n340 midterm sg

7/28/2019 N340 Midterm SG

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Chapter 1

1. What is the difference between an occupation and a profession?

a. Occupation is a job or a career , whereas a profession is a learned

vocation or occupation that has a status of superiority and precedence

within a division of work.

2. What are the characteristics of a profession?

a. A defined knowledge base

b. Power and authority over training and education

c. Registration

d. Altruistic service

e. A code of ethics

f. Lengthy socialization

g. Autonomy

h. A institutionalized goal or social mission

3. Why is nursing not easily called a profession?

a. It is an extension of services provided by wives and mothers

b. Nurses have delayed in identifying and organizing professional knowledge

c. Education for nurses is not yet standardized

d. Autonomy in practice is incomplete because nursing is still dependent on

medicine to direct much of its practice.

4. The scientific approach to understanding reality is characterized by what?

a. observation, verifiability, and experience


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5. What are theories?

a. Theories are made to describe, explain, & predict phenomena in nature,

and to provide understanding of relationships between phenomena.

b. A systematic explanation of an event in which constructs and concepts are

identified and relationships are proposed and predictions made.

c. A creative and rigorous structuring of ideas that project a tentative,

purposeful and systematic view of phenomena.

d. A set of interpretative assumptions, principles, or propositions that help

explain or guide action .

6. What is a nursing philosophy?

a. Statement of foundational & universal assumptions, beliefs & principles about

nature of knowledge & thought (epistemology) & about nature of entities

represented in the metaparadigm.

7. No single dominant philosophy has prevailed in the discipline of nursing .

a. True

8. What is nursing science?

a. Substantive, discipline-specific knowledge that focuses onhuman-

universe-health process articulated in nursing frameworks &theories

b. Nursing science refers to the system of relationships of human responses in

health & illness addressing biologic, behavioral, social, and cultural domains.

9. It is ________ that gives direction to the future generation of substantive nursing

knowledge, and provides the knowledge for all aspects of nursing.

a. Nursing science


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10. What is moral or ethical knowledge?

a. knowledge of what is right and wrong. Values, social and cultural norms of

behavior are components of ethical knowledge.

11. Nursing is an evolving profession, an academic discipline, and a science.

a. True

12. Who was Florence Nightingale ?

a. First modern nursing theorist. First to delineate what she considered

nursing's goal and practice domain, and she postulated that "to nurse" meant

having charge of the client "in the best condition for nature to act upon him"

13. Nightingale established a school for nurses. According to Nightingale, why was

training for nurses necessary? What did she teach?

a. "to teach not only what is to be done, but how to do it". She was the first to

advocate the teaching of symptoms and what they indicate. She taught the

importance of rationale for actions and stressed the significance of "trained

powers of observation and reflection".

14. What is aborrowed or shared theory?

a. Theory developed in another discipline that is not adapted to the worldview

and practice of nursing


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15. What is aconcept ?

a. The elements of components of a phenomenon necessary to understand

the phenomenon . They are abstract and derived from impressions the

human mind receives about phenomena through sensing the environment.

b. A symbolic statement describing a phenomenon or a class of phenomena.

c. Concepts are labels for phenomena

d. Concepts are basic components of a theory

e. Concepts represent some aspect of reality

f. Concepts describe objects, properties, or events

g. Concept are building blocks of theories, abstract ideas or mental images of

phenomena or reality (mass, energy, ego, id)

16. What is metaparadigm ?

a.

Represents the worldview of a discipline global perspective that

includes more specific views and approaches to central concepts

with which the discipline is concerned.


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Chapter 2

Classification of Theories in Nursing

These include classification based on range/scope or abstractness and type or purpose

of the theory .

The Scope of Theory

Have to be able to differentiate theories based on scope , which refers to complexityand degree of abstraction.

This classification scheme typically uses the terms:o Metatheory (philosophy , or worldview) to describe philosophical basis of the

disciplineo Grand theory (macrotheory) to describe comprehensive conceptual

frameworks o Middle range or midrange theory to describe frameworks that are relatively more

focused than the grand theorieso Microtheory , situation specific theory, or practice theory to describe those

smallest in scope.

Your Different Theories

Metatheory Refers to a theory about theor y. Metatheory focuses on broad issues (processes of

generating knowledge and theory development) and it is a forum for debate within

the discipline. Beginning in the 1960s metatheory discussions involved nursing as an academicdiscipline and the relationship of nursing to basic sciences.

Recent metatheoretical issues relate to the philosophy of nursing and address whatlevels of theory development are needed for nursing practice, research, andeducation, and increasing focus on philosophical perspectives of critical theoryand feminism.

Grand Theories

Are the most complex and broadest in scope . They attempt to explain broad areaswithin a discipline and may incorporate numerous other theories.

They are nonspecific and comprised of relatively abstract concepts that lack operational definitions.

Their propositions are also abstract and are not generally amenable to testing. Developed through thoughtful and insightful appraisal of existing ideas as opposed to

empirical research.


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Middle Range Theories

Lies between the nursing models and more circumscribed, concrete ideas. They are substantively specific and encompass a limited number of concepts and a

limited aspect of the real world.

Comprised of relatively concrete concepts that are operationally defined andrelatively concrete propositions that may be empirically tested . Fawcett states that a middle range theory may be 1. A description of a particular

phenomenon 2. An explanation of the relationship between phenomena or 3. A prediction of the effects of one phenomenon or another.

Practice Theories

Also called micro theories, perspective theories, or situation specific theories andare least complex.

They are more specific than middle range theories and produce specific directionsfor practice.

Contain the fewest concepts and refer to specific, easily defined phenomena . Narrow in scope, explain a small aspect of reality, and tend to be perspective. Limited to specific populations or fields of practice and often use knowledge from

other disciplines.

Partial Theories

Are those in the development stage . Some concepts have been identified and some relationships between them have been

identified, but the theory is not complete.

Factor Isolating Theories

They describe, observe, and name concepts, properties and dimensions . Identifies and describes the major concepts of phenomena but does not explain

how or why the concepts are related. The purpose is to provide observation and meaning regarding the phenomena. It is generated and tested by descriptive research techniques.

Factor Relating Theories

Or explanatory theories are those that relate concepts to one another, describe theinterrelationships among concepts or propositions, and specify the associations orrelationships among some concepts.

They attempt to tell how or why the concepts are related and may deal with cause andeffect and correlations or rules that regulate interactions.


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Situation Relating Theories

Are achieved when the conditions under which concepts are related are statedand the relational statements are able to describe future outcomes consistently .

They move to prediction of precise relationships between concepts.

Situation Producing Theories

Are those that prescribe activities necessary to reach defined goals. Address nursing therapeutics and consequences of interventions. Include propositions that call for change and predict consequences of nursing

interventions. Should describe the prescription, the consequences, they type of client, and conditions.

Four kinds of theories described by Dickoff and James are:o Factor isolating theories (descriptive theories),o Factor relating theories (explanatory theories),o Situation related theories (predictive theories or promoting or inhibiting theories),o Situation-producing theories (perspective theories).

-Florence Nightingale

-First modern nursing theorist

-First to delineate nursing goals and practice.

-Believed the role of the nurse was seen as placing the client in the best condition

for nature to act upon him.

-Believed that formal training for nurses was necessary.

Metaparadigm is the global perspective of a discipline that identifies the primary

phenomena of interest to that discipline.

Nursing Metaparadigm:


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Person : refers to being composed of physical, intellectual, biochemical, and

psychosocial needs; a human energy field; a holistic being in the world; an open

system; an integrated whole; an adaptive system; and a being who is greater than the

sum of his parts

Health : ability to function independently; successful adaptation to lifes stressors;

achievement of ones full life potential; and unity of mind, body, and soul

Environment : refers to the external elements that affect the person; internal and

external conditions that influence the organism; significant others with whom the

person interacts; and an open system with boundaries that permit the exchange of

matter, energy, and information with human beings

Nursing : a science, an art, and a practice discipline, and involves caring

Requirements for a metaparadigm:

1. Must identify a domain that is distinctive

2. Must encompass all phenomena of interest to the discipline

3. Must be perspective-neutral

4. Must be international in scope

Caring as a central construct in the discipline of nursing closest to general nursing

phenomena


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Chapter 3

What is aconcept ?

A symbolic statement describing a phenomenon or a class or phenomena Can be abstract ( hope, love) Concrete ( airplane, body temperature) A word ( grief, empathy) Two words (Role strain) Phrase (maternal role

attachment) When they are operationalized, concepts become variables used in hypothesis to

be tested in research

Concepts have been borrowed or derived from other disciplines as well as derived from nursing practiceand research

What is aSummative concept

Represent an entire complex entity of a phenomenon Complex & not measurable ex nursing, health, and environment

What are the characteristics of an Abstract concept ?

Not clearly observable directly or indirectly (art, social support, personality) Must be defined in terms of observable concepts

independent of time and space

Concrete concept

Can be seen felt or heard (char, color red, jazz music) Limited by time and space Observable in reality (observations of objects, properties, or events) Concrete or empirical

Variable (Continuous) concepts

Concepts that describe phenomena according to some dimensions of thephenomena are termed variables

Permit classification of dimension or graduation of phenomena or continuum (BP,pain, sex role orientation, level of well being, and degree of cultural identity)


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Nonvariable (Discrete) concepts

Can be single variable that may be answered with yes or no or fits into apredefined category (religion, marital status, educational attainment)

Theoretically defined concept

Gives meaning to term in context of a theory and permits any reader to assess thevalidity of the definition

Operationally defined concept

Tells how the concept is linked to concrete situations Describes procedures that will be performed to assign a value of the concept Permits concept to be measured and hypothesis to be tested Bridge between theory and empirical world

3 types of grand theories & what makes them different

Based on Human Needs Based on Interactive Process Based on Unitary Process

GRAND THEORIES MAY BE DERIVED FROM CONCEPTUAL MODELS AND ARE THE MOST COMPLEXWIDEST IN SCOPE OF THE LEVELS OF THEORY; THEY ATTEMPT TO EXPLAIN BROAD ISSUES WITHIDISCIPLINE. GRAND THORIES ARE COMPOSED OF RELATIVELY ABSTRACT CONCEPTS AND TYPICALLOPERATIONAL DEFINITIONS; PROPOSITIONSARE ABSTRACT AND ARE NOT DIRECTLY AMENABLE TOTESTING.

In human needs based theories, clients are typically considered to be biopsychosicial beings who are thesum of their parts and who need nursing care. Further, clients are mechanistic beings, and if correctinformation can be gathered, cause or source of their problems can be discerned and measured. Thesetheories focus on clients needs for nursing care.

Grand theories based on Interactive process believe that human are holistic beings who interact with andadapt to situations in which they find themselves. These theorists ascribe to systems theory and agreethat there is constant interaction between humans and their environment. The focus is the relationshipthat is taking place. The interaction between the nurse and patient is happening at all times.


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The unitary process nursing model describes a group of theories that adhered to a unitary processperception of human beings. This group of theorists believed that humans are unitary beings: energysystems embedded in the universal energy system. Within this group of theories, human beings are seen

as unitary, whole, open and free to choose ways of becoming; and health is described as continuoushuman environmental interchanges.

Difference between grand and middle range theories & borrowed theories


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PPT posted week 1

Theory Development: process used to create, modify, or define a theory. The first stepis to define terms.

Levels of Theory :

Meta theory- A philosophical discussion of the foundations. A philosophy. Clarifiesmethodology and roles of other theories.

Grand theory- Human experience, abstract

Middle Range- Variable. Can be proven and tested.

Theory Analysis : Why do we analyze theories?

To find out...

What is the origin of the problem?

Methods

Subject matter

Outcomes

Testability

Usefulness


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PPT Posted week 2

1.) Why do we need nursing theory?

To prevent chaos in nursing careTo improve client/patient careTo guide nursing research to support existing knowledge and to gain new

knowledge

7.) Why nursing theories are important ?

Provides us with a logical and systematic way of examining situationsProvides guidelines for communication between nurses and other members of the

healthcare teamHelps nurses know who we are, our believes, values, and goals.Shows how we contribute to healthcare.Helps nurses to control some of our aspects of care-Nursing protocolsWe need it to continue to develop and evolve as the discipline of nursing.

9.) What is Theory ?

A group of ideas regarded as correct that can be used to explain and predict

phenomenon.A proposed explanation, which is still in conjecture- Many nursing theories due totheir abstract quality.

A way to use ideas in an orderly fashion as a way to view phenomena

10.) What is Nursing Theory ?

What nursing is and what nurses doWhat are its goals and outcomesBy using nursing theory and research, nursing develops nursing practice

guidelines .


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Florence Nightingales concepts of Human, Environment, Health, and Nursing .

14.) Concepts

Concrete concepts can be measured-can be seen, felt, or heard

Concrete concepts can be measured such as in height, weight, or vitals

Abstract concepts (consults) are not clear such as personality .

15.) Types of Concrete Concepts

Enumerative always present and constant , such as gender

Associative must be in combination, such as elderly-age and longevity.

Statistical one property of one thing in distribution in the population rate, such as

the average blood pressure, or disease prevalence.

Summative represent an entire complex phenomena, such as the whole

concept of nursing.


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Chapter 12: THEORIES FROM THE SOCIOLOGIC SCIENCES

I. Exchange Theories : Basis inutilitarianism (The greatest good for the greatest number)

1.) Social Exchange Perspective

Group: Group therapy, group counseling, Group teaching (education ), how groups interact: managinggroups, managing a nursing team

2.) Individualistic Social Exchange

individuals: Advocate for patients through therapeutic communication

3.)Societal/Collectivist Exchange

Societal/Collectivist: Gathering of system, creating a large systems. Collaboration with other systems .

II. Interaction Theories :

1.) Role Theory: when defining expectations for nursing: what the nurse is supposed to do

III.Conflict Theories :

When advocating patients, conflict arises. In terms of conflict theory,we use it in pt advocacy.

Ethical dilemmas

1.) Feminist Theory:

does not only deal with female oppression.

2.) Critical Social Theory

deals with inequality


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Chapter 13

Psychodynamic theories -attempts to explain multidimensional nature of behavior andunderstand how an individuals personality and behavior interface.

Freud -how individuals work psychologically Id -original system of personality; pleasure principle Ego - mind vs external world ; reality principle ; cognitive and

intellectual functions; controls behavior; balances ID and superego Superego -keeps us in the straight and narrow; inhibits impulses of

ID; perfection

Ericksons 8 Stages (psychosocial theory)

nursing care based on developmental stage and age; used to help withappropriate nursing care.

Sullivan (Interpersonal)- Peplau based her nursing theory on Sullivans theory.

Skinner -operant condition; positive reinforcement for patients.

Maslow -behavioral plans; must meet most basic needs first

Carl Rogers (person-centered theory )- patient-centered care

Seyle (general adaptation syndrome)- stress and general adaptation; fight and flightresponse activates sympathetic nervous system

Lazarus- stress, coping, adaptation

Health Belief model- predict health behaviors; people fear disease and that healthactions were motivated in relation to the degree of fear.

Theory of reasoned action -people are rational & make decisions based on informationavailable to them; relationships between beliefs, attitudes, intentions & behaviors


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Chapter 14

Theories from the Biomedical Sciences

Theories from biomedical sciences (biology, medicine, public health, physiology, and pharmacology) have

a tremendous impact on nursing practice and are so integral to nursing that they are overlooked andtaken for granted.

Theories and Models of Disease Causation

Evolution of Theories of Disease Causation

Today, predominant model of disease causation hasevolved to multicausal , involvingfactors such as immune responses, genetics, environment, and behavior .

Germ Theory and Principles of Infection

Application to Nursing: Nursing research has focused on prevention and management ofinfection as well as identifying factors that place an individual at risk for developinginfections. Examples of nursing practice r/t prevention of infection include guidelines forchoosing sterile over nonsterile gloves, techniques of hair removal prior to surgery, andguidelines for prevention of infections related to urinary catheters, central lines, etc.

The Epidemiologic Triangle

This model is oftenused to illustrate the interrelationships among the three essentialcomponents of host, agent, and environment with regard to disease causation . Achange in any of the 3 components can result in the disease process.

Within this triangle, prevention of disease lies in averting exposure to the agent,enhancing physical attributes of the host to resist disease, and minimizing anyenvironmental factors that affect health can also influence progression of diseaseprocess.

The Web of Causation

Application to nursing: Nurses have developed interventions and proposed strategies toaddress complex health problems with many different causes.


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Natural History of Disease: Progress of a disease process in an individualover time

Three levels of prevention (Leavell and Clark) Definition.o Primary prevention : Activities that are directed at

preventing a problem before it occurs. Primary prevention

consists of 2 categories: general health promotion (goodnutrition, adequate shelter, rest, exercise) and specicprotection (immunization, water purication).

o Secondary prevention: Early detection and includes anyscreening activity (mammography, cholesterol screening) andsubsequent efforts to limit disease progression for thoseidentied with a health condition (taking statin meds,lumpectomy with radiation/ chemotherapy).

o Tertiary prevention: Limitation of disability andrehabilitation during period of advanced disease andrecuperation, where disease has occurred and resulted in adegree of damage.

Application to Nursing: Much of nursing practice focuses onefforts to prevent progression of disease at earliest period or phaseusing appropriate levels of prevention.

o Primary- efforts to prevent skin cancer among athletes,primary prevention of cancer through modication of environmental risks, prevention of falls among elders andprevention of cervical cancer through promoting vaccinationagainst HPV

o Secondary- program to promote screening for alcohol use andmisuse among elders, lead screening for pregnant women andchildren, and counseling and testing for BRCA gene mutationsamong at risk women

o Tertiary- information to help nurses work to preventreoccurrences and secondary malignancies among long-termsurvivors of cancer

Theories & Principles r/t to Physiology & Physical FunctioningHomeostasis

Body systems are integrated and are continually adapting to

environmental changes (not just organ-based). How principles of homeostasis are applied in nursingpractice?

o Examples: Physiologic process of homeostasis in human body,

focusing on role of albumin in F&E balance Importance of maintaining homeostasis and blood

glucose levels in patients in ICU


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Use of principles of homeostasis to describe physiologyand function of sleep in healthy infants and youngchildren

Benets in maintaining calcium homeostasis to promotebone health in infants.

(In research) concept of homeostasis served as atheoretical framework in a study to determine effect of soothing music on neonatal behavioral states in thehospital newborn nursery

Stress Management and Adaptation Walter Canon developed the concept of ght or ight to

explain the bodys reaction to emergencies. Fight or ight response prepares the body for muscular activity

(running, self-defense) when reacting to a perceived or actual threat Hans Selye built on Canons work by developing a framework

to describe how the body responds to stress.o Selye believed that changes in organs occur in 3 stages.

(Table 14-1) Stage 1 (the alarm phase) begins with ght or ight

response. Stage 2 ( resistance )- body starts to react & return to

homeostasis. Stage 3 ( exhaustion ) occurs when stressor persists and

body cannot continue to produce hormones as in Stage1, or when damage has occurred to other organs

1. Genetic Theories and Principles2. Application to Nursing

Genetics will greatly affect the way health care is practiced in thefuture, and nurses will need to incorporate genetic technology and discovery into practice and research at individual, family,and community levels.

Nurses familiar with genetics and who are able to think genetically

can ask appropriate questions of patients to assess genetic riskfactors, communicate with patients and their families aboutinherited risks, make referrals to genetic counselors,reinforce counseling, and administer gene therapy orgenetically specic drugs

3. Nursing Interventions Individual

o Educating patients on genetic testing


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o Assisting patients to determine need for testingo Genetic counselingo Educating about individualized medication therapy

Familyo Interpret and share genetic risk and health promotiono Referring to and interfacing with genetic specialistso Explaining risks and benefits of genetic studyo Assessing and counseling families

Communityo Community readiness for genetic screening and interventiono Availability and voluntary access to genetic information,

testing, and assurance of follow-up services Population

o Coordinating genetically focused researcho Collaborative research focusing on ecogenetics, ethics, and

psychosocial issueso Ensuring that patients remain the priority of clinical treatment

and research4. Nurses knowledgeable in genetics can ensure that patients and familiesmake informed and voluntary decisions about genetic information .

5. Genetic counseling : is nondirective, voluntary, and personal, and shouldprecede testing to allow informed decision-making.

6. Counseling should include an explanation of risk factors, exploration of thepersons perception of the condition, and discussion of childbearing options.

7. Goals of genetic counseling are to help clients and family memberscomprehend medical genetic information, appreciate genetic contribution tohealth and illness, understand health options and alternatives, and makeinformed health choices.

Pain Management Application to nursing - other therapeutic options to relieve pain(oral sucrose solution to infants before giving injection; music;guided imagery, etc)


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Chapter 10 Introduction to Middle Range Nursing Theories

- Purpose

o Take overall scale of grand theories and make it applicable and useful inresearch, lower level abstraction and ease of operationalization

o More likely to be practiced (are more specific and concise)

o Function of middle range theories: to describe, explain, or predictphenomena, and, unlike grand theory, they must be explicit andtestable.

- Characteristics of Middle Range Theories

o Straight forward in general

o More readable and user friendly and need to be described in practice

terms in journals that nurses are more likely to reado Focus primarily on client problems and outcomes

o Specific to nursing and specify an area of practice, age, range of client,nursing actions, or interventions

o More likely to testable

- Concepts and Relationships for Middle Range Theories

o Limited number of concepts that are fairly concrete (discrete andobservable) and may be operationally defined

- Categorizing Middle Range Theories

o High-Middle

o Middle

o Low-middle

- Development of Middle Range Theories

o Evolved from grand theories, clinical practice, literature review, practiceguidelines, or standard of care


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Chapter 11 Overview of Selected Middle Range Nursing Theories

High: most abstract and closest to grand, only thing that doesnt qualify themto be grand theories is the lack of certain qualitiesMiddle: intended for diff purpose from grand theoryLow: less abstract

Know specifics of these theories:

Benners model of skill acquisition: 5 stages:

o noviceo advanced beginnero competento proficiento expert nursing implication: continuing education in nursing

Leiningers cultural care diversity and universality theory: First to deal with culture as an area of nursing practice Nursing implication: cultural competence

Kolcabas Theory: Defined comfort within nursing practice; comfort viewed as an

outcome of care Nursing implication: need for comfort

Know that these are middle-range theories:

Penders health promotion model:

The Omaha System:

The Synergy Model:

Becks postpartum depression theory:

Mercers conceptualization of maternal role attainment

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