الرحیم الرحمن الله بسم

SHAHNAZ POULADIASSISTANT PROFESSOR

Nursing Theories

مقدمه

. گذرد- می پرستاری در پردازی تئوری از قرن یک

تئوری- داشتن رشته یک پیشرفت و رشد الزمهاست.

و- فرهنگی اجتمای، های زمینه به پردازی تئوری. است مربوط پرداز نظریه فلسفی

فلسفه

است • یونانی لغتی• . است شده تشکیل دوکلمه دوست ) Phillaاز

داشتن(Sophia) ودانش ) خرد

است فرد کار روش و فکر طرز خرد. است واطالعات معرفت معنای به دانش

فلسفه تاریخچه

قدیم( 1• فلسفهویونان • روم دراجتماعی • های زمینه با فلسفه ارتباط چگونگی

. دهد می نشان رامی • را خود کودکی دوران علم زمان این در

. است گذراندهگفتگوها • و مباحثات از طبیعی دنیای درک جهت

تجربی تحقیق نه است شده می استفادهارسطو • پالتو، سقراط، دوران این فالسفه از

تاریخچه

میانی( 2• فلسفهبه • ویژه به زمان آن اجتماع مسائل و مفاهیم به

. گردد می بر مسیحیت ظهورارواح • مطالعه و الهیات بر تمرکز بیشتر

. است داشته اختصاص•. است وثونال آگوستین دوران این فالسفه از

تاریخچه

مدرن( 3• فلسفهکم • مذهب علمی حیات تجدید با دوران این در

. جنبه آمدند پدید علمی های روش و شد رنگ. شد بیشتر تجربه و کمتر ذهنی های

• ) گرا ) منطق دسکارت دوران این فالسفه از) گرا ) تجربه هیوم

تاریخچه

معاصر( 4• فلسفهمتغیر • اجتماعی وضع مقابل در فلسفه این

. یافت گسترش• : بخش شرعیات( 1دو با مخالفت ظهورویژه( 2• فرهنگ ظهورپراگماتیسم، • اگزیستانسیالیسم، همچون مکاتبی

فلسفه در گرایی جنسیت و مدرنیسم، پست. شود می دیده معاصر

فلسفه تعریف

•. گردد برمی فالسفه عملکرد بهتحلیل( 1•مشخص • یعنی است فکر زبان تحلیل منظور

ها آن توضیح و کلمات کردنکردن( 2• نقدعقاید • و افکار ارزشیابی یا انتقادرا • مشکالت تنهایی به تحلیل افراد این اعتقاد به

. کند نمی حل

فلسفه تعریف

ترکیب(3•ترکیب • و تلفیق را فلسفه کار افراد از برخی

. اند دانسته علمی های تئوریها( 4• ارزش بررسیفلسفه • اصلی کار اساسی های ارزش بررسی

. است معاصر

فلسفه تعریف

عقالنی( 5• سیرعوامل • تاثیر تحت ذهن معتقدند افراد دسته این

بیشتر در عوامل این که گیرد می قرار مختلفو ابتکار از و ساخته محدود را ذهن مواقع . عقالنی سیر اما کنند می جلوگیری خالقیتعوامل اینگونه نفوذ از را ذهن فلسفی فعالیتاصلی های تفاوت از یکی و دارد می نگه مصون

. است فعالیت همین در علم و فلسفه

فلسفه تعریف

علمی( 6• نظریات یابسط تفسیرکه • هستند تفسیرهایی علمی نظریات

و خارجی امور با ها پدیده باره در دانشجویان. کنند می ابراز حقایق

حقایق • عنوان به را ها نظریه این نیز فیلسوفان. دهند می قرار تفسیر مورد علمی

فلسفی مکاتب انواع

مدرنیسم( 1• پست و مدرنیسمدر • که است جریانی گرایی تجدد یا مدرنیسم

گذ به آن های ریشه و است داده رخ غرب تاریخ ، هگل مانند فیلسوفانی به دور های شته

. گردد ..... می بر کانت• : ذهن مفهوم شدن پیدا دوران این مهم موارد از

ذهن دارای که است موجودی عنوان به انسان یا. است فردیت با همراه ضمیر و

فلسفی مکاتب انواع

آلیسم( 2• ایدهدهد • می اهمیت روح یا ذهن به که تئوریهایی به

. شود می اطالقیا • ذهن را انسان ماهیت ها آلیست ایده نظر از

. دهد می اوتشکیل روح

فلسفی مکاتب انواع

رئالیسم( 3•ارسطو • و افالطون نظریات و افکار از

. گیرد می سرچشمهباره • در یا کنیم می نگاه آن به ما که چیزی هر

شده تشکیل دوچیز از عمال کنیم می فکر آنصورت و محتوی است

فلسفی مکاتب انواع

پراگماتیسم( 4•فلسفه • عنوان به که آمریکایی است ای فلسفه

و ..... ای وسیله یا آزمایشی، فلسفه تجربی، . شود می خوانده

هر • که شود می موردتوجه این به مکتب این درقابل چگونه و سودشچیست و فایده چیزی

اجراست. اگزیستانسیالیسم( 5•زندگی • که طوری همان زندگی به مکتب این در

آن باره در که طور آن نه کنند می نگاه شود می. شود می فکر

Objectives• Global terms*Metaparadigm*Domain*Philosophy• Working terms*Phenomenon*Concept*Construct*Proposition• Middle terms*Model*Theory*Paradigm*Discipline*Research*Science

Global Terms

Global terms are those expressions which represent a very broad view of issues that

are relevant to nursing

Global Terms

• MetaparadigmThe major concepts in a discipline

that names the phenomena of concern

Global Terms

• The major metaparadigm in nursing• Person• Nursing• Health• Environment

Global Terms(Metaparadigm)

• Person Definition• Biological human beings with inseparable

mind and body who share certain fundamental human needs (Henderson, 1966)

• An un fragmented whole who carries out or is assisted in carrying out those activities that contribute to the process of living (Roper, Logan, and Tierney, 1990)

Global Terms(Metaparadigm)

• Person Definition• A functional integrated whole with a

motivation to achieve self care (Orem, 1980)• A bio-psycho-social being who

presents as an integrated whole (Roy, 1971)

Global Terms(Metaparadigm)

• Nursing Definition• A profession whose focus is to help the client to

prevent, solve, alleviate or cope with problems associated with the activities he or she carries out in order to live (Roper, Logan and Tierney, 1990)

• A profession that assists the person sick or well in the performance of those activities contributing to health or its recovery that he or she would perform unaided, given the necessary strength, will or knowledge (Henderson,1966)

Global Terms(Metaparadigm)

• Nursing Definition• A human service related to the clients’ need and

ability to undertake self-care and to help them sustain health, recover from disease and injury or cope with their effects (Orem, 1980)

• A socially valued service whose goal to promote a positive adaptation to the stimuli and stresses encountered by the client (Roy, 1971)

Global Terms(Metaparadigm)

• Health Definition• The ability to function independently

regarding fourteen activities of daily living (Henderson, 1966)

• The optimum of independence in each activity of living which enables the individual to function at his/her maximum potential (Roper, Logan and Tierney, 1990)

Global Terms(Metaparadigm)

• Health Definition• A state of wholeness or integrity of the

individual, his parts and his modes of functioning (Orem,1980)

• The adaptation of the person to stimuli on a continuous line between wellness and illness (Roy, 1971)

Global Terms(Metaparadigm)

• Environment Definition• That which may act in a positive or negative

way upon the client (Henderson, 1966)• Circumstances that may impinge upon the

individual as he or she travels along the life-span and cause movement towards maximum dependence or maximum independence (Roper, Logan and Tierney, 1990)

Global Terms(Metaparadigm)

• Environment Definition• A sub-component of man, and with man

forms an integrated system related to self-care (Orem, 1980).

• Both internal and external. From the environmental people are subject to stresses (Roy, 1971).

Global Terms(Domain)

• Domain Definition• Domain is the perspective and territory

of a discipline (Meleis, 1991)• She identifies seven concepts as central

to the domain of nursing. These are : nursing client, transitions, interaction, nursing process, environment, nursing therapeutics and health.

Global Terms(Philosophy)

• Philosophy Definition• Philosophy is a statement of beliefs and

values about the world, a perspective on human being and their world , and an approach to the development of knowledge (Fawcett, 1992).

Nursing Philosophy

• Early works introduce the nursing theory era have contributed to knowledge development by providing direction or forming a basis for subsequent developments

• Later works reflect more recent expansion in the areas of human science and its methods (Alligood, 2002; Meleis, 2004)

Working Terms

• Phenomenon• Concept• Construct• Proposition

Working Terms(Phenomenon)

• A phenomenon is a thing, event or activity that we perceive through our senses . (sixth sense). The aspect of reality that can be perceived. (e.g., Prior to surgery)

Working Terms(Concept)

• Concept is a label used to describe a phenomenon or a group of phenomena (Meleis, 1991). (e.g., Anxiety)• Concepts are the building blocks of

theory• Concepts are special vocabulary in a

theory (Fawcett & Downs, 1992).

Working Terms(Construct)

• If the phenomena are very abstract and the resultant concept is not directly observable or measurable it is often referred to as ‘ Construct’ (e.g., self-esteem).

• If we imagine a continuum of concepts from concrete (thermometer) to abstract (caring), constructs would be placed at the abstract end.

• We must remember that all constructs are concepts, but not all concepts are constructs.

• Constructs may be made measurable by identifying ‘ Variables’. (e.g., Civil status, is perceived as a construct, it could be made measurable by breaking it into variables ‘single’ and ‘widowed’, ‘divorced’, ‘married’.

Working Terms(Proposition)

• Different concepts, constructs, and variables can be linked by statements of relationships. Such linking statements are called ‘Propositions’). (Meleis, 1991)

Middle Terms

• Model• Theory• Discipline• Research• Science

Middle Terms(Model)

• Representation of reality. (Mcfarlane, 1986)

• A simplified way of organizing a complex phenomenon .(Stockwell, 1985)

• A model is a set of concepts and the assumptions that integrate them in to a meaningful configuration. (Fawcett, 1992)

Middle Terms(Model)

• Type of models• One dimensional model

ذهنی • صورت به ها، پدیده باره در کالمی بیانات

• Two dimensional modelلباس • الگوی گرافها، ها، دیاگرام ها، رسم

• Three dimensional modelآناتومیکی • مدلهای ها بازی اسباب ، فیزیکی مدلهای

Middle Terms(Theory)

• The natural science of physics, astronomy, chemistry, biology, etc. have laws to explain how particular phenomenon behave . Such laws enable scientist to predict with an absolute degree of certainty the results of a specific experiment. In nursing, because we are dealing with human being and their complex realities, it is almost impossible to formulate laws. The best that can be done is to generate different types of theory to help us describe, explain, predict or control human behaviors.

Middle Terms(Theory)

• Theory is a set of concepts, definitions and propositions that project a systematic view of phenomena by designing specific interrelationships among concepts for the purpose of describing, explaining, predicting, and controlling phenomena. ( Chinn and Jacobs, 1897)

Middle Terms

• Type of theories• Grand theory is highly abstract and is broad in

scope• Middle range theory is more focused and is

normally the end product of a research study• Narrow range theory is even more specific

while also being based upon research findings, it guides specific actions in the achievement of desirable goals.

The model-theory debate

• Conceptual model conceptual model

Research Research

Theory Theory Theory Theory

Science/Knowledge

Theory-model debate

Grand theories

Research

Mid-range theories Science/ Knowledge

Research

Practice theories

Middle Terms(Paradigm)

• The word ‘Paradigm’ derives from the Greek word paradeigma, meaning pattern.

• Paradigm represents ‘global ideas’ about the individuals, groups, situations and events of interest to a discipline . (Fawcett, 1992)

Middle Terms Type of Paradigms

• There are four main paradigms which may be used for the classification of nursing theories.• System paradigm• Interactional paradigm• Developmental paradigm• Behavioral paradigm

Type of Paradigms(System paradigm)

• Theories within this paradigm are largely based upon the ‘ general system’ paradigm as put forward by Von Bertalanffy (1951).

• Within this paradigm every event and occurrence can be perceived as a system

• انسون نیومن، روی، تئوری ، .

Type of Paradigms(Interactional paradigm)

• Interactional paradigm have their origin in the symbolic interactionist paradigm (Blumer, 1969).

• This paradigm emphasizes the relationships between people and the roles they play in society. Nursing activities are perceived as interactional processes between practitioners and clients.

• کینگ اورالندو، ریل، تئوری

Type of Paradigms(Developmental paradigm)

• The developmental paradigm originated from the work of Freud (1949) and Sullivan (1953).

• The central themes are growth, development, maturation, and change.

• Within this paradigm , human beings are constantly developing whether this be physiologically, socially, cognitively, psychologically or spiritually.

Type of Paradigms(Behavioral paradigm)

• The behavioral paradigm owes much to the theoretical formulations of Abraham Maslow (1954) concerning motivation.

• The behavioral paradigm assumes that individuals normally exist and survive by meeting their own needs.

ترنر، • روس، شال، مین تیرنی، لوگان، روپر، هندرسسون، تئوریباخ ویدن

Middle Terms(Discipline)

• A discipline is characterized by a unique perspective, a distinct way of viewing all phenomena, which ultimately defines the limits and nature of its inquiry. Nursing as a discipline broader than nursing as a science. Its uniqueness stems from its perspective rather than the focus of enquiry or methods of enquiry./

Middle Terms(Research)

• Research is a systematic process of enquiry which utilizes a variety of methodological approaches to investigate the question and concepts of interest in nursing. (Hinshaw, 1989)

Conceptual models

• Frameworks or paradigms that provide a broad frame of reference for the systematic approaches to the phenomena with which the discipline is concerned.

• -different views nursing like Roy focuses on adaptation, King on interaction and Abdellah on interventions

Middle Terms(science)

• Science is a unified body of knowledge about phenomena that is supported by agreed upon evidence. (Meleis, 1991)

• Nursing science is a domain of knowledge concerned with the adaptation of individuals and groups to actual and potential health problems, the environments that influence health in humans, and the therapeutic interventions that promote health and affect the consequences of illness.

References

• Hugh McKenna. (1997). Nursing Theories and Models. First

edition. London,Routledge Company

• Tomey , A.M. & Alligood, M.R. (2006). Nursing Theorists and

their work. Sixth edition. Boston, Mosby

• Meleis, A.I. (2007). Theoretical Nursing. Development &

Progress. Fourth edition, Philadelphia,Lippincott .

• Jacqueline Fawcett. (1984). Analysis and evaluation of

conceptual models of nursing. Philadelphia: F.A.Davis

شما توجه از تشکر با

Theoretical Foundations of Nursing

Definitions of theory

1. Pinnel and Menesis (1986) Systematic set of interrelated concepts,

definitions and deductions that describe, explain or predict interrelationships

Definitions of a theory

2. Walker and Avant (1983)Internally consistent group of relational

statements (concepts, definitions and propositions) that presents a systematic view of phenomenon and which is useful for description, explanation, prediction and control

Definition of a theory

3. Chinn and Krammer creative and vigorous structuring of ideas that

project a tentative, purposeful and systematic view of phenomena

Definitions of a theory

• Ellis coherent set of hypothetical, conceptual and

pragmatic principles forming a general frame of reference for a field of inquiry

Some commonalities

PurposeConceptsDefinitions PropositionsStructured ideasTentative Describe a phenomenon or occurrence

Components/Elements of theory

1.Purpose “Why is the theory formulated”2.Concepts are building blocks of theory – ideas,

mental images of a phenomenon, an event or object that is derived from an individual’s experience and perception

Components/Elements of theory

3.Has a major concept like nursing, person, health or environment.

4. Definitions give meaning to concepts which can either be descriptive or procedural

Components/Elements of theory

- Propositions are expressions of relational statements between and among the concepts. It can be expressed as statements, paradigms or figures .

- Assumptions- accepted “truths” that are basic and fundamental to the theory. Or value assumptions where what is good or right or ought to be.

Theory Development

How does a theory develop?

• Four strategies of theory development1. Theory practice theory ( theory

developed in other discipline and used in nursing situations)

2. Practice – theory evolved from clinical practice

How does a theory develop?3. Research theory or inductive methodMust evolve from research findings or

empirical evidence.

4. Theory research theory theories developed by other disciplines

are utilized but given unique nursing perspective. Original theory examined and given a new research findings.