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Nursing Theories SHAHNAZ POULADI ASSISTANT PROFESSOR مقدمه یک قرن از تئوری پردازی در پرستاری می گذرد. الزمه رشد و پیشرفت یک رشته داشتن تئوری است. تئوری پردازی به زمینه های اجتمای ،فرهنگی و فلسفینظریه پرداز مربوط است. فلسفه • لغتی یونانی است • از دوکلمه تشکیل شده است (Philla .دوست داشتن) (Sophiaخرد ودانش) خرد طرز فکر و روش کار فرد است دانش به معنای معرفت واطالعات است. تاریخچه فلسفه • • • • • • )1فلسفه قدیم در روم ویونان چگونگی ارتباط فلسفه با زمینه های اجتماعی را نشان می دهد. در این زمان علم دوران کودکی خود را می گذرانده است. جهت درک دنیای طبیعی از مباحثات و گفتگوها استفاده می شده است نه تحقیق تجربی از فالسفه این دوران سقراط ،پالتو ،ارسطو تاریخچه • • • • )2فلسفه میانی به مفاهیم و مسائل اجتماع آن زمان به ویژه به ظهور مسیحیت بر می گردد. بیشتر تمرکز بر الهیات و مطالعه ارواح اختصاص داشته است. از فالسفه این دوران آگوستین وثونال است. تاریخچه • )3فلسفه مدرن • در این دوران با تجدید حیات علمی مذهب کم رنگ شد و روش های علمی پدید آمدند .جنبه های ذهنی کمتر و تجربه بیشتر شد. • از فالسفه این دوران دسکارت (منطق گرا) هیوم (تجربه گرا) تاریخچه • • • • • )4فلسفه معاصر این فلسفه در مقابل وضع اجتماعی متغیر گسترش یافت. دو بخش )1 :ظهور مخالفت با شرعیات )2ظهور فرهنگ ویژه مکاتبی همچون اگزیستانسیالیسم ،پراگماتیسم ،پست مدرنیسم ،و جنسیت گرایی در فلسفه معاصر دیده می شود. تعریف فلسفه • • • • • • به عملکرد فالسفه برمی گردد. )1تحلیل منظور تحلیل زبان فکر است یعنی مشخص کردن کلمات و توضیح آن ها )2نقد کردن انتقاد یا ارزشیابی افکار و عقاید به اعتقاد این افراد تحلیل به تنهایی مشکالت را حل نمی کند. تعریف فلسفه • • • • )3ترکیب برخی از افراد کار فلسفه را تلفیق و ترکیب تئوری های علمی دانسته اند. )4بررسی ارزش ها بررسی ارزش های اساسی کار اصلی فلسفه معاصر است. تعریف فلسفه • )5سیر عقالنی • این دسته افراد معتقدند ذهن تحت تاثیر عوامل مختلف قرار می گیرد که این عوامل در بیشتر مواقع ذهن را محدود ساخته و از ابتکار و خالقیت جلوگیری می کنند .اما سیر عقالنی فعالیت فلسفی ذهن را از نفوذ اینگونه عوامل مصون نگه می دارد و یکی از تفاوت های اصلی فلسفه و علم در همین فعالیت است. تعریف فلسفه • )6تفسیر یابسط نظریات علمی • نظریات علمی تفسیرهایی هستند که دانشجویان در باره پدیده ها با امور خارجی و حقایق ابراز می کنند. • فیلسوفان نیز این نظریه ها را به عنوان حقایق علمی مورد تفسیر قرار می دهند. انواع مکاتب فلسفی • )1مدرنیسم و پست مدرنیسم • مدرنیسم یا تجدد گرایی جریانی است که در تاریخ غرب رخ داده است و ریشه های آن به گذ شته های دور به فیلسوفانی مانند هگل ،کانت .....بر می گردد. • از موارد مهم این دوران :پیدا شدن مفهوم ذهن یا انسان به عنوان موجودی است که دارای ذهن و ضمیر همراه با فردیت است. انواع مکاتب فلسفی • )2ایده آلیسم • به تئوریهایی که به ذهن یا روح اهمیت می دهد اطالق می شود. • از نظر ایده آلیست ها ماهیت انسان را ذهن یا روح اوتشکیل می دهد. انواع مکاتب فلسفی • )3رئالیسم • از افکار و نظریات افالطون و ارسطو سرچشمه می گیرد. • هر چیزی که ما به آن نگاه می کنیم یا در باره آن فکر می کنیم عمال از دوچیز تشکیل شده است محتوی و صورت انواع مکاتب فلسفی • • • • • )4پراگماتیسم فلسفه ای است آمریکایی که به عنوان فلسفه تجربی ،فلسفه آزمایشی ،یا وسیله ای و .....خوانده می شود. در این مکتب به این موردتوجه می شود که هر چیزی فایده و سودش چیست و چگونه قابل اجراست. )5اگزیستانسیالیسم در این مکتب به زندگی همان طوری که زندگی می شود نگاه می کنند نه آن طور که در باره آن فکر می شود. 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 • Metaparadigm The 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 lifespan 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 • بیانات کالمی در باره پدیده ها ،به صورت ذهنی • Two dimensional model • رسم ها ،دیاگرام ها ،گرافها ،الگوی لباس • Three dimensional model • مدلهای فیزیکی ،اسباب بازی ها مدلهای آناتومیکی 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 Research Theory conceptual model Research Theory Theory Science/Knowledge Theory Theory-model debate Grand theories Research Mid-range theories Research Practice theories Science/ Knowledge 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، تئوری روی. 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،تئوری ریل 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. ویدن باخ، ترنر، روس، مین شال، تیرنی، لوگان، روپر،• تئوری هندرسسون 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 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 Purpose Concepts Definitions Propositions Structured ideas Tentative 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 development 1. 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 method Must 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. مکاتب پرستاری • • • • • • مکاتب پرستاری بر اساس: پارادایم زمان تکامل تئوری زمینه های فرهنگی و اچتمای سؤاالت مرکزی تئوری ها مفاهیم مرکزی تئوری ها نخستین مکتب تفکر :نیازها 195o-197o - شامل تئوریهایی است که در باره پاسخ به نیازهای مددچو صحبت می کند. در این تئوری ها پیرامون این که پرستاران چه کاری انام می دهند صحبت می کنند. وظایف پرستاران چیست؟ چه نفشهایی پرستاران ایفاء می کنند. در این دسته تئوریها مددچو فرد ناتوانی است که برای بر آورده کردن نیازهای خود به مرابت نیاز دارد. پپالئو بل از هندرسون در باره اینکه پرستاری چیست تئوری می دهد. تئوری بدهللاتئوری اورم دومین مکتب تفکر در پرستاری :تامل 195o-196o • در این دسته تئوری ها بر این موضو که پرستاران چگونه کاری را انچام می دهند ،استوار است. • پاسخ به این دسته سؤاالت بر تامل تمرکز دارد این دسته تئوری ها بر گسترش ارتباط بین پرستاران و بیماران تمرکز دارند. سومین مکتب تفکر :پیامدها • در این دسته تئوری ها بر چرایی مرابت پرستاری تمرکز دارد. • در ابتدا بر پیامد مرابت پرستاری مفهوم پردازی می کنند.بد ار آن بر گیرنده مرابت تمرکز دارد.