_第八章護理理論PPT

1、lSuperstitionlTraditionlSchool learning lAuthoritylTrial and ErrorlMedia and experience lLogical reasoning: deductive and inductivelScientific Methods Create EvaluateAnalyzeApply UnderstandRemember Level World view Frameworks Theories Models Descriptive generalizations Observation Products Vision Wi

2、sdom Knowledge Intelligence Information Data Content Implicit assumptionsConcepts/principles Relationship among concepts Mechanism for relations Taxonomic classificationPhenomena New Vision: Earth Rising as seen from the MoonIntroduction toIntroduction to NursingNursing TheoryTheoryFaculty of Nursin

3、gSchool of MedicineXian Jiaotong University 一、理念的概念理念（philosophy）， 拉丁文philia（愛）及sophia（智慧），智慧之愛。尋找真理。 “理念是指導個人思維及行為的價值觀與信念”。 以原則的形式左右及指引個人的思維方式及行為舉止協(xié)助個人判斷是非決定事物的價值 是引導護理人員認識及判斷護理及其它相關方面的價值觀及信念。(concerned with the values and beliefs of a discipline and provide a guidance for the members of discipline

4、)為護理人員研究護理學的四個核心概念，人、健康、環(huán)境及護理提供專業(yè)理念體系。(Providing the framework for asking questions about central concept of the discipline)禁欲主義階段（禁欲主義階段（asceticism ）（18501920）浪漫主義階段浪漫主義階段 (romanticism) （19211940）實用主義階段實用主義階段 (pragmatism) (19401960)人本存在主義人本存在主義(humanistic existentialism) (1960至今至今) 不同的護理學家，由于其理論的研究

5、重點不同，對護理理念的四個要素有不同的認識，也采用了不同的詞來描述這四個基本概念。人環(huán)境社會健康護理概念之間的相互關系護理理論 一、定義 Webster: 概念是人們對周圍環(huán)境中的某種物體所形成的印象，是人們對客觀事物屬性及本質的理性認識。“A thought or a notion conceived in the mind”Two types:Empirical - observed or experienced through senses i.e. stethoscope, cup, chair, etc.Abstract - not observable i.e. self-conc

6、ept, beliefs, oxygen, etc.二、二、分類分類 （1）根據(jù)人們對概念的認識： 抽象概念 具體概念（2）根據(jù)概念的性質及應用范圍： 列舉性概念 關聯(lián)性概念 聯(lián)合性概念 統(tǒng)計性概念 總結性概念思考、科研、系統(tǒng)觀察會形成概念。Concept FormationA concept as athought, idea or notionA concept as an abstract idea generalized from particular instances Relationship of theStimulus to the conceptInternal Stimul

7、usExternal StimulusScope ExamplesSimpleComplexConcreteAbstractValue in Scientific Inquiry 概念的組成部分為理論（Basic ingredients of a theory）五五.護護理學的概念（理學的概念（Nursing concepts)Such as health, caring, interaction, stress, adaptation, growth, grief, illness, needs, etc. PersonEnvironmentHealth NursingEach person

8、 is a unique individual viewed in holistic terms. By holistic it meant that the individual is considered a total human being with biopsychosocial needs. Each person has the right to dignity, respect, autonomy and the opportunity to grow and develop to their full potential and to achieve optimal func

9、tioning. Each person is seen within a social context.Human beings-unique individuals, family or friendsBio-psychosocialFunctioning-needs, strengthsRights, responsibilities, dignityCultureDevelopmental, lifespanAdaptable, self-responsibleHealth is the multidimensional concept which contains bio-psych

10、osocial elements on a functional continuum. Health is intrinsically related to notions of quality of life, harmony and well-being. Health can be defined objectively and from subjective experience.Well-being, quality of lifeContinuum-health-illnessEquilibriumBiopsychosocial dimensionsAble to do thing

11、s one wantsFeeling goodObjective and subjective elementsThe enrironment is the major determinant of the health of individuals, families, and communities. It provides the context for nursing practice. The environment can be considered along two dimensions: The physical and socio-cultural environment

12、which includes social values, beliefs and customs and internal/external dimension. The environment is ever changing in the context of time and space.Working, family, community, globalAnimate and inanimateTime and spaceCultural, customs, ritualsInternal and externalDynamic, changing The essence of nu

13、rsing is caring. Nursing is a practice-based profession involving both art and science, the art is the process in terms of the nurse-client relationship. The science is the knowledge and skills the nurse contributes to nursing practice. The aim of nursing is to promote well-being, prevent illness, m

14、aintain and restore health, and to help people attain a peaceful death.Caring for individuals, families, communitiesPromotion of well-beingPeaceful deathTechnical skillsA processSupporting lifePractice-basedRelationship with patient and others一、有關護理理論的基本概念一、有關護理理論的基本概念1、知識（、知識（Knowledge）is an awaren

15、ess or perception of reality acquired through learning or investigation) 通過學習或研究而獲得的對現(xiàn)實世界的認識2、科學（、科學（Science ）refers to a body of knowledge, including facts and theories, generated by the use of controlled, rigorous, and precise methods within a delimited area of concern. 通過系統(tǒng)科學的研究而獲得的知識體系（自然、社會、思維三

16、大知識領域）Domain is the perspective and the territory of the discipline. It contains the subject matters of a discipline, the main agreed upon values and beliefs, the central concepts the phenomenon of interest, its central problems, and the methods that are used to provide some answers in the disciplin

17、e.（學科的主要學術價值及觀點，主要問題）A paradigm is a conceptual diagram, it can be a large structure used to organize theory, that are shared by its scientific community.A model is an idea that explains by using symbolic and physical visualization.(用圖示或符號對概念及其關系的解釋） An abstract general plan that presents a systemat

18、ic explanations and relationships among concepts.Theories embody principles for describing, explaining, predicting, and controlling phenomenaUltimate goal of scienceMake scientific findings meaningful and generalizable理論是人們對自然界及人類社會現(xiàn)象的規(guī)律的系統(tǒng)性認識。每個理論都由一個以上的概念及概念之間的相互關系如并列、相關、因果等關系而組成。ComponentsParadig

19、mMetaparadigm PhilosophiesConceptual ModelsTheoriesEmpirical IndicatorsLevels of AbstractionMost AbstractMost Concrete用途：基礎理論及應用理論；應用范圍：宏觀理論及微觀理論；專業(yè)性：護理理論、生物學理論、醫(yī)學理論等。功能：描述性、解釋性及預測性理論描述解釋預測客觀事物指導實踐。Interrelate concepts to create new way of looking at a particular phenomenonLogical in natureRelativel

20、y simple yet generalizableBases for hypotheses to be tested for theory expansionContribute to body of knowledge of a disciplineCan be used by practitioners to guide and improve practiceMust be consistent with other validated theories, laws and principles一、護理理論的概念一、護理理論的概念 護理理論是對護理現(xiàn)象及本質的規(guī)律性系統(tǒng)性認識?？ú常–

21、arper）認為護理的對象是人，護理學的概念及知識需要從以下四個方面綜合來獲?。?1倫理學知識（ethics) 即對護理學的職業(yè)道德 及倫理的規(guī)律性認識。2美學知識(Esthetics )：即護理藝術或護理行為方 面的知識。3個人知識 (Intuition)：即通過個人的直感而獲取服務對象的認識。4科學知識(Science)：即通過科學實驗的方法所獲取的護理學知識。1南丁格爾時代2哥倫比亞大學學派時代（二十世紀50 年代）3耶魯大學學派時代二十世紀60年代4二十世紀70年代5二十世紀80年代到目前1、南丁格爾時代（Nightingale)2、醫(yī)學模式階段(Medical model)3、借用階

22、段(borrowed theories)4、獨特理論階段(Unique theories ) 妥瑞斯（Torres，1990）理論必須具有以下幾個基本的特征： 1理論能夠將概念以特殊的方式聯(lián)系起來，從而提供一個全新的觀察事物的方法或角度。 2護理理論必須具有一定的邏輯性。3理論必須簡單易懂，并容易推廣應用。4理論可以作為假設的基礎而經受檢驗。5通過對理論的實踐及研究，能夠增加 護理學科的知識。6必須對實踐有指導作用。7必須與其它已證實的理論及規(guī)律一致。1按照護理理論的抽象程度及其對實踐的指導意義(scope of the theory)，可以將護理理論分為以下三類： Grand theory

23、Middle range theory Micro theory or partial theoryuBroadest in ScopeuConceptual structures uSubstantively nonspecificuBeing made up of relatively abstract concepts that lack operational definition,uNot developed by empirical research, but by thoughtful and insightful appraisal of existing ideas or c

24、reative leaps beyond existing knowledge. OremLevineRogersJohnsonRoyNeumanKingRoper, Logan,and TierneySubstantively specific;Encompassing a limited number of concepts;Limited aspect of the real world;Derived from works in other disciplines related to nursing;From earlier works in nursing such as phil

25、osophies and theories, and from nursing conceptual models and grand theories;Specific to nursing practice and specify the area of practice, age range of the client, the nursing action or intervention, and the proposed outcomePeplauOrlandoTravelbeeRiehlErickson, Tomlin, & SwainMercerBarnardLeinin

26、gerParseFitzpatrickNewmanAdamPender2按照護理理論的著重點不同，可以將 護理理論分為以下四種類型： 以需要及問題為中心的理論 以護患關系為中心的理論 以系統(tǒng)為中心的理論 以能量源為中心的護理理論PersonTravelbee (1966) - person, family, community for whom illness has a special meaningHenderson (1966) - mind and body inseparable, individuals unique, 14 basic needs Rogers (1970) -

27、unitary human being viewed as an energy field Orem (1971) - individual integrated whole with varying degrees of self care abilityKing (1971) - individuals have ability to perceive, think, feel, choose, set goals and make decisionsBenner & Wrubel (1989) - individual is self-interpreting being eng

28、aged by human capacities in the worldEnvironmentNightingale (1860) - environment is central conceptTravelbee (1966) - environment is context in which human rapport is establishedLevine (1967) - society is viewed as the total environment of the individual, family, and nurseRoy (1976) - environment co

29、nstantly interacts with the individual and impacts adaptationNewman (1986) - environment and person form a unitary pattern reflected in movement-space-time patterns of consciousnessHealthHall (1966) - self-actualization, self loveHenderson (1966) - independent functionLevine (1967) - maintaining hol

30、ism/conservationOrem (1971) - self-care agencyPaterson & Zderad (1976) - authentic awarenessRoy (1976) - continual adaptationNewman (1986) - expanding consciousnessNursingPeplau (1952) - therapeutic interpersonal processOrlando (1961) - process of interaction with and ill individual to meet an immediate needWiedenbach (1964) - three components: identified need; mini