Nurses, especially as they grow into an advanced practice role, use physiological theory in many varied ways, from predicting short- and long-term disease processes to predicting outcomes of prescription medication and other therapies. The nurse is cautioned to use a mindset that is open to diverse frameworks and evaluate research that tests physiological phenomena and its application to clinical practice, thereby assisting the patient in attaining optimum wellness. This chapter reviews a selection of physiological theories that may be used by nurses, especially those in advanced practice roles. It helps introducing the nurse to a broad scope of physiological frameworks that can be used to guide nursing care and enhance the wellness possibilities for patients. The physiological frameworks discussed include: genetic and genomic frameworks; disease causation frameworks; immunological frameworks; motor and skeletal stress frameworks; frameworks for understanding pain mechanisms; and sleep disturbance and fatigue frameworks.
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One does not accidentally blend Watson’s Human Caring Science theory with a Yoga theory. This chapter and the merging of these two theories is the culmination of the many pathways the author have followed, pathways that have diverged and converged over nearly 20 years of nursing education and Yoga teaching. It explores how the author came about interweaving Watson’s Human Caring Science theory with a medieval Yoga model to underpin a first year’s, first semester bachelor of nursing course in Australia. With this background contextualized, the author describes the traditional Yogic Kosha Model, its adaptation, and then author’s blending of it with Watson’s Caritas Processes®. The chapter concludes with a discussion on the adaptation of Watson’s Caring Science to construct new knowledge (epistemology) and ways of being (ontology), while upholding the imperative of values (axiology) such as caring in nursing and society.
Gathering the stories of nurses, analyzing the data, and discovering the theory of moral reckoning was one of the worst and best experiences of the author’s life. The theory of moral reckoning emerged through the inductive process of the classical grounded theory method. Moral reckoning consists of a three-stage process and critical juncture as nurses reflect on motivations, choices, actions, and consequences of a morally troubling patient care situation. In the middle range theory of moral reckoning, the stage of ease is disrupted by a situational bind and then followed by the processes of resolution and reflection. Properties central to the stage of ease include becoming, professionalizing, institutionalizing, and working. A situational bind terminates the stage of ease and throws the nurse into turmoil when core beliefs and other claims conflict. Properties of the stage of reflection include remembering, telling the story, examining conflicts, and living with the consequences.
Qualitative research methods offer a way to study human experience and behavior in this context, and ethnography is a qualitative method through which the world of a particular cultural group can be described. Nursing care is delivered in a variety of settings, over shifts, and across a plethora of specialties. In each of these situations, nurses interact together and share values, assumptions, and beliefs about the care of their patients. Nursing is a culture, and each of the situations described can be considered a subculture of nursing. To gain an understanding of nursing interventions to encourage residents’ self-care in long-term care, nurses in this setting were identified as a cultural group supporting an ethnographic approach to the inquiry. Data collection methods included formal and informal individual and group interviews, participant observation, event analysis, record analysis, and the researcher’s journal.
Graduates of doctoral education for advanced nursing practice are expected to integrate nursing science with knowledge from other fields in order to provide the highest level of nursing care. They are also expected to develop and provide effective plans that will improve the quality of care delivery. This chapter helps the advanced practice registered nurse learn how to design new programs by addressing factors related to planning and organizational decision-making. It describes nursing care delivery models that address organizational structure, process, and outcomes. Program designs that address consumer and societal trends are more likely to be successful and produce improved quality of care. Successful programs must incorporate knowledge from many fields in order to address issues related to the structure, process, and outcomes involved in program planning, development, implementation, and evaluation.
There are numerous reasons to establish an evidence-based practice (
EBP) program for nursing staff at various practice sites. First, patients have complex needs, coupled with shortened in-patient lengths of stay and increases in new therapies used not only in acute settings but also in the community. Nurses must deliver care that is based on evidence of its effectiveness, safety, and currency. An EBPprogram is a proven way to move nursing care toward these desired outcomes. Numerous resources and processes are required to implement and sustain a strong EBPinfrastructure, and the deployment of these resources is an organizational responsibility. Continued efforts to: (a) minimize barriers that impede clinical inquiry, (b) implement strategies to enhance nurses’ EBPknowledge and skills, (c) implement evidence-based project changes, and (d) acknowledge and reward EBPsuccesses, will generate enthusiasm and maintain momentum for a sturdy EBPenvironment.
Comforting consists of caring and a comforting action, or interaction, provided as a process, until the patient reaches an endurable comfort level. The author suggests that the comforting process consists of the nurse recognizing a patient cue or signal of distress, assessing, and intervening with a comforting strategy or procedure. Nurse-comforting strategies buffer the injury/illness experience and alleviate the intensity of symptoms for the patient. A nursing approach supports the patient’s self-comforting strategies. There are two kinds of nursing assessments. The first type is the evaluation and interpretation of physical signs and symptoms. The second type is the assessment of the patients’ comfort level, looking for patient cues and reading their signals of distress. As nursing care consists of many comforting interactions per patient encounter, the Praxis Theory of Comfort and Comforting is a perspective for nursing care. Patient-centered theory is a theory for clinical nursing.
This chapter deals with research methods for identifying concepts, and how to study and build them. Research method includes the prototypical method for concept development. The prototypical method of concept identification and development consists of two stages: an inductive phase, the identification and analysis of the exemplar and the concept, and a deductive phase, exploring the presence of the concept in other situations, of confirmation of the concept as a concept. The prototypical method may be commonly used, and even considered important in nursing care. The chapter describes the attributes of the concept of hope using the prototypical method of concept development. Concept identification using the prototypical method is for relatively undeveloped concepts for which the literature does not provide an adequate example of the concept per se. But, the lay concept is used frequently enough to find an exemplar that fits one’s conceptualization of the concept exactly.
Nursing needed leaders with vision, committed nurse theorists to create the theory, or theories, scientists to develop it, and educators to teach it. But the abstractness of the traditional nursing theories was an anathema: Clinicians complained that they were not relevant to nursing practice; theorists complained that practitioners did not use them. Despite the criticisms of traditional nursing theory, these theories, frameworks for organizing nursing practice and nursing approaches to care, were and still are in some nursing programs highly influential in nursing education. Therefore, recognizing the importance of the adoption of nursing theory, from the mid-1970s to the mid-1990s, all nurses were taught about these theories in their undergraduate and graduate nursing programs. Nursing research no longer uses the traditional nursing metaparadigm as a framework; nurse researchers are free to construct the most appropriate model or theory that meets their needs.
This chapter focuses on the design and interpretation of two major frameworks for measurement they are the norm-referenced and criterion-referenced approaches. Essential steps in the design of a norm-referenced measure are selection of a conceptual model for delineating the nursing or health care aspects of the measurement process; explication of objectives for the measure; development of a blueprint; and construction of the measure, including administration procedures, an item set, and scoring rules and procedures. The chapter discusses the development of criterion-referenced measures. It begins by differentiating the nature of criterion-referenced measurement from norm-referenced measurement and discussing how criterion-referenced measures are fundamentally different from norm-referenced measures. The chapter also discusses the place of criterion-referenced measurement in measuring health and nursing concepts. The criterion-referenced measurement framework is used to classify attributes related to client conditions that may be assessed through direct clinical observation or by laboratory tests.