Nursing as a Profession and Discipline: Exploring its Evolution and Key Concepts, Cheat Sheet of Health psychology

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Week 1 Challenges in Developing a Clear and Concise Definition of Nursing

• previous discussion on whether nursing is a profession or an occupation
• Occupation meaning a job or a career, whereas a profession is a learned vocation or occupation that has status of superiority and precedence within a division of work Nursing as a Profession
• Nursing is an aspiring, evolving profession
• Characteristics of a profession include: (1) defined and specialized knowledge based, (2) control and authority over training and education, (3) credentialing system or registration to ensure competence, (4) altruistic service to society, (5) code of ethics, (6) formal training within institutions of higher education, (7) lengthy socialization to the profession (8) autonomy
• professions must have a group of scholars, investigators or researchers who continually advance the knowledge of the profession with the goal of improving practice
• Professionals are responsible and accountable to the public for their work
• Difficulty deemed a profession because many services were perceived as an extensions of those offered by wives and mothers — nurses have been seen as subservient to medicinal and delayed in identifying and organizing professional knowledge Importance of Nursing as an Academic Discipline
• a discipline is a branch of knowledge ordered through the theories and methods evolving from one more than one worldview of the phenomenon o concern
• nursing knowledge base draws from multiple disciplines such as physiology, sociology, psychology, and medicine to provide academic standing and to inform practice
• Nursing has been attempting to seek a unique to nursing and developing aspects into academic disceipline Nursing is a distinct discipline are (1) an identifiable philosophy (2) at least 1 conceptual framework that defines nursing (3) an acceptable methodology to develop knowledge (4) Defined tasks and procedures
• Science: cause and effect, understanding reality is characterized by base ration, verifiability, and experience; hypothesis testing and experimentation — theoretical explanation of the subject of inquiry and the methodological process of sustaining knowledge in a discipline
• Nursing as a science: nursing draws from many sciences, such as physiology and chemistry — nursing is an applied or practice science
• The substantive, discipline-specific knowledge that focuses on the human-universe health process articulated in the nursing frameworks and theories

Week 2

• inductive reasoning: moves from the small ideas up to a larger understanding
• deductive reasoning: voices from what is observed in a larger situation and concludes what might be true in the smaller situation
• Intuitive thought: feeling in your gut
• Analytical thought: evaluating information gathered and organized
• iterative: back an forth (not doing something over again), until endpoint, a process not end result, inductive (small idea being constructed), reflective Three clinical reasoning frameworks that inform the clinical judgement model
• intuitive-humanistic model: (banner)— the nurse moves from novice to expert through experiential growth in knowledge and skills. Nurses transition through five levels of proficiency: novice,advanced beginner, competent, proficient, and expert. These five stages of acquisition are incorporated into the definition of the nursing clinical judgment
• The CJM supports and explain these cognitive processes as nurses require deep knowledge to make decisions that results in optimal client outcomes. As nursing students move on the continuum from novice to greater expertise in practice, their ability to recognize and analyze cues, prioritize hypothesis and generate solutions for clients, based in evidence and experiences, increases.
• Ways of thinking- dual process reasoning model: two types of reasoning (1) non-analytical reasoning, pattern recognition, gut feelings, experiential; (2) analytical reasoning, hypothesis- drive, purposeful. The underlying idea is that used together, HCPs are able to reason more accurately in clinical situations
• The CJM recognizes that although some parts of clinical judgement, such as recognizing and analyzing cues, often occur at the intuitive or non-analytical layer, more complex parts of decisions, such as generating hypotheses and solutions, and evaluated outcomes, may require in- depth knowledge derived from scientific information (analytical). Additionally, the CJM references the content or external factors that influence clinical judgements.
• Information processing model: across professions, decision making should be modded from “basic cognitive yielding blocks” including memory, attention, and causal reasoning and that decision systems are best understood by developing models on how decision-relevant information is sampled, retrieved, and integrated.
• Used this model to propose a nursing clinical judgment model with 5 iterative processes — this allows for identification of process and identification of points of error. Clinicians must use prerequisite knowledge and skills to guide them when organizing information and therefore the NCBSN focused on decision making within context-specific conditions

The interrelatedness of the CNO competency domains to the core concert: RN

• clinician: RNs are clinicians who provide safe, competent, ethical, compassionate, and

evidence informed care across the lifespan in respond to client needs — RNs integrate

knowledge, skills, judgement, and professional values from nursing and other diverse

resources into their practice

• Communicator: RNs are communicators who use a variety of strategies and relevant

technologies to create and maintain professional relationships, share information, and

foster therapeutic environments

• Professional: RNs are professionals who are committed to the health and well-being of

clients. RNs uphold the profession’s practice standards and ethics and are accountable to

the public and the profession

• Advocate: RNs are advocates who support clients to voice their needs to achieve optimal

health outcomes. RNs also support clients who cannot advocate for themselves

• Collaborator: RNs are collaborators who play an integral role in the healthcare team

partners hip

• Educator: RNs are educators who identify learning needs with clients and apply a broad

range of educational strategies towards achieving optimal health outcomes

• Leader: RNs a re leaders who influence and inspire others to achieve optimal health

outcomes for all

• Scholar: RNs are scholars who demonstrate a lifelong commitment to excellence in

practice through critical inquiry, continuous learning, application of evidence to practice,

and support of research activities

• coordinator: RNs coordinate point of care health service delivery with clients, the

healthcare team, and other sectors to ensure continuous, safe care

Describe hierarchies of evidence and evidence-based practice

• analysis of many randomized control trials: experimental form of impact evaluation in

which the population receiving the program is chosen randomly from the eligible

population and the control group is also random from the same eligible population

• One randomized control trial

• One non randomized quantitative study: quantitative study estimating the effectiveness of

an intervention that does not use randomization to allocate their individuals or

intervention groups

• Quasi experimental study: utilize non-random criteria while assigning subjects to groups

• Synthesis of many qualitative studies: combine and evaluate data from multiple studies

• Non experimental/qualitative: research that lacks the manipulation of an independent

variable

• Expert opinion/experience

Week 3 Describe foundations of abstract thought: levels of abstraction

• theories differ in complexity and scope along a continuum from practice or situation-specific theories to grand theories
• most abstract to least = metatheory, grand theories, middle range, practice Discriminate between three paradigms that influence nursing knowledge, and practice positivism, naturalism, post-positivism
• Positivism: Received view, (positive and empiricism are basically the same). Positivism supports mechanistic, reductionist principles, where the complex can be best understood in terms of basic components. Based on scientific evidence, concrete,observable, measurable e.g., fall risk assessment = cell bell, bed alarm — objective
• Naturalism/ constructivism: Perceived view, argues that the influence of history on science should be emphasized, interpretive view. Focuses on understandings the actions of, and meaning to, individuals. What exists depends on what individuals perceive to exist. E.g., Cultural sensitivity, language barriers — subjective
• Post-positivism/modernism: rejects the notion of a single truth, recognizes the value or science and scientific methods, allows for multiple meanings of reality and multiple ways of knowing in reality. Knowledge is viewed as uncertain, contextual and relative. E.g., Restraint jackets for confused pt Describe the meta paradigm of nursing
• refers globally to the subject matter of greatest interest to member of discipline
• person: a being composed of physical, intellectual, biochemical and psychosocial needs; a human energy field; a holistic being in the world
• Environment: refer to the external elements that affect the person; internal and external conditions that influence the organisms; significant others with whom the person interacts; and open system with boundaries that permit exchange of matter, energy, and information
• Health: the ability to function independently, successful adaptation to life’s stressors; achievement of ones full life potential; and unity of mind, body and soul
• Nursing: a science, an art and a practice discipline involves caring Relationships among the meta paradigm concepts

1. person and health: nursing is concerned with principles and laws that govern human processes of living and dying
2. person and environment: nursing is considered with the patterning of human health experiences within the context of the environment
3. health and nursing: nursing is concerned with the nursing actions or processes that are beneficial to human beings
4. person, environment, and health: nursing is concerned with the human process of living and dying, recognizing that human beings are in continuous relationship with their environments

Week 4

Building Blocks of Theory

• Phenomenon: the big picture, broad and overarching, abstract thinking, hard to measure

• Construct: building block, less abstract than a phenomenon, has concepts, becoming slightly

more specific, measurable

• Concept: more defined, part of a construct, measurable, NOT a statement/sentence, can be

observed, part of something bigger, more concrete than a construct

• Theory/ theorem: relationship, organized ideas, testable, evidence to support it but it is NOT

proven, organized framework linking concepts together - not a phenomenology but

phenomenology is a theoretical approach

• Conceptual model/ conceptual framework: guideline assemble of theories, structures, systems

of concepts, structural representation

Concepts of Theory Testing

• assumption: bias, something you believe in, something you accept as true

• Proposition: suggestion, proposal, expressed idea

• Empirical indicator: something you can measure

• hypothesis: educated guess

• Praxis: application of theory, putting something into practice

• Relationship statement: delineating connection between things, cause and effect

• Taxonomy: classification system, labelling

• Evidence: testable outcome, supporting hypothesis

• Evidence informed practice: physical practice based on evidence

Meleis Transition Model

1. Nature of transactions

• Types: developmental, situation, health/illness, organizational
• Patterns: single, multiple, sequential, simultaneous, related, unreleased
• Properties: awareness, engagement, Change and difference, transition time spam, critical points and events

2. Transition Conditions

• personal: meanings, cultural beliefs and attitudes, socioeconomic status, prep and knowledge
• Community
• Society

3. Patterns of response

• process indicators: feeling connected, interacting, located and being situated
• Outcome indicators/ healthy transition: mastery, fluid integrated identity

4. Nursing therapeutics

• pro motive
• Preventative
• Intervention

Week 6

Steps in Theory Development

1. Concept development: specifying, defining, and clarifying the concepts used to describe a

phenomenon of interest

2. Statement development: formulating and analyzing statements explaining relationships between

concepts, also involves determining empirical referents that can validate them

3. Theory construction: structuring and contextualizing the components of the theory; includes

identifying assumptions and organizing linkages between and among the concepts and

statements to form a theoretical structure

4. Testing theoretical relationships: validating theoretical relationships through empirical testing

5. Application of theory to practice: using research methods to assess how the theory can be

applied in practice, research should provide evidence to evaluate the theory’s usefulness

Steps in Concept Development

1. Select a concept

2. Identify all uses of the concept

3. Determine defining attributes

4. Identify a model case

5. Identify contrary cases, what it is not

6. Antecedents and consequences

7. Empirical indicators

10 principles that define PFCC Concepts

Describe the dimensions in analyzing, evaluating, and comparing theories

• theory description: initial step, the works of a theorist are reviewed with focus on historical

context of the theory

• theory analysis: the second phase of the evaluation process - refers to a systemic process of

objectively examining the origins, content, structure and function of a theory - conducted if the

theory or framework has potential for being useful in practice, research, admin or education

• Non judgemental, detailed examination, aim to understand the theory

• Theory evaluation: final step of the process, assesses the potential contribution to the

disciplines knowledge base — critical reflection involves ascertaining how well a theory serves

its purpose, with the process of evaluation resulting in a decision or action about the use of the

theory

• Considers how the theory is used to direct nursing practice and intervention, whether it

contributes to favourable outcomes

Week 7 Discuss the importance of grand theories and models to nursing science

• discussion and debate on the correct terminology and understanding of conceptual models and grand theories
• Terms are used interchangeably which can be confusing
• General way to differentiate your understanding is according to their level of abstraction
• Conceptual models are so highly abstract that they tend to incorporate all of nursing reality in a broad description of a philosophy - difficult to test them
• Grand theories may come out or derive from conceptual models, they are a less abstract, they remain the most complex and broad of all theoretical categories - their concepts are a little more defined, but still not so defined that testing relationships is feasible
• As a profession, nurses are ultimately concerned about how useful a grand theory is to inform or guide nursing practice, education and research
• Some nurses analyze how amenable they are for testing relationships between contexts
• Nursing grand theories are analyzed for the contribution or value that they bring to extending, expanding or informing nursing as a science **Describe grand theories according to theorist background, philosophical underpinnings and key assumptions, concepts, and relationships:
• human needs (Florence nightingale and Dorothy Orem):
• Florence Nightingale:**
• Theorist background: England late 1800’s, during the crimean war she was present to assist in providing care to wounded soldiers, many soldiers died of infection due to open sewers and lack of cleanliness, she then created the germ theory
• Philosophical underpinnings: her basic tenet was healing and secondary are the tenets of leadership and global action which are necessary to support healing at its deepest level.She believed that nurses were not subservient to physicians but it was an independent progression. Nightingales model is based on anticipating and meeting the needs of patients. Philosophy was based in positivism, descriptive.
• key assumptions, Concepts, Relationships: Pure air and water, efficient drainage, cleanliness, light, healthy environment for healing, cleanliness and social contact, cleanliness prevents morbidity, critical thinking, nursing as art, medicine as science, loyal but not servile - Dorothy Omen - Theorist background: United States 1950’s, practical nursing education
• Philosophical underpinnings: self care deficient nursing theory focuses on person as agent, it is in the school of moderate realism, continuous engagement to function
• Key assumptions, concepts, relationships:
• Metaparadigm Concepts:
• Nursing: seen as an art which the practitioner of nursing gives specialized assistance to persons with disabilities which makes more than ordinary assistance necessary to meet needs for self-care. The nurse also intelligently participates in the medical care the invidious l receives from the physician
• Humans: men, women, and children cared for either singly or as social units, they are the material object of nurses and others who provide care
• Environment: physical, chemical and biological features, including family, culture and community
• Health: being structurally and functionally whole or sound, encompassing both the health of individuals and of groups, and human health is the ability to reflect on ones self, to symbolize experience and communicate with others

• Concepts in Oreos self-care deficit theory
• Self care: human regulatory function to supply or ensure the supply of necessary materials needed for continued life, growth, and development and maintenance of human integrity
• Self care requisites: part of self care, expressions of action to be performed by or for individuals in the interest of controlling human or environmental factors that affect human functioning or development (three types: universal developmental, health deviation)
• Universal self care requisites: common to all humans
• Developmental self care requisites: necessary for growth and development
• Health deviation self care requisites: associated with health deficits
• Therapeutic self care demand: nurses assistance in meeting the clients or client dependents self-care needs is done therapeutically as a result of the clients inability to calculate or to meet therapeutic self- care needs
• Deliberate action: action knowingly taken with some motivation or some outcome sought by the actor, as self-care or dependent care
• Nursing system: product of a series of relations between the persons: legitimate nurse and legitimate client
• Product of nursing: An intellectual product (design for helping the client) and a system of care of long or short duration for persons requiring nursing
• interactive (jean Watson): grounded in post positivism (4 core tenets of positivism - multiple methodologies, macro analysis, reality in context to history, uncovering opposing views). Health is a core value and is understood on a continuum from a high level of wellness to illness. Human beings are understood as holistic who interact and adapt with their environments
• Theorist background: Watson was an American nurse influenced by the thinking of Nightingale. She had degrees in psychiatric and mental health nursing
• Philosophical underpinnings: Watson understood human caring as a deep involvement between humans and nurses. She believed that humans were holistic, and interactive energy fields. She values a respect for the mysteries of life and that spiritual and ethical dimensions were major elements of the human care process. Therefore, humans have responsibility to care for the planet
• key assumptions, Concepts, Relationships:
• Carative processes: (1) altruism; (2) authentically present; (3) spiritual practices; (4) loving trusting care relationships; (5) authentic listening; (6) solution seeking; (7) trans personal teaching and learning; (8) healing environments; (9) human dignity, (10) open to mystery
• Assumptions:
• An ontological assumption of oneness, wholeness, unity, relatedness, and connectedness
• An epistemological assumptions that there are multiple ways of knowing
• Diversity of knowing assumes all, and various forms of evidence can be included
• A caring science model makes these diverse perspective explicitly and directly
• Moral-metaphysical integration with science evokes spirit; this orientation is not only possible but also necessary for our science, humanity, society-civilization, and work-planet
• a caring science emergency, founded on new assumptions, makes explicit an expanding unitary, energetic worldview with a relationship human caring ethic and ontology as its starting point

- Interactive

• Usefulness: used in diverse setting, acknowledges the experience of both the patient and nurse. Practiced in clinical practice in iran but decided incorporating the theory into undergraduate nursing would be a sound solution
• Testability: allows both quantitative and qualitative research methods
• Parsimoniousness: comparatively parsimonious, although a number of new concepts and terms are defined. There are only 10 carative processes or areas to be addressed by nurses. And 5 working assumptions and 3 considerations
• Value to nursing as a science: explicitly describes the connection between nursing and caring, used in education and in practice internationally. As well as numerous research studies.
• Unitary
• Usefulness: usefulness lies in its potential to deconstruct and understand practice, education and research situations from a new perspective
• Text ability: the test ability is inductive and constructivist rather than reductionist and quantitative
• Parsimoniousness: terminology is different for nurses and an unusual, less pragmatic way to view nursing practice. The nine assumptions have been synthesized to four assumptions and core concepts and three relationship statement
• Value to nursing as a science: human becoming theory values the intentionality of humans and their free choice. It guides and support co creation of health choices

Week 8 Discuss the importance of middle range theories to nursing science

• the name middle suggests in relation to levels of abstraction
• Infers that middle range theories are less abstract (more concrete) than grand theories but as as concrete as practice theories
• The concepts are more specifically defined and are amenable to quantitative measurement
• Easier to predict relationships between and among concepts, which ones operationalized are referred to are variables
• They tend to be more useful in practice because they are easier to understand and lend themselves to development and testing of interventions
• Can be used to describe, explain and predict relationships between variables, as compared to grand theories, which are too abstract for testing
• Can be used as a framework
• Straightforward and easy to use - have a number of concepts with specific focus. Their scope on reality is narrower than grand theories. They are nursing specific and tend to focus on specific client problems **Describe middle range theories according to theorist background, philosophical underpinnings and key assumptions, concepts and relationships in nursing middle range theories
• Benners model of skill acquisition:** Novice, advanced beginner, competent, proficient, expert
• Theorist background:
• Philosophical underpinnings
• Key assumptions, concepts, and relationships
• Five central concepts: competence, skill acquisition, experience, clinical knowledge, practical knowledge
• Seven domains of practice: helping role, teaching or coaching function, diagnostic monitoring, effective management of rapidly changing situations, administering and monitoring interventions, monitoring and ensuring quality practices, organizational and work role competences - Meleis Transition model:
• Theorist background:
• Philosophical underpinnings
• Key assumptions, concepts, and relationships:
• Four major categories of transitions:
• developmental transitions- birth, adolescence, menopause, aging, death
• Situational transitions- changes in family situations or changes in living arrangements
• Health-illness transitions- recovery process, hospital discharge, diagnosis of chronic illness
• Organizational transition- changing environmental conditions that affect the lives of clients; may be social, political, or economic
• Other key concepts:
• Patterns: denote whether a transition is single, multiple, sequential, simultaneous, related or unrelated
• Propertoes: interrelated in a complex way and refer to awareness, engagement, change/ difference, time span, critical points and evens

Week 9 Discuss the importance of practice theories to nursing science

• theory without application is an intellectual exercise
• To move this cognitive or intellectual understanding of our would and healthcare and nursing in particular, theories need to be applied to the real, objective world in which we love and work
• Theory as both a process and a product can be useful in our day to day working lives
• We can determine if any theory might be useful to practice situations
• Theory-practice gap: gap between theoretical knowledge and practical application of nursing - understood as a relative relationship; one in which there is either a lack of theoretical knowledge or the theoretical knowledge is not used 7 purposes for the role of theory in practice
• (1) Identify relevant areas for study, (2) Proposes plausible approaches to examine health problems, (3) Develops middle range theory linked to a research, (4) define concepts and propose relationships, (5) interpret findings, (6) develop clinical practice protocols, (7) generate nursing diagnoses 4 steps of theory process

1. Analyzing concepts
2. Construction relationships
3. Testing relationships
4. Validating relationships 2 products of theory
5. Set of concepts
6. Set of relationships 4 types of relationships between or among concepts in theories

• description of relationships between or among concepts
• Explanation of relationships between or among concepts
• Prediction of relationships between or among concepts
• Prescription of relationships between or among concepts Describe theories specific to nursing practice, nursing administration and nursing education and nursing research
• Theory in practice or theory based practice:
• application of various models, theories and principles from nursing, biological, behavioural, medical, and sociocultural sciences assessed as appropriate to the clinical situation
• To choose a theory that may be appropriate for practice, a nurse needs to consider several factors
• The goals and context of the theory and the goals and context of practice situation must be congruent
• Who?- identify the recipients of the theory, who does it apply to?
• Where?- what are the practice settings and situations that might resonate the theoretical situations?
• What?- what recipient problems are being considered for theoretical application and does the theory lend itself to describing, explaining them, or predicting them? the theoretical concepts and their variables must be consistent for congruent with the practice concepts, theoretical explanations to clinical situation
• How?- how will it be used or applied? Is it to understand, analyze, or interpret health conditions? Will is describe, explain, predict, etc?
• When?- are there specific times or conditions of the practice settings and situations for which the theory is appropriate

• theory in nursing administration
• Main constructs: organizational design, shared governance, transformational leadership, patient care delivery models, case management, disease/chronic illness management, quality management, performance improvement, evidence-based practice
• Organizational design concepts: work specialization, chain of command, span of control: line and staff authority, authority and responsibility, centralization and decentralization, departementalization
• Shared/ professional governance concepts: councillor model, administrative model, congressional model
• Transformational leadership concepts:creating a vision, building a social architecture as a framework for commitment to vision and organizational identity, developing sustaining organizational trust, self esteem of others, focus on relationships and interpersonal skills
• Patient delivery care models concepts: total patient care, team nursing, primary nursing, patient family centred care - Theory in education
• Includes curriculum concepts related to the metaparadigm of nursing
• the application of one single theoretical model threaded throughout the entire curriculum
• an eclectic theoretical approach- various and different theoretical models are incorporated across the curriculum according to course specific objectives - Theory in research
• A systemic inquiry that uses disciplined methods to answer a question or solve problems
• Theory is related to research in 3 ways: (1) theory can generate research questions, (2) theory can be tested by research, (3) theory can be the conceptual framework for research
• descriptive theory: concepts focus on dimensions, characteristics, situations, and commonalities of a phenomenon
• Explanatory theory: correlation ship, the why and to what extent one phenomenon is related to another, concept, suggests propositions
• Predictive theory: predicts relationships, generates and tests hypotheses by experimental research