護(hù)理學(xué)導(dǎo)論第八章 護(hù)理理論課件

知識(shí)來源

Sourceofknowledge

SuperstitionTraditionSchoollearningAuthorityTrialandErrorMediaandexperienceLogicalreasoning:deductiveandinductiveScientificMethods護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論學(xué)習(xí)的層次結(jié)構(gòu)

HierarchyofLearningCreateEvaluateAnalyzeApplyUnderstandRemember護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論理論研究的層次結(jié)構(gòu)

LeveloftheoreticaldiscourseLevelWorldview

FrameworksTheoriesModelsDescriptivegeneralizationsObservationProducts

VisionWisdomKnowledgeIntelligenceInformationDataContent

ImplicitassumptionsConcepts/principlesRelationshipamongconcepts

MechanismforrelationsTaxonomicclassificationPhenomena

護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論NewVision:EarthRisingasseenfromtheMoon護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論第一章護(hù)理理論概述

Introductionto

NursingTheoryFacultyofNursingSchoolofMedicineXi’anJiaotongUniversity護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論第一節(jié)護(hù)理理念

Nursingphilosophy

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(gè)人思維及行為的價(jià)值觀與信念”。以原則的形式左右及指引個(gè)人的思維方式及行為舉止協(xié)助個(gè)人判斷是非決定事物的價(jià)值護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論二、護(hù)理理念(nursingphilosophy)

是引導(dǎo)護(hù)理人員認(rèn)識(shí)及判斷護(hù)理及其它相關(guān)方面的價(jià)值觀及信念。(concernedwiththevaluesandbeliefsofadisciplineandprovideaguidanceforthemembersofdiscipline)為護(hù)理人員研究護(hù)理學(xué)的四個(gè)核心概念，人、健康、環(huán)境及護(hù)理提供專業(yè)理念體系。(Providingtheframeworkforaskingquestionsaboutcentralconceptofthediscipline)護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論三、護(hù)理理念的發(fā)展過程禁欲主義階段（asceticism

）（1850~1920）浪漫主義階段(romanticism)

（1921~1940）實(shí)用主義階段(pragmatism)

(1940~1960)人本存在主義(humanisticexistentialism)

(1960~至今)護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論四、護(hù)理理念與護(hù)理理論的關(guān)系

不同的護(hù)理學(xué)家，由于其理論的研究重點(diǎn)不同，對(duì)護(hù)理理念的四個(gè)要素有不同的認(rèn)識(shí)，也采用了不同的詞來描述這四個(gè)基本概念。護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論人環(huán)境社會(huì)健康護(hù)理概念之間的相互關(guān)系護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論第二節(jié)護(hù)理學(xué)的核心概念

Centralconceptsofnursing

一、定義

Webster:概念是人們對(duì)周圍環(huán)境中的某種物體所形成的印象，是人們對(duì)客觀事物屬性及本質(zhì)的理性認(rèn)識(shí)。護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論WhatisaConcept?“Athoughtoranotionconceivedinthemind”Twotypes:Empirical-observedorexperiencedthroughsensesi.e.stethoscope,cup,chair,etc.Abstract-notobservablei.e.self-concept,beliefs,oxygen,etc.護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論二、分類

（1）根據(jù)人們對(duì)概念的認(rèn)識(shí)：

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(jì)性概念

總結(jié)性概念護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論三、概念的形成過程（conceptformation)思考、科研、系統(tǒng)觀察會(huì)形成概念。護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論ConceptFormationAconceptasathought,ideaornotionAconceptasanabstractideageneralizedfromparticularinstancesRelationshipoftheStimulustotheconceptInternalStimulusExternalStimulusScope

ExamplesSimpleComplexConcreteAbstractValueinScientificInquiry護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論四、概念與理論的關(guān)系概念的組成部分為理論（Basicingredientsofatheory）護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論五.護(hù)理學(xué)的概念（Nursingconcepts)Suchashealth,caring,interaction,stress,adaptation,growth,grief,illness,needs,etc.

護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論FourBasicConceptsofNursingPersonEnvironmentHealthNursing護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論P(yáng)erson(description)Eachpersonisauniqueindividualviewedinholisticterms.Byholisticitmeantthattheindividualisconsideredatotalhumanbeingwithbiopsychosocialneeds.Eachpersonhastherighttodignity,respect,autonomyandtheopportunitytogrowanddeveloptotheirfullpotentialandtoachieveoptimalfunctioning.Eachpersonisseenwithinasocialcontext.護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論P(yáng)ersonHumanbeings-uniqueindividuals,familyorfriendsBio-psychosocialFunctioning-needs,strengthsRights,responsibilities,dignityCultureDevelopmental,lifespanAdaptable,self-responsible護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論Health(description)Healthisthemultidimensionalconceptwhichcontainsbio-psychosocialelementsonafunctionalcontinuum.Healthisintrinsicallyrelatedtonotionsofqualityoflife,harmonyandwell-being.Healthcanbedefinedobjectivelyandfromsubjectiveexperience.護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論HealthWell-being,qualityoflifeContinuum-health-illnessEquilibriumBiopsychosocialdimensionsAbletodothingsonewantsFeelinggoodObjectiveandsubjectiveelements護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論Environment(description)Theenrironmentisthemajordeterminantofthehealthofindividuals,families,andcommunities.Itprovidesthecontextfornursingpractice.Theenvironmentcanbeconsideredalongtwodimensions:Thephysicalandsocio-culturalenvironmentwhichincludessocialvalues,beliefsandcustomsandinternal/externaldimension.Theenvironmentiseverchanginginthecontextoftimeandspace.護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論EnvironmentWorking,family,community,globalAnimateandinanimateTimeandspaceCultural,customs,ritualsInternalandexternalDynamic,changing護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論Nursing(Description)Theessenceofnursingiscaring.Nursingisapractice-basedprofessioninvolvingbothartandscience,theartistheprocessintermsofthenurse-clientrelationship.Thescienceistheknowledgeandskillsthenursecontributestonursingpractice.Theaimofnursingistopromotewell-being,preventillness,maintainandrestorehealth,andtohelppeopleattainapeacefuldeath.護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論NursingCaringforindividuals,families,communitiesPromotionofwell-beingPeacefuldeathTechnicalskillsAprocessSupportinglifePractice-basedRelationshipwithpatientandothers護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論第三節(jié)護(hù)理理論

NursingTheory一、有關(guān)護(hù)理理論的基本概念1、知識(shí)（Knowledge）isanawarenessorperceptionofrealityacquiredthroughlearningorinvestigation)通過學(xué)習(xí)或研究而獲得的對(duì)現(xiàn)實(shí)世界的認(rèn)識(shí)護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論2、科學(xué)（Science）referstoabodyofknowledge,includingfactsandtheories,generatedbytheuseofcontrolled,rigorous,andprecisemethodswithinadelimitedareaofconcern.通過系統(tǒng)科學(xué)的研究而獲得的知識(shí)體系（自然、社會(huì)、思維三大知識(shí)領(lǐng)域）護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論3、Metaparadiam（學(xué)科領(lǐng)域或觀點(diǎn)）Domainistheperspectiveandtheterritoryofthediscipline.Itcontainsthesubjectmattersofadiscipline,themainagreeduponvaluesandbeliefs,thecentralconceptsthephenomenonofinterest,itscentralproblems,andthemethodsthatareusedtoprovidesomeanswersinthediscipline.（學(xué)科的主要學(xué)術(shù)價(jià)值及觀點(diǎn)，主要問題）護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論4、Paradigm（科學(xué)觀）

Aparadigmisaconceptualdiagram,itcanbealargestructureusedtoorganizetheory,thataresharedbyitsscientificcommunity.護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論5、Model(模式）Amodelisanideathatexplainsbyusingsymbolicandphysicalvisualization.(用圖示或符號(hào)對(duì)概念及其關(guān)系的解釋）護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論6、理論（Theory）Anabstractgeneralplanthatpresentsasystematicexplanationsandrelationshipsamongconcepts.Theoriesembodyprinciplesfordescribing,explaining,predicting,andcontrollingphenomenaUltimategoalofscienceMakescientificfindingsmeaningfulandgeneralizable護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論理論是人們對(duì)自然界及人類社會(huì)現(xiàn)象的規(guī)律的系統(tǒng)性認(rèn)識(shí)。每個(gè)理論都由一個(gè)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。護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論MetaparadigmofNursingComponentsParadigmMetaparadigm PhilosophiesConceptualModelsTheoriesEmpiricalIndicators LevelsofAbstractionMostAbstractMostConcrete護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論二、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(hù)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(cè)性理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論

三．理論的功能

描述解釋預(yù)測(cè)客觀事物指導(dǎo)實(shí)踐。護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論CharacteristicsofaTheoryInterrelateconceptstocreatenewwayoflookingataparticularphenomenonLogicalinnatureRelativelysimpleyetgeneralizableBasesforhypothesestobetestedfortheoryexpansionContributetobodyofknowledgeofadisciplineCanbeusedbypractitionerstoguideandimprovepracticeMustbeconsistentwithothervalidatedtheories,lawsandprinciples護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論第四節(jié)護(hù)理理論一、護(hù)理理論的概念護(hù)理理論是對(duì)護(hù)理現(xiàn)象及本質(zhì)的規(guī)律性系統(tǒng)性認(rèn)識(shí)。卡渤（Carper）認(rèn)為護(hù)理的對(duì)象是人，護(hù)理學(xué)的概念及知識(shí)需要從以下四個(gè)方面綜合來獲取：護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論1．倫理學(xué)知識(shí)（ethics)即對(duì)護(hù)理學(xué)的職業(yè)道德及倫理的規(guī)律性認(rèn)識(shí)。2．美學(xué)知識(shí)(Esthetics)：即護(hù)理藝術(shù)或護(hù)理行為方面的知識(shí)。3．個(gè)人知識(shí)(Intuition)：即通過個(gè)人的直感而獲取服務(wù)對(duì)象的認(rèn)識(shí)。4．科學(xué)知識(shí)(Science)：即通過科學(xué)實(shí)驗(yàn)的方法所獲取的護(hù)理學(xué)知識(shí)。護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論二、發(fā)展背景

1．南丁格爾時(shí)代2．哥倫比亞大學(xué)學(xué)派時(shí)代（二十世紀(jì)50

年代）3．耶魯大學(xué)學(xué)派時(shí)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年代到目前護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論三、發(fā)展階段1、南丁格爾時(shí)代（Nightingale)2、醫(yī)學(xué)模式階段(Medicalmodel)3、借用階段(borrowedtheories)4、獨(dú)特理論階段(Uniquetheories)護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論四、護(hù)理理論的特征妥瑞斯（Torres，1990）理論必須具有以下幾個(gè)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(gè)全新的觀察事物的方法或角度。

2．護(hù)理理論必須具有一定的邏輯性。護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論3．理論必須簡(jiǎn)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(yàn)。5．通過對(duì)理論的實(shí)踐及研究，能夠增加護(hù)理學(xué)科的知識(shí)。6．必須對(duì)實(shí)踐有指導(dǎo)作用。7．必須與其它已證實(shí)的理論及規(guī)律一致。護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論五、護(hù)理理論的分類1．按照護(hù)理理論的抽象程度及其對(duì)實(shí)踐的指導(dǎo)意義(scopeofthetheory)，可以將護(hù)理理論分為以下三類：

Grandtheory

Middlerangetheory

Microtheoryorpartialtheory護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論GrandTheories

宏觀理論BroadestinScopeConceptualstructuresSubstantivelynonspecificBeingmadeupofrelativelyabstractconceptsthatlackoperationaldefinition,Notdevelopedbyempiricalresearch,butbythoughtfulandinsightfulappraisalofexistingideasorcreativeleapsbeyondexistingknowledge.

護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論GrandTheoriesOremLevineRogersJohnsonRoyNeumanKingRoper,Logan,andTierney護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論MiddleRangeNursingTheories

次宏觀理論（中層理論）Substantivelyspecific;Encompassingalimitednumberofconcepts;Limitedaspectoftherealworld;Derivedfromworksinotherdisciplinesrelatedtonursing;Fromearlierworksinnursingsuchasphilosophiesandtheories,andfromnursingconceptualmodelsandgrandtheories;Specifictonursingpracticeandspecifytheareaofpractice,agerangeoftheclient,thenursingactionorintervention,andtheproposedoutcome 護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論MiddleRangeNursingTheoriesPeplauOrlandoTravelbeeRiehlErickson,Tomlin,&SwainMercerBarnardLeiningerParseFitzpatrickNewmanAdamPender護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論2．按照護(hù)理理論的著重點(diǎn)不同，可以將護(hù)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(hù)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(hù)理理論護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論NursingTheories

CategorizedbyconceptsPersonTravelbee(1966)-person,family,communityforwhomillnesshasaspecialmeaningHenderson(1966)-mindandbodyinseparable,individualsunique,14basicneedsRogers(1970)-unitaryhumanbeingviewedasanenergyfieldOrem(1971)-individualintegratedwholewithvarying

degreesofselfcareabilityKing(1971)

-individualshaveabilitytoperceive,think,

feel,choose,setgoalsandmakedecisionsBenner&Wrubel(1989)-individualisself-interpretingbeingengagedbyhumancapacitiesintheworld護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論NursingTheories

CategorizedbyconceptsEnvironmentNightingale(1860)-environmentiscentralconceptTravelbee(1966)-environmentiscontextin whichhumanrapportisestablishedLevine(1967)-societyisviewedasthetotal environmentoftheindividual,family,andnurseRoy(1976)-environmentconstantlyinteractswiththeindividualandimpactsadaptationNewman(1986)-environmentandpersonformaunitarypatternreflectedinmovement-space-timepatternsofconsciousness護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論NursingTheories

CategorizedbyconceptsHealthHall(1966)-self-actualization,selfloveHenderson(1966)-independentfunctionLevine(1967)-maintainingholism/conservationOrem(1971)-self-careagencyPaterson&Zderad(1976)-authenticawarenessRoy(1976)-continualadaptationNewman(1986)-expandingconsciousness護(hù)理學(xué)導(dǎo)論_第八章護(hù)理理論NursingTheories

CategorizedbyconceptsNursingPeplau(1952)-therapeuticinterpersonalprocessOrlando(1961)-processofinteractionwithandillindividualtomeetanimmediateneedWiedenbach(1964)-threecomponents: identifiedneed;ministrationofhelp;validationLevine(1967)-supportiveandtherapeuticWatson(1985)-humanscienceandanartbasedonthemoralidealandvalue