Nursing Theories in Implementing Theoretical Courses in Nursing Hesook Suzie Kim, PhD, RN Professor, College of Nursing University of Rhode Island

Types of Theoretical Courses in Nursing Health, health care, health care systems, & related ecosystem and cultural issues The profession of nursing Methods of inquiry and research Theoretical courses with clinical contents for different population groups Nursing practice Nursing interaction

Variations in the Modes of Incorporating Nursing Theories in the Courses Conceptual framework or grand theory as the schema for organizing curricular contents Conceptual framework or grand theory as the schema for systematizing nursing process Eclectic selection and teaching of nursing theories

As the Schema for Organizing Curricular Content Holism as the organizing framework Systems perspective as the organizing framework Adaptation perspective as the organizing framework Needs perspective as the organizing framework Self-care perspective as the organizing framework Caring perspective as the organizing framework

As the Schema for Systematizing Nursing Process Major conceptual categories regarding persons as the basis for organizing assessment data Explanatory ideas as the basis for making inferences about patients’ status Explanatory ideas as the basis for selecting patient-care approaches

Eclectic selection and teaching of nursing theories No specific commitment to a specific grand theory or conceptual framework The major impetus for bringing in nursing theories – Heuristic value Commitment to Pluralism in nursing knowledge development and applicability Can be opportunistic, biased, or haphazardly selected

Eclectic selection and teaching of nursing theories Guidelines for this approach Establishment of Ontological Commitments regarding Humans, Human Living, and Practice Epistemological understanding regarding the Nature of Nursing Knowledge Formalization of A Model of Nursing Practice

Ontological Commitments Ontology of Humans & Human Living Biophysical entity Self & individuality Social, cultural, & historical embeddedness Boundedness & determinism Language, intentionality, self-determination, and consciousness Ontology of Practice Human to human engagement Helping as the normative focus Responsibility in one’s own action Practice as situation-bound

The Nature of Nursing Knowledge Client phenomena of interest to nursing – Nursing’s epistemic concerns regarding humans as clients of nursing Types of Knowledge needed for practice Enlightenment & Understanding Explanation & Prediction Control & Manipulation Multiple routes to nursing knowledge development

Formalization of a Model of Nursing Practice An example from AACN Practice in providing care Holistic base by incorporating bio-psycho-social & spiritual aspects Advocacy and Education Clinical judgment & decision-making Clients with diverse background Engagement in diverse environment Practice in designing, managing, & coordinating care Coordination in a health-care team Information management Practice as a member of the nursing profession

A Model of Nursing Practice Two Philosophical Orientations Philosophy of Care Philosophy of Therapy Three Dimensions of Practice Scientific Dimension Ethical Dimension Aesthetic Dimension Two Interacting Phases of Practice Deliberation Enactment

A Model of Nursing Practice Ethical Dimension Philosophy of Therapy Scientific Dimension Philosophy of Care Deliberation Enactment Aesthetic Dimension

Nursing Epistemology Four Types of Cognitive Needs in Nursing and Four Spheres of Knowledge Inferential Needs – Generalized Knowledge Sphere Referential Needs – Situated Hermeneutic Knowledge Sphere Transformative Needs – Critical Hermeneutic Knowledge Sphere Desiderative Needs – Ethical/Aesthetic Knowledge Sphere

Nursing Epistemology GENERALIZED KNOWLEDGE SPHERE SITUATED HERMENEUTIC CRITICAL HERMENEUTIC KNOWLEDGE SPHERE INFERENTIAL FOCUS TRANSFORMATIVE FOCUS REFERENTIAL FOCUS SYNTHESIS DISIDERATIVE FOCUS ETHICAL/AESTHETIC KNOWLEDGE SPHERE

Theories in Different Knowledge Spheres Generalized Knowledge Sphere – Inferential theories (Descriptive, Explanatory, & Prescriptive) Situated Hermeneutic Knowledge Sphere – Referential theories (Descriptive) Critical Hermeneutic Knowledge Sphere – Transformative theories (Descriptive, Explanatory, & Prescriptive-transformative) Ethical/Aesthetic Knowledge Sphere – Normative theories

Selection & Incorporation of Nursing Theories Selection of the Subject Matter or Topics in Courses (Based on some other organizing theory or framework) Survey of nursing theories in the literature related to the subject matter Selection of nursing theories in relation to four cognitive needs Incorporation into teaching

Incorporation of Nursing Theories into Teaching Understanding the phenomena Finding nursing approaches related to the phenomena Theories for Inferential Purpose Theories for Referential Purpose Theories for Transformative Purpose Theories for Desiderative Purpose

An Example: Pain Inferential Focus Referential Focus Transformative Focus Desiderative Focus Understanding the Phenomena Biochemistry of pain Gate control theory of pain Psychological theory of pain expression Pain experience trajectory Embodied experience of pain Suffering Meaning theory of pain Meta-narratives of pain Stigma of pain Transcultural theory of pain Nursing approaches re: the phenomena Theories of pain assessment Theories of pain management Clinical assessment of pain Phenomenology of pain management Theories of client-nurse collaboration Theories of emancipation & empowerment Ethical theory of pain management Normative theory of pain management

A Proposal Knowledge of key nursing theories which are well established and have disciplinary respect Determination of general nursing theories applicable to many (or across) nursing phenomena Selection of nursing theories specific to given nursing phenomena Focus on establishing the nursing practice perspective

Types of Theoretical Courses in Nursing Health, health care, health care systems, & related ecosystem and cultural issues The profession of nursing Methods of inquiry and research Theoretical courses with clinical contents for different population groups Nursing practice Nursing interaction