necessary to fully care for a patient. A profession is an occupation that requires a specialized body of knowledge and training. The all-encompassing nature of the nursing profession sets it apart from the medical profession, which treats an illness with a specific medical diagnosis. Nurses build on their broad education and understanding of illness to promote wellness and health maintenance. Nurses include the patient and family in their care while collaborating with all members of the health care team. Caring, which often is considered to be synonymous with nursing, is a fundamental value for nurses in both their personal and professional lives.
- Why is theory important to the nursing profession? Nursing knowledge is derived from basic and nursing sciences, experience, aesthetics, nurses’ attitudes, and standards of practice. As nursing continues to grow as a practice-oriented profession, new knowledge is needed to prescribe specific interventions to improve patient outcomes. Nursing theories and related concepts continue to evolve. The nursing process is used in clinical settings to determine individual patient needs (see Unit 3). Although the nursing process is central to nursing, it is not a theory. It provides a systematic process for the delivery of nursing care, not the knowledge component of the discipline. However, nurses use theory to provide direction in how to use the nursing process. For example, the theory of caring influences what nurses need to assess, how to determine patient needs, how to plan care, how to select individualized nursing interventions, and how to evaluate patient outcomes.
- Four concepts. a. Self-care: Self-initiated activities that a person performs to maintain life, health, and well-being. b. Self-care agency: An individual’s ability to engage in self-care based on developmental level, experiences, and available resources. c. Therapeutic self-care demand: Comprehensive self-care actions required to meet personal selfcare requisites. d. Self-care requisites: Actions directed to meeting universal needs common to all people, such as air, water, food, elimination, activity, rest, solitude/social interactions, safety, and promotion of human function.
- Focuses on cultural care that addresses a. Preservation: Activities that help a patient maintain health. b. Accommodation: Activities that promote ways a patient adapts to and negotiates adjustments to health. c. Repatterning: Activities that help a patient reconstruct life patterns to promote health.
- Ten factors: The first three factors relate to the science of caring, and the rest relate to a focus of nursing practice. Forming values. Instilling faith and hope. Cultivating sensitivity to self and others. Developing a helping-trusting relationship. Promoting and accepting expression of positive and negative feelings. Using problem-solving for caring processes. Promoting transpersonal teaching and learning. Providing supportive, protective, or corrective mental, physical, sociocultural, and spiritual environments. Assisting with meeting needs while preserving dignity and wholeness.
- Holds that people respond in four modes. a. Physiologic: Relates to basic physiological issues (e.g., oxygenation, exercise, nutrition, elimination, fluid and electrolyte balance, and temperature regulation). b. Self-concept: Relates to the physical self (e.g., threats to bodily functions) or personal self (e.g., anxiety, guilt, and distress responses to physical or emotional stressors). c. Role function: Relates to a patient’s ability to adapt to physical and emotional stressors to maintain personal life roles. d. Interdependence: Relates to issues that interrupt a patient’s ability to maintain significant relationships.
- Shared theory also known as a borrowed or interdisciplinary theory, explains a phenomenon specific to the discipline that developed the theory (McEwen and Wills, 2019). For example, Piaget’s theory of cognitive development helps to explain how children think, reason, and perceive the world. Knowledge and use of this theory help pediatric nurses design appropriate therapeutic play interventions for ill toddlers or school-age children. Knowles’ adult learning theory helps a nurse plan and provide appropriate discharge teaching for a patient who is recovering from surgery.
- Altruism: A profession provides services needed by society. Additionally, practitioners’ motivation is public service over personal gain (altruism). Nurses recognize nursing as their life's work, being an important component of their lives and clearly defining who they are. Nurses focus on service to their patients and the community. Body of Knowledge and Research: There is a well-defined, specific, and unique body of theoretical knowledge in nursing, leading to defined skills, abilities, and norms, that is enlarged by research. A profession is distinguished by a specific culture with norms and values common to its members. To advance knowledge in their field, professionals publish and communicate their knowledge. A profession develops, evaluates, and uses theory as a basis for practice. Accountability: Nursing requires accountability, which involves accepting responsibility for actions and omissions. Accountability has legal, ethical, and professional implications. It is essential for developing trusting relationships with patients and co-workers. Higher Education: Professionals are educated in institutions of higher learning. A profession requires that its members have an extended education, as well as a basic liberal foundation. Higher education provides the basis for practice and allows for lifelong educational opportunities, such as earning a master's or doctoral degree with its associated advantages of professional development. Greater professional opportunities for nurses and the training necessary to extend nursing science through advanced practice and research are possible through higher education. A profession has a clear standard of educational preparation for entry into practice. Autonomy: Members of a profession have autonomy in decision making and practice and are self-regulating in that they develop their own policies in collaboration with one another. Nursing professionals make independent decisions within their scope of practice and are responsible for the results and consequences of those decisions. Code of Ethics: Professions have codes of ethics to guide decisions for practice and conduct. Ethics is the standards of right and wrong behavior. The ICN and the ANA each have developed a code of ethics for nurses. Public opinion polls show that nurses are admired for their nursing ethics and honesty by rating them the highest of all professionals. Professional Organization: Numerous organizations have evolved to support and encourage high standards in nursing. Members participate in these organizations, which aim to support and advance nursing. Each organization participates in determining responsibilities and standards of conduct for individual members and the group and in regulating its members' adherence to its own professional standards. The ANA is an example of a professional organization that provides standards of professional nursing practice. Licensure: A profession is committed to competence and has a legally recognized license. Members are accountable for continuing their education. An RN is committed to professional development and is required to continue to learn and maintain competency. All licensed nurses keep their knowledge base current by formal and informal continuing education and can demonstrate competency when required. Diversity: “Inherent in nursing is respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, color, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status” (ICN, 2012, p. 1). Diversity includes developmental aspects, morphologic aspects (body frame size/obesity), culture, religion, and ethnicity. In providing care, the nurse promotes an environment in which the human rights, values, customs, and spiritual beliefs of the individual, family, and community are respected. To respect the diversity of patients, nurses practice culturally competent care. Culturally competent care is is a method of bringing interprofessional health care providers together to discuss health concerns whereby cultural differences enhance, rather than hinder, the conversation through a respectful atmosphere responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients. .
- The profession of nursing is guided by standards of practice and nurse practice acts. The Standards of Professional Nursing Practice published by the ANA help ensure quality care and serve as legal criteria for adequate patient care. ANA standards have two parts. The first part, the standards of practice, includes six responsibilities for the nursing process: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation (ANA, 2015). Nurses providing direct patient care continuously follow these standards as they utilize the nursing process. The second part of Standards of Professional Nursing Practice focuses on standards of professional performance, which includes ethics, culturally congruent practice, communication, collaboration, leadership, education, EBP and research, quality of practice, professional practice evaluation, resource utilization, and environmental health (ANA, 2015).
- General Type of Nurses in UAE HAAD/DOH, DHA, MOHAP Registered Nurse – considered as General Nurse/ Staff Nurse. The following but not limited are the Duties and Responsibilities: Perform routine procedures (blood pressure measurements, administering injections, etc.) and fill in patients' charts Monitor patient's condition and assess their needs to provide the best possible care and advice Observe and interpret patient's symptoms and communicate them to physicians Collaborate with physicians and nurses to devise individualized care plans for patients Adjust and administer patient's medication and provide treatments according to physician's orders Inspect the facilities and act to maintain excellent hygiene and safety (decontaminating equipment, sanitizing surfaces, preparing beds, etc.) Provide instant medical care in emergencies Critical Care Nurse/ ICU Nurse – a Registered Nurse who provides care to acutely and critically ill patients in a highly technical and ongoing monitoring environment. These patients are facing life-threatening problems with varying needs, which require extensive medication protocols and therapies. Pediatric Nurse – A registered Pediatric Nurse provides health and medical care for infants, children, and adolescents. The Pediatric Nurse can talk to children and ask questions about their health, especially when children are scared and cannot communicate their problems. Mental Health Nurse – Registered Mental health nurses work as part of a professional and medical staff team that includes doctors, social workers, therapists, and psychiatrists. They work in a range of settings, including hospitals and people's homes. They support people with issues ranging from anxiety and depression to personality and eating disorders. Community Health Nurse – The community nurse acts as a teacher and counselor primarily but also plays a vital role in preventing widespread illness and disease in the community she serves Duties & Responsibilities Provide direct care, educate individuals or the public, advocate for health improvements, and perform research in community health. She might also lead or collaborate with other health care professionals, organizations, political figures, and community members to promote health for her community. Planning and delivering a community health program, taking into account the physical, social, spiritual, mental, and environmental factors that influence each individual, family, and community Delivering an immunization program in accordance to Healthcare Immunization Policy and Procedure Ensures to maintain an infectious disease reporting program Homecare Nurse - Homecare aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home care providers render services in the patients' own homes. These services may include some combination of professional health care services and life assistance services. Home Care Nurses provide care to patients in their homes under the guidance of a physician School Nurse - School nurses work to promote a healthy school environment. Beyond promoting health and safety for students within the school facility during the school day, they also encourage students to maintain healthy habits and behaviors when they are not in school. These nursing professionals are also responsible for identifying both actual and potential health problems, providing case management services, and collaborating with educators, school officials, students, and families to ensure students respond positively to their environment and develop normally.