醫(yī)學課件-護理理論-課件

1、知識來源 Source of knowledge SuperstitionTraditionSchool learning AuthorityTrial and ErrorMedia and experience Logical reasoning: deductive and inductiveScientific Methods 1.知識來源 Source of knowledge Supe學習的層次結(jié)構(gòu)Hierarchy of Learning Create EvaluateAnalyzeApply UnderstandRemember 2.學習的層次結(jié)構(gòu)Hierarchy of Lea

2、rning 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 Content Implicit assumptionsConcepts/principles Relationship among concepts Mechanism for relations Taxonom

3、ic classificationPhenomena 3.理論研究的層次結(jié)構(gòu)Level of theoreticalNew Vision: Earth Rising as seen from the Moon4.New Vision: Earth Rising as se護理理論概述Introduction to Nursing TheoryFaculty of NursingSchool of MedicineXian Jiaotong University5.護理理論概述Introduction to Nursing6.6.7.7.第一節(jié) 護理理念Nursing philosophy 一、

4、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8.第一節(jié) 護理理念Nursing philosophy 二、護理理念(nursing philosophy) 是引導護理人員認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 d

5、iscipline)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)9.二、護理理念(nursing philosophy) 是三、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) (1

6、960至今)10.三、護理理念的發(fā)展過程禁欲主義階段（asceticism ）四、護理理念與護理理論的關(guān)系 不同的護理學家，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識，也采用了不同的詞來描述這四個基本概念。11.四、護理理念與護理理論的關(guān)系 不同的護理學家，由于其理人環(huán)境社會健康護理概念之間的相互關(guān)系護理理論12.人環(huán)境社會健康護理概念之間的相互關(guān)系護理理論12.第二節(jié) 護理學的核心概念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)的理性認識。13.第二節(jié) 護理學的核心

7、概念Central concepts What is a Concept?“A thought or a notion conceived in the mind”Two types:Empirical - observed or experienced through sensesi.e. stethoscope, cup, chair, etc.Abstract - not observablei.e. self-concept, beliefs, oxygen, etc.14.What is a Concept?“A thought o二、分類 （1）根據(jù)人們對概念的認識： 抽象概念 具

8、體概念（2）根據(jù)概念的性質(zhì)及應用范圍： 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15.二、分類 15.16.16.17.17.18.18.19.19.20.20.21.21.22.22.23.23.24.24.25.25.26.26.27.27.28.28.三、概念的形成過程 （concept formation)思考、科研、系統(tǒng)觀察會形成概念。29.三、概念的形成過程 （concept formation)思Concept FormationA concept as athought, idea or notionA concept as an abstract idea

9、generalized from particular instances Relationship of theStimulus to the conceptInternal StimulusExternal StimulusScope ExamplesSimpleComplexConcreteAbstractValue in Scientific Inquiry 30.Concept FormationA concept as 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）31.四、概念與理論的關(guān)系概念的組成部分為理論（Basic i

10、ng五.護理學的概念（Nursing concepts)Such as health, caring, interaction, stress, adaptation, growth, grief, illness, needs, etc. 32.五.護理學的概念（Nursing concepts)32.Four Basic Concepts of NursingPersonEnvironmentHealth Nursing33.Four Basic Concepts of NursingPerson (description)Each person is a unique individua

11、l 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 i

12、s seen within a social context.34.Person (description)Each persoPerson Human beings-unique individuals, family or friendsBio-psychosocialFunctioning-needs, strengthsRights, responsibilities, dignityCultureDevelopmental, lifespanAdaptable, self-responsible35.Person Human beings-unique indHealth (desc

13、ription)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.36.Health (description)Health is

14、HealthWell-being, quality of lifeContinuum-health-illnessEquilibriumBiopsychosocial dimensionsAble to do things one wantsFeeling goodObjective and subjective elements37.HealthWell-being, quality of lEnvironment (description)The enrironment is the major determinant of the health of individuals, famil

15、ies, 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 o

16、f time and space.38.Environment (description)The eEnvironmentWorking, family, community, globalAnimate and inanimateTime and spaceCultural, customs, ritualsInternal and externalDynamic, changing 39.EnvironmentWorking, family, coNursing( Description)The essence of nursing is caring. Nursing is a prac

17、tice-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

18、 help people attain a peaceful death.40.Nursing( Description)The essenNursingCaring for individuals, families, communitiesPromotion of well-beingPeaceful deathTechnical skillsA processSupporting lifePractice-basedRelationship with patient and others41.NursingCaring for individuals,第三節(jié) 護理理論Nursing Th

19、eory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) 通過學習或研究而獲得的對現(xiàn)實世界的認識42.第三節(jié) 護理理論Nursing Theory一、有關(guān)護理2、科學（Science ）refers to a body of knowledge, including facts and theories, generated by the use of controlled, rigorous, and precise

20、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、思維三大知識領(lǐng)域）43.2、科學（Science ）refers to a body3、Metaparadiam （學科領(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 c

21、oncepts the phenomenon of interest, its central problems, and the methods that are used to provide some answers in the discipline.（學科的主要學術(shù)價值及觀點，主要問題）44.3、Metaparadiam （學科領(lǐng)域或觀點）Domai4、Paradigm（科學觀） A paradigm is a conceptual diagram, it can be a large structure used to organize theory, that are share

22、d by its scientific community.45.4、Paradigm（科學觀） A paradigm is 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）46.5、Model (模式）A model is an idea6、理論（Theory） An abstract general plan that presents a systematic explanations and relationships

23、among concepts.Theories embody principles for describing, explaining, predicting, and controlling phenomenaUltimate goal of scienceMake scientific findings meaningful and generalizable47.6、理論（Theory） An abstract gener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(guān)系如并列、相關(guān)、因果等關(guān)系而組成。48.理論是人們對自然界及人類社會現(xiàn)

24、象的規(guī)律的系統(tǒng)性認識。48.Metaparadigm of NursingComponentsParadigmMetaparadigm PhilosophiesConceptual ModelsTheoriesEmpirical IndicatorsLevels of AbstractionMost AbstractMost Concrete49.Metaparadigm of NursingCompone二、理論的分類 用途：基礎(chǔ)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50.二、理論的分類 用途：基礎(chǔ)理論及應用理

25、論；50. 三理論的功能 描述解釋預測客觀事物指導實踐。51. 三理論的功能 描述51.Characteristics of a TheoryInterrelate concepts to create new way of looking at a particular phenomenonLogical in natureRelatively simple yet generalizableBases for hypotheses to be tested for theory expansionContribute to body of knowledge of a discipline

26、Can be used by practitioners to guide and improve practiceMust be consistent with other validated theories, laws and principles52.Characteristics of a TheoryInt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)性認識?？ú常–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?。?53.第四節(jié) 護理理論一、護理理論的概念53.1倫理學知識（ethics) 即對護理學的職業(yè)道德 及倫理的規(guī)

27、律性認識。2美學知識(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。54.1倫理學知識（ethics) 即對護理學的職業(yè)道德54.二、發(fā)展背景 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55.二、發(fā)展背景 1南丁格爾時代55.三、發(fā)展階段1、南丁格爾時代（Nightingale)2、醫(yī)學模式階段(Medical model)3、借用階段(borrow

28、ed theories)4、獨特理論階段(Unique theories )56.三、發(fā)展階段1、南丁格爾時代（Nightingale)56.四、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。57.四、護理理論的特征 妥瑞斯（Torres，1990）理論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(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。58.3理論必

29、須簡單易懂，并容易推廣應用。58.五、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 theory59.五、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Grand Theories宏觀理論Broadest in ScopeConceptual structures Substantively nonspecificBeing made up of relatively abstract c

30、oncepts that lack operational definition,Not developed by empirical research, but by thoughtful and insightful appraisal of existing ideas or creative leaps beyond existing knowledge. 60.Grand Theories宏觀理論Broadest inGrand TheoriesOremLevineRogersJohnsonRoyNeumanKingRoper, Logan,and Tierney61.Grand T

31、heoriesOrem61.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 concept

32、ual 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 outcome62.Middle Range Nursing TheoriesMiddle Range Nursing TheoriesPeplauOrlandoTravelbeeRiehlErickson, Tomlin, & SwainMercerBar

33、nardLeiningerParseFitzpatrickNewmanAdamPender63.Middle Range Nursing TheoriesP2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64.2按照護理理論的著重點不同，可以將64.Nursing Theories Categorized by conceptsPersonTravelbee (1966) - person, family, community for whom illness has a specia

34、l meaningHenderson (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 abilityKing (1971) - individuals have ability to perceive, think, feel,

35、choose, set goals and make decisionsBenner & Wrubel (1989) - individual is self-interpreting being engaged by human capacities in the world65.Nursing Theories Categorized Nursing Theories Categorized by conceptsEnvironmentNightingale (1860) - environment is central conceptTravelbee (1966) - environm

36、ent is context in which human rapport is establishedLevine (1967) - society is viewed as the total environment of the individual, family, and nurseRoy (1976) - environment constantly interacts with the individual and impacts adaptationNewman (1986) - environment and person form a unitary pattern ref

37、lected in movement-space-time patterns of consciousness66.Nursing Theories Categorized Nursing Theories Categorized by conceptsHealthHall (1966) - self-actualization, self loveHenderson (1966) - independent functionLevine (1967) - maintaining holism/conservationOrem (1971) - self-care agencyPaterson

38、 & Zderad (1976) - authentic awarenessRoy (1976) - continual adaptationNewman (1986) - expanding consciousness67.Nursing Theories Categorized Nursing Theories Categorized by conceptsNursingPeplau (1952) - therapeutic interpersonal processOrlando (1961) - process of interaction with and ill individual to meet an immediate needWiedenbach (1964) - three components: identified need; ministration of help; validationLevine (1967) - supportive and therapeuticWatson (1985) - human science and an art based on the moral ideal and value of caring68.Nursing Theories