知識來源Sourceofknowledg.ppt

知識來源 Source of knowledge,Superstition Tradition School learning Authority Trial and Error Media and experience Logical reasoning: deductive and inductive Scientific Methods,學(xué)習(xí)的層次結(jié)構(gòu) Hierarchy of Learning,Create Evaluate Analyze Apply Understand Remember,理論研究的層次結(jié)構(gòu) Level of theoretical discourse,Level,World view,Frameworks,Theories,Models,Descriptive generalizations,Observation,Products,Vision,Wisdom,Knowledge,Intelligence,Information,Data,New Vision: Earth Rising as seen from the Moon,第一章 護理理論概述 Introduction to Nursing Theory,Faculty of Nursing School of Medicine Xian Jiaotong University,第一節(jié) 護理理念 Nursing philosophy,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(dǎo)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,二、護理理念(nursing philosophy),是引導(dǎo)護理人員認(rèn)識及判斷護理及其它相關(guān)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) 為護理人員研究護理學(xué)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),三、護理理念的發(fā)展過程,禁欲主義階段（asceticism ）（18501920） 浪漫主義階段 (romanticism) （19211940） 實用主義階段 (pragmatism) (19401960) 人本存在主義(humanistic existentialism) (1960至今),四、護理理念與護理理論的關(guān)系,不同的護理學(xué)家，由于其理論的研究重點不同，對護理理念的四個要素有不同的認(rèn)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(guān)系,護理理論,第二節(jié) 護理學(xué)的核心概念 Central concepts of nursing,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(zhì)的理性認(rèn)識。,What is a Concept?,“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-concept, beliefs, oxygen, etc.,二、分類 （1）根據(jù)人們對概念的認(rèn)識： 抽象概念 具體概念 （2）根據(jù)概念的性質(zhì)及應(yīng)用范圍： 列舉性概念 關(guān)聯(lián)性概念 聯(lián)合性概念 統(tǒng)計性概念 總結(jié)性概念,三、概念的形成過程 （concept formation),思考、科研、系統(tǒng)觀察會形成概念。,Concept Formation,A concept as a thought, idea or notion,A concept as an abstract idea generalized from particular instances,Relationship of the Stimulus to the concept,Internal Stimulus,External Stimulus,Scope,Examples,Simple Complex,Concrete Abstract,Value in Scientific Inquiry,四、概念與理論的關(guān)系,概念的組成部分為理論（Basic ingredients of a theory）,五.護理學(xué)的概念（Nursing concepts) Such as health, caring, interaction, stress, adaptation, growth, grief, illness, needs, etc.,Four Basic Concepts of Nursing,Person Environment Health Nursing,Person (description),Each person 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 functioning. Each person is seen within a social context.,Person,Human beings-unique individuals, family or friends Bio-psychosocial Functioning-needs, strengths Rights, responsibilities, dignity Culture Developmental, lifespan Adaptable, self-responsible,Health (description),Health is the multidimensional concept which contains bio-psychosocial 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.,Health,Well-being, quality of life Continuum-health-illness Equilibrium Biopsychosocial dimensions Able to do things one wants Feeling good Objective and subjective elements,Environment (description),The 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 which includes social values, beliefs and customs and internal/external dimension. The environment is ever changing in the context of time and space.,Environment,Working, family, community, global Animate and inanimate Time and space Cultural, customs, rituals Internal and external Dynamic, changing,Nursing( Description),The essence of nursing 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, maintain and restore health, and to help people attain a peaceful death.,Nursing,Caring for individuals, families, communities Promotion of well-being Peaceful death Technical skills A process Supporting life Practice-based Relationship with patient and others,第三節(jié) 護理理論 Nursing Theory,一、有關(guān)護理理論的基本概念 1、知識（Knowledge）is an awareness or perception of reality acquired through learning or investigation) 通過學(xué)習(xí)或研究而獲得的對現(xiàn)實世界的認(rèn)識,2、科學(xué)（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(xué)的研究而獲得的知識體系（自然、社會、思維三大知識領(lǐng)域）,3、Metaparadiam （學(xué)科領(lǐng)域或觀點）,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 discipline.（學(xué)科的主要學(xué)術(shù)價值及觀點，主要問題）,4、Paradigm（科學(xué)觀）,A paradigm is a conceptual diagram, it can be a large structure used to organize theory, that are shared by its scientific community.,5、Model (模式）,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(guān)系的解釋）,6、理論（Theory）,An abstract general plan that presents a systematic explanations and relationships among concepts. Theories embody principles for describing, explaining, predicting, and controlling phenomena Ultimate goal of science Make 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(rèn)識。 每個理論都由一個以上的概念及概念之間的相互關(guān)系如并列、相關(guān)、因果等關(guān)系而組成。,Metaparadigm of Nursing,Components Paradigm Metaparadigm Philosophies Conceptual Models Theories Empirical Indicators,Levels of Abstraction Most Abstract Most Concrete,二、理論的分類,用途：基礎(chǔ)理論及應(yīng)用理論； 應(yīng)用范圍：宏觀理論及微觀理論； 專業(yè)性：護理理論、生物學(xué)理論、醫(yī)學(xué)理論等。 功能：描述性、解釋性及預(yù)測性理論,三理論的功能,描述 解釋 預(yù)測客觀事物 指導(dǎo)實踐。,Characteristics of a Theory,Interrelate concepts to create new way of looking at a particular phenomenon Logical in nature Relatively simple yet generalizable Bases for hypotheses to be tested for theory expansion Contribute to body of knowledge of a discipline Can be used by practitioners to guide and improve practice Must be consistent with other validated theories, laws and principles,第四節(jié) 護理理論,一、護理理論的概念 護理理論是對護理現(xiàn)象及本質(zhì)的規(guī)律性系統(tǒng)性認(rèn)識。 卡渤（Carper）認(rèn)為護理的對象是人，護理學(xué)的概念及知識需要從以下四個方面綜合來獲取：,1倫理學(xué)知識（ethics) 即對護理學(xué)的職業(yè)道德 及倫理的規(guī)律性認(rèn)識。 2美學(xué)知識(Esthetics )：即護理藝術(shù)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(wù)對象的認(rèn)識。 4科學(xué)知識(Science)：即通過科學(xué)實驗的方法所獲取的護理學(xué)知識。,二、發(fā)展背景,1南丁格爾時代 2哥倫比亞大學(xué)學(xué)派時代（二十世紀(jì)50 年代） 3耶魯大學(xué)學(xué)派時代二十世紀(jì)60年代 4二十世紀(jì)70年代 5二十世紀(jì)80年代到目前,三、發(fā)展階段,1、南丁格爾時代（Nightingale) 2、醫(yī)學(xué)模式階段(Medical model) 3、借用階段(borrowed theories) 4、獨特理論階段(Unique theories ),四、護理理論的特征,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?qū)⒏拍钜蕴厥獾姆绞铰?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(yīng)用。 4理論可以作為假設(shè)的基礎(chǔ)而經(jīng)受檢驗。 5通過對理論的實踐及研究，能夠增加 護理學(xué)科的知識。 6必須對實踐有指導(dǎo)作用。 7必須與其它已證實的理論及規(guī)律一致。,五、護理理論的分類,1按照護理理論的抽象程度及其對實踐的指導(dǎo)意義(scope of the theory)，可以將護理理論分為以下三類： Grand theory Middle range theory Micro theory or partial theory,Grand Theories 宏觀理論,Broadest in Scope Conceptual structures Substantively nonspecific Being made up of relatively abstract concepts that lack operational definition, Not developed by empirical research, but by thoughtful and insightful appraisal of existing ideas or creative leaps beyond existing knowledge.,Grand Theories,Orem Levine Rogers Johnson Roy Neuman King Roper, Logan,and Tierney,Middle Range Nursing Theories 次宏觀理論（中層理論）,Substantively 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 philosophies 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 outcome,Middle Range Nursing Theories,Peplau Orlando Travelbee Riehl Erickson, Tomlin, & Swain Mercer Barnard Leininger Parse Fitzpatrick Newman Adam Pender,2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(guān)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,Nursing Theories Categorized by concepts,Person Travelbee (1966) - person, family, community for whom illness has a special meaning Henderson (1966) - mind and body inseparable, individuals unique, 14 basic needs Rogers (1970) - unitary human being viewed as an energy field Orem (1971) - individual integrated whole with varying degrees of self care ability King (1971) - individuals have ability to perceive, think, feel, choose, set goals and make decisions Benner & Wrubel (1989) - individual is self-interpreting being engaged by human capacities in the world,Nursing Theories Categorized by concepts,Environment Nightingale (1860) - environment is central concept Travelbee (1966) - environment is context in which human rapport is established Levine (1967) - society is viewed as the total environment of the individual, family, and nurse Roy (1976) - environment constantly interacts with the individual and impacts adaptation Newman (1986) - environment and person form a unitary pattern reflected in movement-space-time patterns of consciousness,Nursing Theories Categorized by concepts,Health Hall (1966) - self-actualization, self love Henderson (1966) - independent function Levine (1967) - maintaining holism/conservation Orem (1971) - self-care agency Paterson & Zderad (1976) - authentic awareness Roy (1976) - continual adaptation Newman (1986) - expanding consciousness,Nursing Theories Categorized by concepts,Nursing Peplau (1952) - therapeutic interpersonal process Orlando (1961) - process of interaction with and ill individual to meet an immediate need Wiedenbach (1964) - three components: identified need; ministration of help; validation Levine (1967) - supportive and therapeutic Watson (1985) - human science and an art