PAMELA D.

GABRIEL MAN STUDENT

Permit number: midterm : 217480 finals: 217481

THEORETICAL FRAMEWORK IN NURSING PRACTICE

1. Define the following: a. Concepts - the basic unit in language of theoretical thinking is the concept. Concepts are words that present reality and enhance our ability to communicate about it. b. Theory - is composed of a group of concepts that described a pattern of reality. A theory is a statement that explains or characterizes a process, an occurrence, or an event and is based on observed facts.

2. What are the uses of theory in Nursing? 1. The primary of purpose of nursing theory is to generate scientific knowledge; nursing theory and nursing research are closely related. 2. Provide direction and guidance for structuring professional nursing practice, education, and research and differentiating the focus of nursing from other profession. 3. In practice, assist the nurses to describe, explain and predict everyday experiences. 4. Serve to guide assessment, intervention and evaluation of nursing care. 5. Help to establish criteria to measure the quality of nursing care.

3. Describe the relationship of theory, research and nursing practice. In research, theory serves as a framework for generating knowledge and new ideas. Also in assist discovering knowledge gaps in the specific field of study. As well as offer a systematic approach to identify questions for study, select variables, interpret findings and validate nursing interventions. In practice, it helps build a common nursing terminology to use in communicating with other health professions. Ideas are developed and words defined. It also offers a systematic approach to identify questions for study, select variables, interpret findings and validate nursing interventions. 4. The Nursing Process is an important tool utilized to provide efficient nursing care. a. What is the nursing process? Nursing Process is the systematic, rational method of planning and providing individualized nursing care. Its purpose is to identify a client s health status, actual or

potential health care problems or needs; to establish plans to meet the identified needs; and to deliver specific nursing interventions to meet those needs. b. What are the components/ steps of the nursing process? The nursing process consists of five components pr phases. Assessing, diagnosing, planning, intervention or implementation and evaluation. i. Assessing is collecting, organizing, validating and recording data about a client s health status.

ii. Diagnosing is a process which results in a diagnostic statement or nursing diagnosis. iii. Planning involving series of steps in which the nurse and the client set priorities and goals or expected outcomes to resolve or minimize the identified problems of the client. iv. Implementing is putting the nursing care plan into action. v. Evaluating is assessing the client s response to nursing intervention and then comparing the response to the goals or outcome criteria written in the planning phase. c. Cite two relevant nursing theories and one non-nursing theory that you can apply per step of the nursing process. Nursing process: ASSESSMENT: Diagnosis: henderson s 14 components and definition of nursing Henderson s 14 components analysis: compare data to knowledge base of health and disease

Planning: Identifying individual s ability to meet own needs with or without assistance, taking into consideration strength, will or knowledge. Implementation: Documenting how the nurse can assist the individual, sick or well. Implementation based on the physiological principles, age, cultural background, emotional balance, and the intellectual capacities. Carrying out treatment prescribed by the physician. Evaluation: Henderson s 14 components and definition of nursing. Using the acceptable definition of nursing and appropriate laws related to the practice of nursing. The quality of care is drastically affected by the preparation and native ability of the nursing personnel rather that the amount of hours of care. Successful outcomes of nursing care are based on the speed with which or degree to which the patient performs independently the activities of daily living. Watson s theory and nursing process

Watson points out that nursing process contains the same steps as the scientific research process. They both try to solve a problem. Both provide a framework for decision making. Watson elaborates the two process as: Assessment: Involves observation, identification and review of the problem; use of applicable knowledge in literature. Also includes and conceptual knowledge for the formulation and conceptualization of framework, and the formulation of hypothesis; defining variables that will be examined in solving the problem. Using the variables gathered from the assessment to prioritize the health care needs of the patient. It helps to determine how variables would be examined or measured; includes a conceptual approach or design for problem solving. It determines what data would be collected and how on whom. It is the direct action and implementation of the plan. Also, it includes the collection of the data. Analysis of the data as well as the examination of the effects of interventions based on the data. Includes the interpretation of the results, the degree to which positive outcome has occurred and whether the result can be generalized. It may also generate additional hypothesis or may even lead to the generation of a nursing theory.

Diagnosis:

Planning:

Implementation:

Evaluation:

Abraham Maslow (Hierarchy of Needs) and nursing process Assessment: Abraham Maslow Hierarchy of needs: a. b. c. d. e. Diagnosis: Physiological needs Safety needs Love and belongingness needs Self-esteem needs Self-actualization needs

Comparing the data collected in each level of needs with the data and knowledge in the nursing practice. Identifying the individual s most important need where the nurse can decide which among the presenting problems must he or she attends first.

Planning:

Implementation:

Implementation based in Maslow s needs principle. Carrying out treatment prescribed by the physician, independent and collaborative nursing care in terms of their immediate relative importance as to the needs principle. Identifying the relative effect of the implemented care and the comparative analysis of client s present condition with the norms in Maslow s hierarchy of needs.

Evaluation:

5. Enumerate 2 nursing theories and their proponents. Describe each as to their framework and propositions. a. Nola Pender s Health Promotion Model Theoretical Propositions Theoretical statements derived from the model provide a basis for investigate work on health behaviors. The HPM is based on the following theoretical propositions. 1. Prior behavior and inherited and acquired characteristics influence beliefs, affect and enactment of health-promoting behavior. 2. Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits. 3. Perceived barriers can constrain commitment to action, a mediator of behavior as well as actual behavior. 4. Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior. 5. Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior. 6. Positive affect toward a behavior results in greater perceived self- efficacy, which can in turn, result in increased positive affect. 7. When positive emotions or affect are associated with behavior, the probability of commitment and action is increased. 8. Persons are more likely to commit and to engage in health-promoting behaviors when significant others model the behavior, expect the behavior. 9. Families, peers and health care providers are important sources of interpersonal influence that ca increase or decrease commitment to and engagement in healthpromoting behavior. 10. Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior. 11. The greatest the commitments to a specific plan of action, the more likely healthpromoting behaviors are to be maintained over time.

12. Commitment to a plan of action is less likely to result in the desired behavior when competing demands over which persons have little control require immediate attention. 13. Commitment to a plan of action is less likely result in the desired behavior when other actions are more attractive and thus preferred over the target behavior. 14. Persons can modify cognitions, affect and the interpersonal and physical environment to create incentives for health actions. Theoretical framework: 1. Individual characteristics and experience 2. Prior related behavior 3. Frequency of the similar behavior in the past. Direct and indirect effects on the likelihood of engaging in health promoting behaviors. Imogene king s Theory of Goal Attainment Theoretical Propositions From the theory of goal attainment king developed predictive propositions, which include: 1. If perceptual interaction accuracy is present in nurse-client interactions, transaction will occur. 2. If nurse and client make transaction, goal will be attained. 3. If goal are attained, satisfaction occur. 4. Proposition continue. 5. If transactions are made in nurse-client interactions, growth and development will be enhanced. 6. If role expectations and role performance as perceived by nurse and client are congruent, transaction will occur. 7. If role conflict is experience by nurse or client or both, stress in nurse-client interaction will occur. 8. If nurse with special knowledge skill communication appropriate information to client, mutual goal setting and goal attainment will occur. Theoretical Framework 1. Human Being/person: is social being who are rational and sentient. Person has ability to perceive, think, feel, choose, set, goals, select means to achieve goals, and to make decision. According to king, human being has three fundamental needs: a. The need for the health information that is unable at the time when it is needed and can be used. b. The need or care that seek to prevent illness and c. The need for care when human beings are unable to help themselves

2. Health. According to King, health involves dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of one s resources to achieve maximum potential for daily living. 3. Environment: it is the background for human interactions. It involves: a. Internal environment transforms energy to enable person to adjust to continuous external environment changes. b. External environment involves formal and informal organizations. Nurse is a part of the patient s environment. 6. State one non-nursing theory that is relevant to the nursing practice. Define the provisions of this theory. Maslow, Abraham H. (1908-1970) Theory

Abraham Maslow has been considered the Father of Humanistic Psychology. Maslow's theory is based on the notion that experience is the primary phenomenon in the study of human learning and behavior. He placed emphasis on choice, creativity, values, self-realization, all distinctively human qualities, and believed that meaningfulness and subjectivity were more important than objectivity. For Maslow, development of human potential, dignity and worth are ultimate concerns. He is famous for proposing that human motivation is based on a hierarchy of needs. The lowest level of needs are physiological and survival needs such as hunger and thirst. Further levels include belonging and love, self-esteem, and self-actualization. From Maslow's perspective, the drive to learn is intrinsic. The purpose of learning is to bring about selfactualization, and the goals of educators should include this process. Learning contributes to psychological health. Maslow proposed other goals of learning, including discovery of one's vocation or destiny; knowledge of values; realization of life as precious, acquisition of peak experiences, sense of accomplishment, satisfaction of psychological needs, awareness of beauty and wonder in life, impulse control, developing choice, and grappling with the critical existential problems of life. Maslow's theory of learning highlighted the differences between experiential knowledge and spectator knowledge. He regarded spectator, or scientific, knowledge to be inferior to experiential.

7. Theory formulation can be an important contribution of every nurse practitioner to the field of nursing. Discuss the three major steps in theory construction. The three major steps in theory constructions are theory analysis, theory derivation, and theory synthesis. a. Theory analysis provides a means of combining concepts and statements in a new way that could offer insights and provide new hypothesis. Meaning it provides another answer or an intelligent guess. It is also a determinant of the weakness and strengths of theory. Theory analysis truly understands the meaning of one framework. The guidelines to keep in mind for this step: i. To determine the origin of the theory. ii. Examine the meaning or significance of the theory. iii. b. Theory Synthesis is a systematic aimed at constructing theory, an interrelated system of ideas, from empirical evidence. Theory synthesis results lay bares the conceptual structure and linkages of extant knowledge about phenomenon. c. Theory Derivation- it provides a concepts or a new structure for the concepts that might produce an interesting new unifying idea. Theory derivation is very useful because somehow it serves as guidelines for another people to improve theories about it.

Theoretical Framework The researchers will base this study on a number of theories. One of them is the Psychoanalytic Theory discovered by Sigmund Freud. It institutes that anxiety is the appropriate mechanism of defense against certain danger situations. These danger situations, as described by Freud, are the fear of abandonment by or the loss of the loved one (the object), the risk of losing the objects love, the danger of retaliation and punishment, and finally the hazard of reproach by the superego. Thus, symptom formation, character and impulse disorders, and perversions, as well as sublimations, represent compromise formations different forms of adaptive integration that the ego tries to achieve through more or less successfully reconciling the different forces in the mind. There is also the Interpersonal Theory that states the cause of anxiety is fear of interpersonal rejection. This theory was introduced by Harry Stack Sullivan. It holds that personality development and mental disorder such as panic disorder are determined primarily by the interplay of personal and social forces rather than constitutional factors in the individual. Another theory is the Behavioral Theory that says that anxiety is a product of frustration. According to hardy et al, anxiety results when the individual doubts his or her ability to cope with the situation that causes him or her stress (1996). The stress brought about by his lack of confidence consequently turns into anxiety. In addition, the researchers will also base this study on the Learning Theory by Ivan Pavlov. In Learning Theory, anxiety is seen both as a response to learned cues and as a drive, or motivator of behavior. Anxiety is caused by exposure to early life fearful experiences. Under this theory, Pavlov mentions Classical Conditioning. He says that it happens when an animal or human learns to associate a neutral stimulus (signal) with a stimulus that has intrinsic meaning based on how closely in time the two stimuli are presented. For example, if a child sees that a certain individual feels pain when getting injected. As he gets older, he would feel anxious when he sees a syringe because he associates it with pain through what he witnessed when he was younger.