Metaparadigm for nursing Philosophy

- Framework for the discipline that - The second knowledge structure

sets forth the phenomena of interest level
and the propositions, principles, and - Specifies the definitions of the
methods of discipline. metaparadigm
- Very general; intended to reflect - Works that specifies philosophical
agreement among the different approaches to nursing
concepts in nursing practice
Florence Nightingale
Caring
- Born May 12, 1820 in Florence, Italy
- Essence of nursing and the dominant, - Belonged to a well-educated,
unifying, and distinctive feature of affluent, aristocratic Victorian family
nursing - Parents: Edward and Frances
Nightingale
Communication
- Sister: Parthenope
- The process of sharing information - In 1837, wrote about God calling in
- Process of generating and her diary: “God spoke to me and
transmitting meanings called me to His service.”
- July 6, 1851 – accepted for training
Environment at Fliedner School of Nursing in
- External and internal surroundings Kaiserswerth, Germany, a Protestant
that influence or affect the person religious community with a hospital
facility
Health - After 3 months of training, was
- State of complete physical, mental, declared trained as a nurse
and social well being - November 5, 1854 (crimean war) Sir
- Not merely the absence of disease or Sidney Herbert, Secretary at War,
infirmity that is influenced by requested Nightingale to go to
political, economic, socio-cultural, Scutari, Turkey
and environmental factors - Provided trained nurses and
addressed the environmental
Nursing problems in the crimean war
- Art and science of caring for - Established St. Thomas Hospital and
individuals, families, groups, or King’s College Hospital in London
community - “Notes on Nursing: What it is, What
is is not” published in 1859. Included
Person her ideas on Environmental Theory.
- The recipients of care; can be an - Died in her sleep on August 13, 1910
individual, family, or community at South St. Park Lane, London
- The First Nursing Theorist
- The Lady of the Lamp
- The Mother of Modern Nursing
 Environmental Theory - “keep the pores of the skin free from
all obstructing secretions”
- Control of the environment of
- Unwashed skin poisoned the patient
individuals and families; major
- ‘every nurse should wash hands
component of nursing care
frequently’
- Focuses on the physical
7. Variety
environment; influenced by the
- Vital to patient’s recovery
social and psychological
- Beautiful objects, brilliant colors, cut
environment of the individual
flowers, reading, pets, etc. hobbies
Nightingale Canons: may alleviate suffering
8. Nutrition and taking food
1. Health of Houses - Diff variety of food according to
- presence of pure air, water, efficient patient’s condition
drainage, cleanliness, and light - Frequent small servings
2. Ventilation and Warmth - No business while patient is eating
- “keep the air he breathes as pure as 9. Chattering hopes and advices
the external air without chilling him” - ‘do not attempt to cheer the sick by
- noxious air affect the client’s health exaggerating recovery’
- temperature should not be too - Giving false hope causes worry and
warm or too cold fatigue
3. Light 10. Petty Management
- “light has quite as real and tangible - “what you do when you are there,
effects upon the human body” shall be done when you are not
- Take the patient outside for direct there”
sunlight - Environment should be well-
- Keep rooms well lit managed to protect from physical &
4. Noise psychological harm
- “unnecessary noise, or noise that 11. Observation of the sick
creates an expectation in the mind is - ‘most important practical lesson to
that which hurts a patient” nurses is what and how to observe’
- Sudden noise, thoughtless chatter, - Precise, specific, and individualized
and whispering in a patient’s room questions & observations to provide
should be avoided appropriate actions
5. Cleanliness of rooms, walls, and
beddings Nightingale’s 4 major concepts
- “the greater part of nursing”
Person for Nightingale
- Dirty environment is a source of
infection - Patient
- Removal of dust w/ damp cloth - ‘nurses performed tasks for patient
- Beddings changed and aired and controlled environment to
- Clean room is a healthy room enhance recovery’
6. Personal cleanliness - Passive patient
 - Some references to the patient - Wrote Notes on Nursing to provide
performing self-care women with guidelines for providing
- Nurse is in control of the patient’s nursing care and to give advice on
environment how to “think like a nurse”
- Physical, intellectual, emotional, and
Patricia Benner
social and spiritual being unable to
manipulate environment to promote - Born in Hampton, Virginia
health - California: spent childhood and got
early and professional education
Health for Nightingale
- BSN degree from Pasadena College
- ‘being well and using every power to in 1970
the fullest extent’ - Earned master’s degree in nursing,
- Disease as a reparative process major emphasis in medical-surgical
nature instituted from a want of nursing from University of
attention California, San Francisco University
- Prevention of disease through of California
environmental control; will greatly - Influenced by Virginia Henderson
uplift maintenance of health; called it - Influenced to a large degree by
Modern Public Health Nursing Hubert Dreyfus, a prof at Uni of Cali
- Hubert Dreyfus developed Dreyfus
Environment for Nightingale
Model of Skill Acquisition
- Fitzpatrick and Whail: “those o Benner later adapted to
elements that can be manipulated to clinical nursing practice
place a patient in the best possible - Concepts of “Stages of Expertise:
condition” From Novice to Expert”
- Both physical and psychological
Benner’s Concepts of “Stages of
component
Expertise: From Novice to Expert”
- Physical component:
o Light - Benner emphasizes the difference in
o Warmth Knowing how and Knowing what
o Nutrition - Knowing how: practical knowledge
o Room temperature - Knowing what: theoretical
o Activity explanation
- Psychological component: - “an individual may know how before
o Avoiding chattering hopes the development of a theoretical
and advices explanation”
o Providing Variety - Clinical practice is an area of inquiry
and a source of knowledge
Nursing for Nightingale - Adapted the Dreyfus Model of Skill
Acquisition to clinical nursing
- Spiritual calling
practice
- “nursing is having the responsibility
for someone else’s health”
From Novice to Expert: Excellence and - Focus away from self and toward the
Power in Clinical Nursing Practice patient
5. Expert
A. Five Levels/Stages of Skill
- Last stage
Acquisition and Development in
- No longer relies on analytical
Nursing:
principle
1. Novice
- Intuitive grasp
- No background experience
- Knows the patient
- Difficulty distinguishing relevant and
B. Seven Domains of Nursing
irrelevant aspects of a situation
Practice
- Context-free rules to guide their
1. The helping role domain
action
- Healing relationship
- Nursing students
- Active patient participation
2. The Teaching-Coaching Function
2. Advanced Beginner
Domain
- Sufficient experience to understand
- Timing and coaching
aspects of the situation
- Teaching patients
- Guided by rules
- Motivating patients
- Oriented by task completion
- Negotiating agreement on goals
- Clinical situations are tests of their
3. The Diagnostic and Patient-
abilities
Monitoring Function Domain
- Newly graduated nurses
- Competencies in ongoing assessment
and anticipation of outcomes
3. Competent
4. The Effective Management of
- Conscious and deliberate planning
Rapidly Changing Situations
- Identify important aspects
Domain
- Consistency, predictability, time
- Contingency management
management as essential components
- Assess and manage care during crisis
- Sense of mastery is acquired through
situations
planning and predictability
5. The Administering and Monitoring
- Time management and organization
Therapeutic Interventions and
of tasks >>> timing in relation to the
Regimens Domain
patients’ needs
- Prevent complications during drug
- Most essential in clinical learning
therapy, wound management, and
- Recognize patterns
hospitalization
- Allow the situation to guide
6. The Monitoring and Ensuring the
responses
Quality of Health Care Practices
4. Proficient
Domain
- Perceives the situation as a whole
- Maintenance of safety, continuous
(total picture)
quality improvement, collaborative
- Performance is guided by maxims
and consultation physicians, self-
- Evolves with the situation
evaluation, and management of
- Doesn’t rely on preset goals
technology
- Increased confidence
 7. The Organizational and Work-Role - “situation” conveys a social
Competencies Domain environment with social definition
- Priority setting and meaningfulness
- Team building and coordination - Person’s past, present, and future
- Coping with staff shortages influence the current situation
- Providing for continuity
Nursing for Benner
Benner’s 4 Major Concepts
- Caring relationship
Person for Benner - “enabling condition of connection
and concern”
- Self-interpreting being
- Caring practice whose science is
- The Person does not come into the
guided by the moral art and ethics of
world predefined but gets defined in
care and responsibility
the course of living a life
- The person is embodied: the body Jean Watson
can respond to meaningful situations
- Born in 1940 in the Appalachian
- 4 major aspects of understanding that
Mountains of West Virginia
the person must deal with:
- Graduated from Lewis-Gale School
o The role of the situation
of Nursing
o The role of the body
- Married husband right after and
o The role of personal concerns moved to Colorado
o The role of temporality - Continued nursing education at the
Health for Benner University of Colorado
- Later held both faculty and
- Lived experience of being healthy administrative positions in the
and being ill School of Nursing at the University
- Health can be assessed; whereas of Colorado Health and Sciences
well-being is the human experience Center
of health or wholeness - Worked to establish the Center for
- Well-being and being ill are distinct Human Caring at the University of
ways of being in the world Colorado
- Not just described as the absence of
disease and illness Concepts of Jean Watson’s
- Person can be diseased but not “Transpersonal Caring Theory”
experiencing illness - The goal of nursing is to facilitate
- Illness is the human experience of individuals in gaining a higher
loss or dysfunction degree of harmony within the mind-
- Disease is what can be assessed at body-spirit
the physical level - Such harmony generates self-
Environment for Benner knowledge, self-reverence, self-
healing, and self-care process
through human-to-human caring
process and caring transactions
Concepts:  Promotion of holistic
1. Transpersonal caring nursing care and
relationship positive health
o A human-to-human  Provide a sense of
connectedness occurring in a well-being through
nurse-patient encounter beliefs which are
o Both nurse and patient are meaningful to the
“touched by the human center individual
of the other.” c. Cultivation of sensitivity to
o Situation wherein the nurse one’s self and to others
enters into the life space or  Explores the need of
phenomenal field of another the nurse to begin to
person and is able to detect feel an emotion as it
the other person’s condition presents itself
of being, feel this condition,  Interact genuinely and
and respond in a way that the sensitively with others
person being cared for has a  More sensitive =
release of feelings, thought, more authentic
and tension.  Encourages self-
2. Ten caritive factors growth and self-
o Factors that characterize the actualization in both
nursing caring transaction the nurse and those
occurring within a given with whom the nurse
caring moment or occasion interacts
o Not intended to be a checklist  Promote health and
o Philosophical and conceptual higher-level
functioning only
guide for nursing
when they form
a. Formation of a humanistic-
person to person
altruistic system of values
relationships
 Begins
developmentally at an
early age with values
d. Establishing a helping-trust
shared with the
relationship
parents
 Promotes and accepts
 Mediated through
the expression of both
one’s own life
positive and negative
experiences and
feelings
exposure to the
 Strongest tool is the
humanities
mode of
b. Instillation of faith-hope
communication
 Essential to both the
 Congruence – being
caritive and curative
real, genuine, etc.
processes
  Empathy – ability to prediction, and that
experience and permits self-
understand the other correction
person’s perceptions  Similar to the research
and feelings and to process; systematic
communicate those and organized
understanding g. Promotion of interpersonal
 Non-possessive teaching-learning
warmth – moderate  Separates the concept
speaking volume, of caring from curing
relaxes, open posture,  The caring nurse must
and facial experience focus on the learning
congruent with other process as much as
communications the teaching process
 Effective  Wellness and health
communication – has responsibility shifted
cognitive, affective, to the patient
and behavior response  Nurse facilitates this
components. Includes process to provide
verbal, nonverbal, and self-care, determine
listening in a way that personal needs, and
connotes empathetic provide opportunities
understanding for their personal
e. The expression of feelings, growth
both positive and negative h. Provision for a supportive,
 Sharing of feelings is protective and/or corrective
a risk-taking mental, physical, socio-
experience for both cultural and spiritual
nurse and patient environment
 “feelings alter  Divided into external
thoughts and and internal variables
behavior, and they which the nurse
need to be considered manipulates to
and allowed for in a provide support and
caring relationship” protection for the
f. Systematic use of the person’s mental and
scientific problem-solving physical well-being
method for decision making  Both environments
 The scientific are interdependent
problem-solving  Internal – mental and
method is the only spiritual well-being
method that allows and socio-cultural
for control and beliefs
  External – comfort, j. Allowance for existential-
privacy, safety, and phenomenological forces
clean surrounding  Phenomenology is a
i. Assistance with the way of understanding
gratification of human needs people from the way
 Similar to Maslow’s things appear to them
hierarchy of needs (POV)
 Each need is equally  Lived experiences
important for quality  Helps the nurse
nursing care and the reconcile and mediate
promotion of optimal  Nurse assists the
health person to find the
 Lower-order needs strength or courage to
first before higher- confront life or death
order needs 3. Caring occasion/caring moment
 Lower order needs  Occurs whenever the
(biophysical needs) nurse and others come
1. The need for together with their unique
food and fluid life histories and
2. The need for phenomenal filed in a
elimination human-to-human
3. The need for transaction.
ventilation
Watson’s 4 Major Concepts
 Lower order needs
(psychophysical Person for Watson
needs)
1. The need for - Human being refers to “a valued
activity- person… to be cared, respected,
inactivity nurtured, understood, and assisted…
2. The need for a philosophical view of a person as a
sexuality fully functional integrated self…
 Higher order needs human is viewed as greater than and
(psychosocial needs) different from the sum of his or her
1. The need for parts”
achievement - Human is basically more than just
2. The need for the sum of his or her parts
affiliation Health for Watson
3. Intrapersonal-
interpersonal - Watson adds 3 elements to WHO
need definition of health:
4. The need for o A high level of overall
self- physical, mental and social
actualization functioning
 o A general adaptive-
maintenance level of daily
functioning
o The absence of illness (or the
presence of efforts that leads
its absence)
Environment for Watson
- Caring (and nursing) has existed in
every society
- Caring attitude not transmitted from
generation to generation
- It is transmitted by the culture of the
profession as a unique way of coping
with its environment
Nursing for Watson
- “… is concerned with promoting
health, preventing illness, caring for
the sick and restoring health”.
- Focuses on health promotion and
treatment of disease.
- Holistic health care is central to the
practice of caring in nursing
- ‘a human science of human health-
illness that are mediated by
professional, personal, scientific,
esthetic, and ethical human
transactions’.