There is a knowledge base, authority over education, altruistic service, a code Of ethics and registration requirements for practice ( Mac Owen, 2007 ) A discipline is a unique perspective, a distinct way of viewing all phenomenon Which defines the limits and nature Of its inquiry. It is a branch Of knowledge ordered through the theories and methods evolving from more than one worldview of the phenomenon of concern. According to Mac Owen (2007) nursing knowledge base draws from many disciplines. In the past it has depended heavily on physiology, sociology, psychology and medicine to provide academic standing and to improve practice.
However, recently nursing has been seeking hat is unique to nursing and developing those aspects into an academic discipline, What are the cornerstones of a discipline? L. Research- this is a systematic method of inquiry to discover an/or validate knowledge thus establishing a knowledge base to be used in practice. It contributes to the development of theory for practice, 2. Theory- is an intellectual invention which groups knowledge, ideas and experience seeking to illumine a given phenomena. It involves intellectual operations and is comprised of facts, principles, and concepts that are arranged to claim their interrelatedness.
It describes something, a happening, a honeymoon, or explains phenomena and organize ideas and knowledge. Theory development is essential to nursing practice in that it describes, predicts, controls and explains phenomenon of interest to nurses. It validates, enhances and improves nursing practice promoting understanding and explanation of the phenomena and gives rise to the body of knowledge. 3. Practice – It is the application of the discipline with a knowledge base a vehicle for implementation of theory as well as validation and impetus for research.
According to Mêlées (2007) there are 4 important defining characteristics that determine nursing perspective: 1. Nature of nursing as human science 2. Nursing as a practice- oriented discipline 3. Nursing as a caring discipline – the caring relationships that nurses and patients develop 4 Nursing as a health oriented discipline. It is an art where nurses grasp the meaning that is inherent in their encounter with patients, establish connections With clients skillfully perform nursing activities, choose between alternatives and to morally conduct nursing practice. The Stages in the Development of the Nursing Discipline 1.
Stage of Practice, Apprenticeship and service- In this stage the mission of urging is to provide care and comfort to enhance healing and sense of well- being and to create a healthy environment that helps decrease suffering and deterioration. 2. Stage of Education and Administration- In this stage the focus of nursing is on what curriculum to develop and what training programs to offer to teach nursing practice also, vatu educational programs are best for prospective nurses, and what is the best venue for the education of nurses; is it the university or in the hospital 3.
Stage of Research- In this stage nurses begin to look for means to improve the practice Of nursing. Nurses begin to engage in nursing inquiries and scientific endeavors. Thus, theory development improve because of research. 4. Stage of Theory – This stage focuses on the fundamental questions about the essence of nursing, its mission, and its goals. Theory development at this time is influenced by many factors: paradigm of related disciplines, by the educational background which stems from existentialism, pragmatism, psychoanalysis, as well as trot humanism.
According to Mêlées (2007) three themes in nursing evolved during this stage, These are: acceptance of the complexity Of nursing ND the inevitability tot multiple theories; acceptance of the need to test and corroborate major propositions of differing theories before dismissing any of them; and the idea that concepts or theories remaining in the field, through cumulative effect become the bases for the development of a scientific perspective. 5. Stage of Philosophy – This stage focus on the raising and answering of questions about the nature of nursing knowledge.
It is during this stage that nurses ask questions related to values, meanings and realities. 6. Stage of Integration- This stage is characterized by dialogues and discussions elated to Structures such as nursing, science, theories. Philosophy, clinical knowledge and nursing specialties. This stage marks the development of educational programs that are organized around the integration Of theory, research and practice. It is during this stage that members of specialty areas develop theories related to their fields.
A final characteristic of this stage, according to Mêlées (1997) , is the systematic reappraisal of philosophical and theoretical underpinning that have guided the definitions and the conceptualization of the central concepts of the domain of nursing. 7. Stage tot Interdisciplinary – In the beginning of the 21st century there was integration that challenged members of different disciplines to build programs of research that incorporate theories and evidences from different disciplines.
Relationships are forged between research and clinicians who are members of different disciplines to develop joint institutes to advance research programs or to provide more comprehensive education. LESSON 2 NURSING’S INTERMARRIAGE A intermarriage is the global perspective of a discipline that identifies the primary phenomena that re Of interest to that discipline and explain how the spelling deals with those phenomena in a unique manner (Faucet 2000) as cited by Mac Owen (2007).
The intermarriage includes major philosophical orientations or worldviews of a discipline, the conceptual models and theories that guide research and other scholarly activities. Person or nursing client- The recipient of care including its physical, intellectual, spiritual, psychological, and sculptural components (Catalane 1990). He is 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 um of his parts ( Wagner 1986) The client may be an individual, family, or community.
Health refers to the degree of wellness or illness experienced by the person. It is the ability to function independently, successful adaptation to life stresses, achievement of ones full life potential, and unity of mind, body, and soul. (Wagner 1 981) It is a continuum raging from a completely healthy state where there is no disease in to a completely unhealthy stage which ends in death At any given time in ones life , everyone is located somewhere along the health continuum and may move closer to one side or the other depending on his life tuition.
The concept of health will vary from person to person and culture to culture ( Throne at AY 1998 ) Environment refers to all external and internal conditions, circumstances and influence affecting the person, significant others with whom the person interacts, and an open system With boundaries that permit the exchange Of the matter, energy and information with human beings (Wagner 1986) In nursing, the concept Of environment includes not only the simple surroundings but also to indicate elements such as living conditions, public sanitation, air and water, quality, interpersonal relationships and social interactions.
Nightingale’s Environment. Theory marked the beginning of the development of theoretical nursing. She believed that the focus of nursing should be in creating a positive environment through the manipulation of the patients surroundings in order to enhance the reparative process. Nursing is a science, an art and a practice discipline and involves caring. Goals of nursing include care of the well, care of the sick, assisting with self care activities, helping individuals attain their human potential and discovering and using natures laws of health.
The purposes of nursing care include placing the linen in the best condition for nature to restore health, promote the adaptation of the individual, facilitate the development of an interaction between the nurse and the client in which jointly set goals are met and promote harmony between the individual and the environment. Furthermore, nursing practice facilitates, supports, and assists individuals, families, communities, and society to enhance, maintain, and recover health and to reduce and ameliorate the effects Of illness.
Relationships among the Intermarriage concepts 1. Person and health – nursing is concerned with the principles and that govern he life process, well – being, and optional functioning Of human beings, sick or well. 2. Person and environment – nursing is concerned with the patterning of human behavior in interaction with the environment in normal life and critical life situations. 3. Health and nursing – nursing is concerned with the nursing action or process by which positive changes in both status are affected. 4.
Person, environment, and health, nursing is concerned with the wholeness or health of human beings, recognizing that they are in continuous interaction with their environment. ( Facet and Mailings, 1996) The concepts of Nursing, health, client, and environment are seen through various viewpoints by different nursing theories. However, certain assumptions are shared by them, Some of these assumptions are: 1. Clients will benefit from nursing care; Human beings have an inner capacity to improve their health; beings interact with each other; 3. Human 4.
Human beings do not exist in isolation, They are influenced by the individuals, families and environment; 5. The health of human beings consists of more than their biological needs; 6. Improved health is a goal of society, thus, of nursing; 7. Health is a positive value; The major focus Of nursing is the client. Nursing assists the client to adapt to their illness and environment; and 9. Nursing as a discipline requires content and process. Change as a process relates to the four concepts Of nursing, namely, client, health, environment, and nursing.
LESSON 3 THE NURSING PROCESS The nursing process, a tool for nursing practice, has been described and discussed by most of the nursing theorists. This is because the nursing process steps of assessment, diagnosis, planning, implementation elimination and evaluation have been good source tot ideas tort nursing theories. Nurse interactions, decision-making conceptualizations as well as ideas related to priority setting in many nursing theories are derived from the concept of nursing process.
History of Nursing process Nursing process is traditionally defined as a systematic method for assessing health status, diagnosis health needs, formulating a plan of care, initiating the plan, and evaluating the effectiveness Of the plan. (Potter and Perry, 1993) According to Potter and Perry (1993), the term nursing process was first used by Lydia Hall minion followed by Dorothy Johnson in 1959. Orlando (1961), and Wideband (1963) introduced a three-step nursing model into nursing model into nursing education and practice. Their models required the nurse to assess clients’ needs as s first step of the process.
In 1967, the Western Interstate Commission of Higher Education, defined the nursing process as “the interrelationship between a patient and a nurse in a given setting; it incorporates the behaviors of patient and nurse and the resulting interaction,” (Potter & Perry(1993) Also in 1 967, the faculty of the Catholic University tot America divided the nursing process into following phases: assessment, planning, intervention, evaluation, (Yuri & Walsh, 1988). These four phases were then used as bases tort the development of nursing care plans In 1973, nursing educators and practicing nurses began to use the five step nursing process.
The publication of the Standards of Nursing Practice by the American Nurses Association (ANA) in which the five components of the nursing process were described strengthened the use of the five-step nursing process. In 1992, the Joint Commission on Accreditation of Healthcare Organization [COACH), mandated that hospitals, in order to receive accreditation, must incorporate the urging process in its documentation. The five components (steps, phases) of the nursing process are as follows: a) Assessment b) nursing diagnosis c)Panning d)implementation / Intervention e) Evaluation.
The purposes of the five-step process are: a) to establish a client data base; b) identify the client’s health care needs; c) determine priorities of care; goals and expected outcomes; d) establish a nursing care plan; e) provide nursing interventions to meet client needs: and to determine the effectiveness of nursing care in meeting expected outcomes and achieving client goals A brief review of the five components of the nursing process follows: Assessment. Nursing assessment is the process of gathering, verifying and communicating data about client. The client’s data base is used in developing individualized care plan.
Sources of data includes; the health history obtained through interviews of the client and significant others medical and other records, pertinent literature, information from other health team members, laboratory and diagnostic findings, results of physical examination through inspection, palpation, percussion and auscultation information obtained by interviews and observations about the physical, developmental, intellectual, spiritual dimensions Of the clients as well as his ‘her responses to present condition and to factors in the environment. Data collected may either be objective or subjective.
Subjective data are clients’ perception about their health problems. Only clients can provide this information. A good example of subjective data are those related to pain. Only client can feel and describe the pain being complained about. On the other hand, objective data are those that can observed or measured. Gordon (1982) introduced a typology of functional health patterns which racing nurses found to be helpful as a framework in assessing clients. The eleven health patterns are: 1. Health perception-health management pattern Nutritional-metabolic pattern Elimination pattern 4.
Activity-exercise pattern 5. Cognitive-perceptual pattern 6. Sleep-rest pattern 7. Self-perception-self-concept pattern 8. Role-relationship pattern 9. Coping-stress-tolerance pattern 10. Value-belief pattern Some Other typologies Of nursing problems have been developed by Other nursing theorists, thus, emphasis on when to assess is very much influenced by the theoretical framework that is being subscribed to by the nurse. Nursing Diagnosis. The second component of the nursing process is the Nursing Diagnosis. Nursing diagnoses are defined as labels given to problems that fall within the domain of nursing.
According to Mêlées (1997), TTT is a concise summary, a conceptual statement of the client’s health status. ” The nursing literature contains many definitions tort nursing diagnosis. All tot these definitions add to better understanding of what the concept means, Some of these definitions are: 1. Nursing diagnosis is a concise phrase or term summarizing a cluster of empirical indicators representing patterns of unitary man (Roy, 1982) 2, A nursing diagnosis is a clinical judgment about an individual, family or community Vichy is derived through a deliberate, systematic process of data collection analysis.
It provides the basis for prescriptions for definitive therapy for Which the nurse is accountable. (Shoemaker, 1989) 3. A nursing diagnosis is a statement that describes the human response of an individual or group Which the nurse can legally identify and for Which the nurse can order the definitive interventions to maintain the health state or to reduce, eliminate or prevent alternation. 4. A nursing diagnosis is a clinical judgment about individual. Family, community responses to actual or potential health problems and live processes.
Nursing diagnosis provides the bases for selecting nursing interventions to which the nurse is accountable (AND 1 990) These are just a few of the definitions and they can be summarized as being a statement that describes a client’s actual or potential response to a health problem to which the nurse is capable of and is called upon to provide competent interventions. The evolution of the term nursing was fraught with controversy. Nurses at first were hesitant to use the term nursing diagnosis mostly because they lived that the term belonged to the realm of medicine.
In fact, the pros and cons of the use of the term was debated by other health professionals including those in the medical professions. Originally, nursing curriculum was organized around diseases and medical conditions. However, starting mid-xi’s on to early ass nursing leaders and educators started to revise the curriculum around client-centered problems (Carpenter, 1989). It was in the early g’s when the term nursing diagnosis came into being. Creative nursing leaders and educators formulated nursing diagnosis and wrote individualized nursing care plan.
However, professional nursing, notably the American Nurses Association, was at first not supportive Of the use Of the diagnosis label for the reason mentioned earlier. The works of Henderson, Abdullah and other theorists, encouraged nursing in terms of patient problems and the subsequent use of the term nursing diagnosis. By the ass and xi’s, activities concerning nursing diagnosis increased. There was an increase in the number of articles in nursing literature which supported the use of nursing diagnosis. In 1973, the first conference of Nursing Diagnosis was held to establish a classification system. In 1982, the North
American Nursing Diagnosis Association (AND), was established. The purpose of AND was to develop, refine and promote a taxonomy of nursing diagnostic terminology of general use tort professional nursing’ (Kim, 1984). The American Nurses Association (ANA), has officially sanctioned AND as the organization to govern the development of classification system of nursing diagnosis (Carpenter, 1989), Presently, practicing nurses and educators use AND nursing diagnosis taxonomy as guidelines in developing individualized nursing care plans for their patients. (see Appendix for Namedropping diagnosis as of 1 992)
The process involved in formulating nursing diagnosis includes analysis and interpretation Of data gathered during the assessment phase, identification of clients need and problems, and finally, formulating the nursing diagnosis. In the assessment phase, data were collected from a variety Of sources, validated and sorted out into clusters. From the clustered data, the nurse guided by her own knowledge and experienced, interprets. She recognizes patterns and trends, and draws conclusions from patient’s response. When a relationship among patterns is identified, a list of client. Centered problem or needs begins to merge.
Thus, one can see that the formulation of nursing diagnosis makes use of diagnostic process. Aside from improving communication among nurses, nursing diagnosis also improves communication between nurses and clients. Nursing diagnoses facilitate communication in several ways: the list of nursing diagnoses is used as reference to understand clients health care needs; Nursing diagnoses provide consistency in communicating about clients level of wellness and discharge planning: nursing diagnoses encourage nurses to prioritize and therefore, help them to develop their organizational skill.
Planning, Planning is a category of nursing behavior in which client-centered goals are established and strategies are designed to achieve the goal ( Potter and Perry, I gal The primary purpose of the planning step of the nursing process is ‘to design a plan of care for the client data, once implemented, results in the prevention or resolution Of client’s health problems” ( Taylor, 1996) The three basic types of planning critical to comprehensive nursing care are: Initial, ongoing problem oriented and discharge. The initial plan is developed by the nurse who performs the admission nursing history and the physical assessment.
This plan addresses each problem in the prioritize nursing diagnosis and identifies priorities, Standardized plans can be used as bases for planning, but the plan itself should be individualized. Ongoing problem oriented planning is carried out why any nurse who interacts with the client. Its chief purpose is to keep the plan up to date. At this stage of planning, nursing diagnoses are stated more clearly and new diagnoses and new goals are added when needed. Discharge planning is best carried out by the nurse who has worked more closely with the client and family and in conjunction tit other members of the health team.
