NRG As Science

NRG106: Fundamentals of Nursing Practice
Nursing Program, DAVAO DOCTORS COLLEGE
NURSING AS A SCIENCE
• Nursing practice is based on a body of knowledge that is continually changing with new
discoveries and innovations.
• nursing practice requires a blend of the most current knowledge and practice standards with an
insightful and compassionate approach to patient care.
• The science of nursing is based on data obtained from current research. Nursing theory helps to
identify the focus, means, and goals of practice. Nursing theories enhance communication and
accountability for patient care (Meleis, 2012).
ROLE OF NURSING THEORY

Direct links exist among theory, education, research, and clinical practice. In many cases, nursing theory
guides knowledge development and directs education, research, and practice although each influences
the others. The interface between nursing experts in each area helps to ensure that work in the other
areas remains relevant, current, useful, and ultimately influences health.
METAPARADIGM IN NURSING
Theoretical work in nursing focused on articulating relationships between four major concepts: person,
environment, health, and nursing. Because these four concepts can be superimposed on almost any work
in nursing, they are sometimes collectively referred to as a metaparadigm for nursing.
The nursing metaparadigm allows nurses to understand and explain what nursing is, what nursing does,
and why nurses do what they do (Fawcett and DeSanto-Mayeda, 2013).
PERSON
• The individuals or clients are the recipients of nursing care (includes individuals, families, groups,
and communities).
• The person is the recipient of nursing care and central to the nursing care you provide. Because
each person's needs are often complex, it is important to provide individualized patient-centered
care.
HEALTH
• It is the degree of wellness or well-being that the client experiences.
• has different meanings for each patient, the clinical setting, and the health care profession. It is a
state of being that people define in relation to their own values, personality, and lifestyle. It is
dynamic and continuously changing. Your challenge as a nurse is to provide the best possible care
based on a patient's level of health and health care needs at the time of care delivery.
DOMINGO T. SO, JR., RN, MAN

2ND SEMESTER SY 2020-2021
Berman, A., Snyder, S. & Frandsen G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (10th ed.). Boston: Pearson Education, Inc.
Potter, P, Perry, A.G., Stockert, P., Hall, A.M., & Ostendorf, W. (2017). Fundamentals of Nursing (9th ed.). Elsvier, Inc.
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ENVIRONMENT
• is the internal and external surroundings that affect the client. This includes people in the physical
environment, such as families, friends, and significant others.
• all possible conditions affecting patients and the settings where they go for their health care.
There is a continuous interaction between a patient and the environment. This interaction has
positive and negative effects on a person's level of health and health care needs. Factors in the
home, school, workplace, or community all influence the level of these needs.
NURSING
• attributes, characteristics, and actions of the nurse providing care on behalf of, or in conjunction
with, the client
• is the “protection, promotion, and optimization of health and abilities, prevention of illness and
injury, alleviation of suffering through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities, and populations” (ANA, 2014).
OVERVIEW OF SELECTED NURSING THEORIES

Nightingale’s Environmental Theory
• Nightingale linked health with five environmental factors: (1) pure or fresh air, (2) pure water, (3)
efficient drainage, (4) cleanliness, and (5) light, especially direct sunlight. Deficiencies in these five
factors produced lack of health or illness.
• Nightingale set the stage for further work in the development of nursing theories. Her general
concepts about ventilation, cleanliness, quiet, warmth, and diet remain integral parts of nursing
and health care today.
Peplau’s Interpersonal Relations Model

• Hildegard Peplau, a psychiatric nurse, introduced her interpersonal concepts in 1952
• Central to Peplau’s theory is the existence of a therapeutic relationship between the nurse and
the client. Nurses enter into a personal relationship with an individual when a need is present.
• The nurse-client relationship evolves in four phases:
1. Orientation. The client seeks help and the nurse assists the client to understand the
problem and the extent of the need for help.
2. Identification. The client assumes a posture of dependence, interdependence, or
independence in relation to the nurse (relatedness). The nurse’s focus is on ensuring the
individual that the nurse understands the interpersonal meaning of the client’s situation.
3. Exploitation. The client derives full value from what the nurse offers through the
relationship. The client uses available services based on self-interest and needs. Power
shifts from the nurse to the client.
4. Resolution. In the final phase, old needs and goals are put aside and new ones adopted.
Once older needs are resolved, newer and more mature ones emerge.
• To help clients fulfill their needs, nurses assume many roles: stranger, teacher, resource person,
surrogate, leader, and counselor. Peplau’s model continues to be used by clinicians when working
with individuals who have psychological problems

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Orem’s General Theory of Nursing

• Dorothea Orem’s theory, first published in 1971, includes three related concepts: self-care, self-
care deficit, and nursing systems. Self-care theory is based on four concepts: self-care, self-care
agency, self-care requisites, and therapeutic self-care demand. Self-care refers to those activities
an individual performs independently throughout life to promote and maintain personal well-
being. Self-care agency is the individual’s ability to perform self-care activities. It consists of two
agents: a self-care agent (an individual who performs self-care independently) and a dependent
care agent (a person other than the individual who provides the care). Most adults care for
themselves, whereas infants and people weakened by illness or disability require assistance with
self-care activities.
• Therapeutic self-care demand refers to all self-care activities required to meet existing self-care
requisites, or in other words, actions to maintain health and well-being.
• Self-care deficit results when self-care agency is not adequate to meet the known self-care
demand.
• self-care deficit theory explains not only when nursing is needed but also how people can be
assisted through five methods of helping: acting or doing for, guiding, teaching, supporting, and
providing an environment that promotes the individual’s abilities to meet current and future
demands.
Leininger’s Cultural Care Diversity and Universality Theory

• human caring, although a universal phenomenon, varies among cultures in its expressions,
processes, and patterns; it is largely culturally derived. Leininger produced the Sunrise model to
depict her theory of cultural care diversity and universality. This model emphasizes that health
and care are influenced by elements of the social structure, such as technology, religious and
philosophical factors, kinship and social systems, cultural values, political and legal factors,
economic factors, and educational factors. These social factors are addressed within
environmental contexts, language expressions, and ethnohistory. Each of these systems is part of
the social structure of any society; health care expressions, patterns, and practices are also
integral parts of these aspects of social structure. In order for nurses to assist people of diverse
cultures, Leininger presents three intervention modes:
1. Culture care preservation and maintenance
2. Culture care accommodation, negotiation, or both
3. Culture care restructuring and repatterning.
Roy’s Adaptation Model

• adaptation as “the process and outcome whereby the thinking and feeling person uses conscious
awareness and choice to create human and environmental integration”
• focuses on the individual as a biopsychosocial adaptive system that employs a feedback cycle of
input (stimuli), throughput (control processes), and output (behaviors or adaptive responses).
Both the individual and the environment are sources of stimuli that require modification to
promote adaptation, an ongoing purposive response. Adaptive responses contribute to health,
which she defines as the process of being and becoming integrated; ineffective or maladaptive
responses do not contribute to health. Each person’s adaptation level is unique and constantly
changing.

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• The goal of Roy’s model is to enhance life processes through adaptation in four adaptive modes.
Individuals respond to needs (stimuli) in one of the four modes:
1. The physiological mode involves the body’s basic physiological needs and ways of
adapting with regard to fluids and electrolytes, activity and rest, circulation and oxygen,
nutrition and elimination, protection, the senses, and neurologic and endocrine function.
2. The self-concept mode includes two components: the physical self, which involves
sensation and body image, and the personal self, which involves self-ideal, self-
consistency, and the moral-ethical self.
3. The role function mode is determined by the need for social integrity and refers to the
performance of duties based on given positions within society.
4. The interdependence mode involves one’s relations with significant others and support
systems that provide help, affection, and attention.
Watson’s Human Caring Theory

• the practice of caring is central to nursing
• it is the unifying focus for practice. Nursing interventions related to human care originally referred
to as carative factors have now been translated into 10 clinical caritas processes (Watson, 2013):
1. Embrace altruistic values and practice loving kindness with self and others.
2. Instill faith and hope and honor others.
3. Be sensitive to self and others by nurturing individual beliefs and practices.
4. Develop helping–trusting, human caring relationships.
5. Promote and accept positive and negative feelings as you authentically listen to another’s
story.
6. Use creative scientific problem-solving methods for caring decision making.
7. Share teaching and learning that addresses the individual needs and comprehension
styles.
8. Create a healing environment for the physical and spiritual self which respects human
dignity.
9. Assist with basic physical, emotional, and spiritual human needs.
10. Open to mystery and allow miracles to enter.

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EVIDENCE-BASED PRACTICE
Current standards of professional performance for nurses include using evidence and research findings in
practice. Nurses today are actively involved in generating and publishing evidence in order to improve
client care and expand nursing’s knowledge base. These activities support the current emphasis on
practice that is based on evidence and on all nurses needing to be able to locate, understand, and evaluate
both research findings and non-research evidence. All nurses need a basic understanding of the research
process and its relationship to evidence-based practice.
• Evidence-based practice (EBP), or evidence-based nursing, occurs when the nurse can “integrate
best current evidence with clinical expertise and patient/family
preferences and values for delivery of optimal health care”
(Cronenwett et al., 2007).
• evidence includes theories, opinions of recognized experts, clinical
expertise, clinical experiences, and findings from client assessments,
findings from research studies are often given the most weight in the
decision-making process. This emphasis is because research entails using formal and systematic
processes to address problems and answer questions. The disciplined thinking and the careful
planning and execution that characterize research means that the resulting findings should be
accurate, dependable, and free from bias.
• Sources of Synthesized Knowledge:

o Cochrane Collaborative
o Database of Abstracts of Reviews of Effects (DARE)
o Evidence-Based Nursing Journal
o Health Information Resource Database
o Johanna Briggs Institute
o National Guidelines Clearinghouse
o Essential Evidence Plus/Patient-Oriented Evidence That Matters (POEMS)
o Worldviews on Evidence-Based Nursing
• Other scholars and practitioners express concerns about the current prominence and conception
of EBP as primarily using research as the source of evidence. Some believe that the best evidence
for EBP is theory rather than research (Fawcett, 2012). Reasons for concerns about reliance solely
on research for EBP include the following:
o Research is often done under very controlled circumstances, which is very different from
the real world of health care delivery.
o Research evidence suggests that there is one best solution to a problem for all clients and
this limited perspective stifles creativity.
o Research may ignore the significance of life events to the individual. Nursing care should
consider feasibility, appropriateness, meaningfulness, and effectiveness (FAME) of
interventions and plans (Pearson, Jordan, & Munn, 2012).
o Not all published research is robust and flawless.
o EBP should promote cost-effective care, but cost is often not included in traditional
research studies.
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NURSING RESEARCH
Florence Nightingale demonstrated how research findings could be used to improve nursing care. By
systematically collecting, organizing, and reporting data, Nightingale was able to institute sanitary reforms
and significantly reduce mortality rates from contagious diseases and infection. accrediting organizations
require all baccalaureate and higher degree programs to include coursework in research and evidence-
based practice. All nurses, however, have a responsibility to identify nursing issues that require research
and to participate in research studies to the extent they are able.
The journal Nursing Research was first published in 1952 to serve as a vehicle for communicating nurses’
research findings. The publication of many other nursing research journals followed, some dedicated to
research and others combining clinical and research articles.
Approaches to Nursing Research

Nurse researchers use two major approaches to investigating clients’ responses to health alterations and
nursing interventions. These approaches, quantitative and qualitative research, originate from different
philosophical perspectives and generate different types of data. Both approaches make valuable
contributions to evidence-based practice.
• QUANTITATIVE RESEARCH
o entails the systematic collection, statistical analysis, and interpretation of numerical data.
Quantitative research is characterized by planned and fixed study processes, careful
attention to extraneous variables (any variables that could influence the results of the
study other than the specific variable[s] being studied for their influence) or
contaminating factors in the study environment, and an objective and distanced
relationship between the researcher and what is being studied. Reports of quantitative
research are characterized by statistical information, tables, and graphs, which can make
them intimidating to read.
• QUALITATIVE RESEARCH
o is the systematic collection and thematic analysis of narrative data. In other words, the
research collects and analyzes words, rather than numbers. The qualitative approach to
research is rooted in the philosophical perspective of naturalism (sometimes referred to
as constructivism), which maintains that reality is relative or contextual and constructed
by individuals who are experiencing a phenomenon.
o Nurse researchers tend to use one of three distinct qualitative traditions:
1. Phenomenology - focuses on lived experiences
2. Ethnography - focuses on cultural patterns of thoughts and behaviors
3. grounded theory - focuses on social processes
o Additional qualitative types include historical and case study research.

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Overview of the Research Process

o The research process is a process in which decisions are made that result in a detailed plan or
proposal for a study, as well as the actual implementation of the plan.
o Nurses who are reading research reports to inform their practice need a basic understanding of
the research process in order to judge the credibility of a study’s findings and their usefulness for
EBP.
o Although the research process unfolds somewhat differently for quantitative and qualitative
studies, the same general steps are involved:
1. Formulating the research problem and purpose
 to narrow a broad area of interest into a more specific problem that indicates the
issue of concern behind the study
 a research problem should be significant to nursing and offer the potential to
improve client care. The problem must also be feasible to study in light of the
resources (including time and skill) that are available to conduct the study.
 One strategy for stating the problem you wish to explore is to use the PICO
format:
1. P – Patient, population, or problem of interest
2. I – Intervention or therapy to consider for the subject of interest
3. C – Comparison of interventions, such as no treatment
4. O – Outcome of the intervention.
2. Determining study methods

 The methodological elements of the research process deal with how the study is
organized, who or what will be the sources of information for the study, and data
collection details such as what data will be collected, how data will be collected,
and the timing of data collection. The first methodological decision made by a
researcher is whether the study will use a quantitative or qualitative research
approach. This decision has implications for subsequent methodological
decisions about research design, sampling, and data collection, as well as data
analysis.
 Research design refers to the overall structure or blueprint or general layout of a
study. The research design indicates how many times data will be collected in a
study, the timing of data collection relative to other study events, the types of
relationships between variables that are being examined, the number of groups
being compared in the study, and how extraneous variables will be controlled so
that study findings are more reliable and accurate. There are two major types of
research designs. With an experimental design, the researcher controls the
independent variable by administering an experimental treatment to some
participants while withholding it from others. Experimental designs are used to
determine cause-and-effect relationships. With a nonexperimental design, there
is no manipulation of the independent variable; in fact, there may be no
identifiable independent and dependent variables in the study. Nonexperimental
designs are used for descriptive research studies.

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3. Collecting research data

 The actual data collection phase of a research study, all of the methodological
decisions that have been made are implemented
 Detailed data collection protocols or instructions and careful training of research
assistants are strategies that can be used to ensure the consistency and integrity
of data collection procedures
1. Reliability refers to the consistency of measures. Validity refers to the
completeness and conceptual accuracy of measures
4. Analyzing research data
 the collected data are organized and analyzed to answer the research question(s)
or test the study’s hypothesis
 If a study has used a quantitative approach, data analysis involves the application
of a variety of statistical procedures. Descriptive statistics are procedures that
organize and summarize large volumes of data including measures of central
tendency and measures of variability
1. Descriptive Statistics: Measures of Central Tendency and Variability:
MEASURES OF CENTRAL TENDENCY
• Mean—the arithmetic average for a set of scores. The mean is
calculated by summing all scores and dividing by the number of
scores.
• Median—the middle value in a distribution of scores or the value
above and below which 50% of the scores lie.
• Mode—the most common or frequently occurring value in a data
set.
MEASURES OF VARIABILITY
• Range—the difference or span between the lowest and highest
value for a variable.
• Standard deviation—the average amount by which a single score
in a distribution deviates or differs from the mean score.
2. Commonly Used Inferential Statistics
• Independent t-test—used to compare the mean performance of
two independent groups (such as men and women).
• Dependent (or paired) t-tests—used to compare the mean
performance of two dependent or related groups (such as a
before and after test given to the same individuals).
• Analysis of variance (ANOVA)—used to compare the mean
performance of three or more groups.
• Pearson’s product-moment correlation coefficient (Pearson’s )—
used to describe and test the relationship between two
continuous variables (such as age and weight).
• Chi-squared—used to compare the distribution of a condition
across two or more groups.

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5. Communicating research findings

 Research findings must be made public if they are to become accessible and used
to guide practice decisions. Research findings can be communicated through
publication in journals or at conferences.
6. Using research findings in practice
 EBP entails using research findings and other sources of evidence to guide
decisions about client care. Before a study’s findings are used to guide practice,
they should undergo three types of evaluation:
1. scientific validation
• Done thorough critique of a study for its conceptual and
methodological integrity. This means scrutinizing how the study
was conceptualized, designed, and conducted in order to make a
judgment about the overall quality of its findings
2. comparative analysis
• involves assessing study findings for their implementation
potential. Three factors are considered:
1. how the study’s findings compare to findings from other
studies about the problem;
2. how the study’s findings will transfer from the research
conditions to the clinical practice conditions in which
they will be used; and
3. practical or feasibility considerations that need to be
addressed when applying the findings in practice
3. cost–benefit appraisal
• involves consideration of the potential risks and benefits of both
implementing a change based on a study’s findings and not
implementing a change.
Research-Related Roles and Responsibilities for Nurses
In today’s EBP environment, all nurses, regardless of their educational preparation, need to be able to
assume two research-related roles:
• RESEARCH CONSUMER
o Being a research consumer means routinely searching and reading the current research
literature in order to stay current with new insights in client experiences and nursing and
medical interventions. Two skills are fundamental to this role: locating relevant literature
and critiquing research reports.
• RESEARCH TEAM MEMBER

o nurses need to be able to function as a member of a research team. This role is particularly
important in hospitals that are seeking or wishing to maintain magnet recognition status.
Nurses in hospitals with this designation are expected to be involved in research and EBP
activities on an ongoing basis.
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o Depending on their individual experience with research, nurses who are working directly
with clients can make particularly valuable contributions to research projects, including:
 Identifying clinically relevant problems that need to be studied
 Reviewing the literature to provide background information for a study
 Recruiting study participants
 Securing clients’ consent to participate in a study
 Designing data collection instruments
 Pilot-testing data collection procedures
 Collecting research data
 Monitoring for adverse effects of study participation
 Implementing research interventions
 Assisting with interpretation of study findings.
PROTECTING THE RIGHTS OF STUDY PARTICIPANTS

Because nursing research usually involves humans, a major nursing responsibility is to be aware of and to
advocate on behalf of clients’ rights. Before any research on humans can be started, the researcher must
obtain approval from the relevant committee designated to protect human subjects’ rights.
All nurses who practice in settings where research is being conducted with human subjects or who
participate in such research play an important role in safeguarding the rights
• RIGHT NOT TO BE HARMED

o The risk of harm to a research subject is exposure to the possibility of injury going beyond
everyday situations. The risk can be immediate or delayed and can be physical, emotional,
legal, financial, or social in nature.
o Potential risks of participating in a study need to be detailed in informed consent
documents.
• RIGHT TO FULL DISCLOSURE
o Even though it may be possible to collect research data about a client as part of everyday
care without the client’s particular knowledge or consent, to do so is considered
unethical. Full disclosure, the act of making clear the client’s role in a research situation,
is a basic right. This means that deception, by either withholding information about a
client’s participation in a study or giving the client false or misleading information about
what participating in the study will involve, must not occur.
• RIGHT TO SELF-DETERMINATION
o participants should feel free from constraints, coercion, or any undue influence to
participate in a study.
• RIGHT TO PRIVACY
o Privacy enables a client to participate without worrying about later embarrassment. The
anonymity of a study participant must be ensured even if the investigator cannot link a
specific person to the information reported. Confidentiality means that any information
a participant relates will not be made public or available to others without the
participant’s consent.

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NRG106: Fundamentals of Nursing Practice

Nursing Program, DAVAO DOCTORS COLLEGE

ROLE OF NURSING THEORY

DOMINGO T. SO, JR., RN, MAN

OVERVIEW OF SELECTED NURSING THEORIES

Peplau’s Interpersonal Relations Model

DOMINGO T. SO, JR., RN, MAN

Orem’s General Theory of Nursing

Leininger’s Cultural Care Diversity and Universality Theory

Roy’s Adaptation Model

DOMINGO T. SO, JR., RN, MAN

Watson’s Human Caring Theory

DOMINGO T. SO, JR., RN, MAN

• Sources of Synthesized Knowledge:

Approaches to Nursing Research

DOMINGO T. SO, JR., RN, MAN

Overview of the Research Process

2. Determining study methods

DOMINGO T. SO, JR., RN, MAN

3. Collecting research data

DOMINGO T. SO, JR., RN, MAN

5. Communicating research findings

Research-Related Roles and Responsibilities for Nurses

• RESEARCH TEAM MEMBER

PROTECTING THE RIGHTS OF STUDY PARTICIPANTS

• RIGHT NOT TO BE HARMED

DOMINGO T. SO, JR., RN, MAN

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