You are on page 1of 40

Contemporary Perspectives of

Nursing
Hallmarks of 20th Century Nursing
Theoretical development
Theories shared with other disciplines

Success in Nursing Science


Continued research
Global focus
Profession vs. academic discipline

Use of conceptual models


Contemporary Perspectives of
Nursing
Where are we going?
In order to advance nursing, Fawcett
believes:
Use of conceptual models to guide practice
Establish formal linkages between nursing
education and nursing service
Recognition of clinical scholars

Assess new knowledge for suitability to practice


Contemporary Perspectives of
Nursing
Just because research is conducted by
nurses, does that make it nursing
research?
Most studies do not use a nursing
framework
Contemporary Perspectives of
Nursing
Current trends
Nursing has become more sophisticated
Our most talented RNs choose advanced
practice
Many nurses are often told by physicians
that they are too smart to stay on the floor
Talk occurs every so often about bringing
another type of provider to the bedside
Contemporary Perspectives of
Nursing
Physicians are much less threatened by
Physicians Assistants because of the
different philosophy they are taught in
PA school
Nurses tend to cherish their autonomy
vs. grown up in the mind set that MD
stands for minor deity
Contemporary Perspectives of
Nursing
Many job advertisements are written as
Wanted: ARNP or PA-C
Are we interchangeable?
What do we bring to the table that is
unique and different when time is
money and quantity is desired over
quality patient interactions?
Contemporary Perspectives of
Nursing
When we ask for equal billing,
prescriptive authority, etc. are we
infringing on the doctors turf?
When the media portrays ARNPs, how
is it usually approached?
Is changing our entry to practice
preparation considered a threat?
Contemporary Perspectives of
Nursing
Human Science
Understanding life experiences
Subjectivity is fundamental

Objectivity is a human creation

Current theorists incorporate human


science
Do any other disciplines look at human
science the way we do?
Contemporary Perspectives of
Nursing
How does free will play into the
equation?
Are we charged with monitoring patient
choices and determining if they are
appropriate?
How do you handle a perceived poor
choice by your patient?
Theory Based Advanced Nursing
Practice
All nurses use knowledge they acquired
during their formal education to guide
their practice
Most are unaware of existing theories
and how to apply them
Most are greatly influenced by the
medical model
Theory Based Advanced Nursing
Practice
Practitioner programs base themselves
heavily on the medical model
Junior Doctors vs. Senior Nurses
Theories improve the quality of care by
clearly defining the boundaries and
goals of nursing assessment, diagnosis,
and interventions.
Theory Based Advanced Nursing
Practice
Theories help us to maintain
consistency and congruency of care
Theories may improve efficiency and
effectiveness
Theories enhance professional
autonomy and accountability
Theory Based Advanced Nursing
Practice
Theory can be used to
Collect, organize, and classify client data
Understand, analyze, and interpret clients health
situations
Guide formulation of diagnosis
Plan, implement and evaluate care strategies
Explain actions and interactions with clients
Describe and explain client responses
Achieve desired outcomes for clients
Theory Based Advanced Nursing
Practice
Issues related to theory based nursing
practice
Enthusiasm for using theories in advanced
practice is low due to the theory-practice gap
Most see little correlation between the philosophical
concerns of nursing models and the relevance to clinical
practice
Theories are not routinely used to guide practice
Theory Based Advanced Nursing
Practice
Nurses do not use Nursing Theories
because they do not know them, understand
them, know how to apply them, or believe in
them. (McKenna, 1977)
Martha Rogers (1989) said Nursing
knowledgeis often seen as being
unscientific, intuitive, and highly subjective
Theory Based Advanced Nursing
Practice
Are most conceptual models too abstract to
apply to clinical practice?
If a theory is not useful in practice, then its
value is questionable
Nursing often uses theories from other
disciplines (Erickson, Selye, Kubler-Ross)
Nurses tend to blend them with medical model
theory to base their practice
Theory Based Advanced Nursing
Practice
Do you think that combining theories
from other disciplines with nursing
theories and picking and choosing your
beliefs compromises nursing theory?
Nurses often study other disciplines to
better understand human behavior
We are able to bring a unique perspective
by blending social science and nursing
theories
Theory Based Advanced Nursing
Practice
Should we use one theory consistently
or blend the concepts we like from
multiple theories?
Do nursing models that fragment the
patient into elementary parts that
respond in a predictable way to
stressors lead to fragmented, non-
holistic care?
Theory Based Advanced Nursing
Practice
Can we blend the metaparadigm concepts of
nursing theory with clinical practice?
First we must understand and be able to use the
theoretical model most closely aligned with our
chosen practice area
Then we must use it as the lens by which we view
the client and their world
This helps you move from the what is to the
what could be
Theory Based Advanced Nursing
Practice
Perspective transformation
Moving from one frame of reference to another
Medical model to nursing model
Many steps are involved in this transformation
Stability upset when new framework introduced
Dissonance challenge of change
Confusion the struggle to learn the new way
Leads to anxiety, anger, and grieving for the old ways
Dwelling with uncertainty the revelation that the
confusion is not based on their personal inadequacy
Theory Based Advanced Nursing
Practice
Many steps are involved in this
transformation (cont.)
Synthesis the first step in pulling it together
Model becomes clearer, and insight begins
Resolution comfort level increases
dramatically
Reconceptualization the permanent shift from
the old way of thinking to the new one
Return to stability once the practice is firmly
based on the new model or theory
Theory Based Advanced Nursing
Practice
Examples of models used in practice
Peplaus Interpersonal Model used in
psychiatric nursing because of its goal
directed, nurse-patient interpersonal
process to promote clients personality and
living
Orlandos Model is used as an approach to
understand the communication process
Theory Based Advanced Nursing
Practice
Orems Self care model identifies requisites for
client self care and identifies means specific
nursing systems to deliver the care
Ambulatory surgery centers
Outpatient care centers
Parses Man-living-health theory assists us to
explore the past life experiences to predict future
behaviors
Newman used systems theory to describe
stressors and interventions based on the levels of
protection
Theory Based Advanced Nursing
Practice
Guidelines for selecting models and theories
for nursing practice
Consider your personal values and beliefs about
nursing, clients, health, and environment
Examine the underlying assumptions, values, and
beliefs of various nursing models, and how the
major concepts are defined
Identify several models that are congruent with
your personal beliefs and values about nursing,
client, and health
Theory Based Advanced Nursing
Practice
Guidelines for selecting models and
theories for nursing practice
Identify the similarities and differences in
clients focus, nursing actions, and client
outcomes of these models
Practice applying the models and theories
to clients with different health concerns to
determine which ones best fit specific
situations and guide nursing actions that
will achieve desired client outcomes
Theory Based Advanced Nursing
Practice
Contemporary Perspectives of
Nursing II
Humanistic Nursing
Paterson and Zderad (1976)
Phenomenological methodology
Phenomenology is the study of human
experience and its influence on behavior
Nursing is concerned with human experiences
Guilt
Anger
Hopelessness
fear
Contemporary Perspectives of
Nursing II
Phenomenologic nursology
Phase I Preparation for the nurse (knower) for
coming to know (the patient)
Phase II Nurse knowing the other (patient)
intuitively
Phase III Nurse knowing the other scientifically
Phase IV Nurse complementarily synthesizing
known others
Phase V Succession within the nurse from the
many to the paradoxical one (conclusion)
Contemporary Perspectives of
Nursing II
Contemporary Perspectives of
Nursing II
Phenomenologic Framework
Does not offer guidelines for administering
patient care
Does not offer a means of evaluating the
effectiveness of care
Does not hold the nurse accountable for
quality of care
Bases interactions on lived human
experiences
Contemporary Perspectives of
Nursing II
Phenomenologic Framework

Can empathy for the human situation be


taught?

Can we predict how clients behave based


solely from the context of their life
experiences?
Contemporary Perspectives of
Nursing II
Phenomenological theories have
become popular in psychiatric nursing
They offer a broader base to evaluate
from
They do not offer treatment advise
They seek to inform the nurse that lived
experiences can influence thought and
action processes
Contemporary Perspectives of
Nursing II
Planning in the phenomenologic framework is
complex
The patient is guided to make responsible
choices
The nurse guides the patient through the use
of therapeutic communication
Validation of fears and concerns is
problematic (can be viewed as enabling)
Contemporary Perspectives of
Nursing II
As the patients progress through their
problems, they are able to see the irrationality
of their fears and anxiety
Active planning on the part of the patients
causes an awakening within them
Health belief model
Maintenance within the comfort environment
is important
Contemporary Perspectives of
Nursing II
Theory of Humanistic Nursing begins to
take us out of the measurable, empiric
world and into a more philosophical one
It is important that clients are not
encouraged to forget the past, because
they will be doomed to repeat it
Contemporary Perspectives of
Nursing II
Multiparadigm approaches to healing
Many of our patients practice a variety of
healing methods
Herbals

Acupuncture

Visualization

These vary from the western tradition of


allopathic medicine
Contemporary Perspectives of
Nursing II
Contemporary Perspectives of
Nursing II
Contemporary Perspectives of
Nursing II
The multiparadigm model is holistic and
avoids the medicine-nursing and
practice-academia dichotomies
It speaks to the domain of healing which
is an integral part of the domain of
nursing
It may yield referrals to non traditional
providers for advanced practice nurses
Contemporary Perspectives of
Nursing II
What are the potential research
applications of the multiparadigm
model?
Do you think it is time to bridge the gap
between holistic nursing and biomedical
nursing practice?
How does it influence the
metaparadigms of nursing?