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1、知识来源 Source of knowledge,SuperstitionTraditionSchool learning AuthorityTrial and ErrorMedia and experience Logical reasoning:deductive and inductiveScientific Methods,学习的层次结构Hierarchy of Learning,Create EvaluateAnalyzeApply UnderstandRemember,理论研究的层次结构Level of theoretical discourse,Level,World view,
2、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 护理理论概述Introduction to Nursing Theory,Faculty of NursingSchool of MedicineXian Jiaotong University,第一节 护理理念Nursing philos
3、ophy,一、理念的概念理念（philosophy），拉丁文philia（爱）及sophia（智慧），智慧之爱。寻找真理。“理念是指导个人思维及行为的价值观与信念”。以原则的形式左右及指引个人的思维方式及行为举止协助个人判断是非决定事物的价值,二、护理理念(nursing philosophy),是引导护理人员认识及判断护理及其它相关方面的价值观及信念。(concerned with the values and beliefs of a discipline and provide a guidance for the members of discipline)为护理人员研究护理学的四个核
4、心概念，人、健康、环境及护理提供专业理念体系。(Providing the framework for asking questions about central concept of the discipline),三、护理理念的发展过程,禁欲主义阶段（asceticism）（18501920）浪漫主义阶段(romanticism)（19211940）实用主义阶段(pragmatism)(19401960)人本存在主义(humanistic existentialism)(1960至今),四、护理理念与护理理论的关系,不同的护理学家，由于其理论的研究重点不同，对护理理念的四个要素有不同的认
5、识，也采用了不同的词来描述这四个基本概念。,人,环境,社会,健康,护理,概念之间的相互关系,护理理论,第二节 护理学的核心概念Central concepts of nursing,一、定义 Webster:概念是人们对周围环境中的某种物体所形成的印象，是人们对客观事物属性及本质的理性认识。,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.A
6、bstract-not observablei.e.self-concept,beliefs,oxygen,etc.,二、分类（1）根据人们对概念的认识：抽象概念 具体概念（2）根据概念的性质及应用范围：列举性概念 关联性概念 联合性概念 统计性概念 总结性概念,三、概念的形成过程（concept formation),思考、科研、系统观察会形成概念。,Concept Formation,A concept as athought,idea or notion,A concept as an abstract idea generalized from particular instances
7、,Relationship of theStimulus to the concept,Internal Stimulus,External Stimulus,Scope,Examples,SimpleComplex,ConcreteAbstract,Value in Scientific Inquiry,四、概念与理论的关系,概念的组成部分为理论（Basic ingredients of a theory）,五.护理学的概念（Nursing concepts)Such as health,caring,interaction,stress,adaptation,growth,grief,il
8、lness,needs,etc.,Four Basic Concepts of Nursing,PersonEnvironmentHealth 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,r
9、espect,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 friendsBio-psychosocialFunctioning-needs,strengthsRights,responsibilities,dignityCultureDev
10、elopmental,lifespanAdaptable,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
11、subjective experience.,Health,Well-being,quality of lifeContinuum-health-illnessEquilibriumBiopsychosocial dimensionsAble to do things one wantsFeeling goodObjective and subjective elements,Environment(description),The enrironment is the major determinant of the health of individuals,families,and co
12、mmunities.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
13、.,Environment,Working,family,community,globalAnimate and inanimateTime and spaceCultural,customs,ritualsInternal and externalDynamic,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
14、 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,communitiesProm
15、otion of well-beingPeaceful deathTechnical skillsA processSupporting lifePractice-basedRelationship with patient and others,第三节 护理理论Nursing Theory,一、有关护理理论的基本概念1、知识（Knowledge）is an awareness or perception of reality acquired through learning or investigation)通过学习或研究而获得的对现实世界的认识,2、科学（Science）refers t
16、o a body of knowledge,including facts and theories,generated by the use of controlled,rigorous,and precise methods within a delimited area of concern.通过系统科学的研究而获得的知识体系（自然、社会、思维三大知识领域）,3、Metaparadiam（学科领域或观点）,Domain is the perspective and the territory of the discipline.It contains the subject matter
17、s 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.（学科的主要学术价值及观点，主要问题）,4、Paradigm（科学观）,A paradigm is a conceptual diagram,it can be a large structure us
18、ed 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.(用图示或符号对概念及其关系的解释）,6、理论（Theory）,An abstract general plan that presents a systematic explanations and relationships among concepts.Theories embo
19、dy principles for describing,explaining,predicting,and controlling phenomenaUltimate goal of scienceMake scientific findings meaningful and generalizable,理论是人们对自然界及人类社会现象的规律的系统性认识。每个理论都由一个以上的概念及概念之间的相互关系如并列、相关、因果等关系而组成。,Metaparadigm of Nursing,ComponentsParadigmMetaparadigm PhilosophiesConceptual Mo
20、delsTheoriesEmpirical Indicators,Levels of AbstractionMost AbstractMost Concrete,二、理论的分类,用途：基础理论及应用理论；应用范围：宏观理论及微观理论；专业性：护理理论、生物学理论、医学理论等。功能：描述性、解释性及预测性理论,三理论的功能,描述解释预测客观事物指导实践。,Characteristics of a Theory,Interrelate concepts to create new way of looking at a particular phenomenonLogical in natureR
21、elatively 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,第四节 护理理论,一、护理理论的概念 护理理论是对护理现象及本质的规律性系统
22、性认识。卡渤（Carper）认为护理的对象是人，护理学的概念及知识需要从以下四个方面综合来获取：,1伦理学知识（ethics)即对护理学的职业道德 及伦理的规律性认识。2美学知识(Esthetics)：即护理艺术或护理行为方 面的知识。3个人知识(Intuition)：即通过个人的直感而获取服务对象的认识。4科学知识(Science)：即通过科学实验的方法所获取的护理学知识。,二、发展背景,1南丁格尔时代2哥伦比亚大学学派时代（二十世纪50 年代）3耶鲁大学学派时代二十世纪60年代4二十世纪70年代5二十世纪80年代到目前,三、发展阶段,1、南丁格尔时代（Nightingale)2、医学模式阶
23、段(Medical model)3、借用阶段(borrowed theories)4、独特理论阶段(Unique theories),四、护理理论的特征,妥瑞斯（Torres，1990）理论必须具有以下几个基本的特征：1理论能够将概念以特殊的方式联系起来，从而提供一个全新的观察事物的方法或角度。2护理理论必须具有一定的逻辑性。,3理论必须简单易懂，并容易推广应用。4理论可以作为假设的基础而经受检验。5通过对理论的实践及研究，能够增加 护理学科的知识。6必须对实践有指导作用。7必须与其它已证实的理论及规律一致。,五、护理理论的分类,1按照护理理论的抽象程度及其对实践的指导意义(scope of
24、the theory)，可以将护理理论分为以下三类：Grand theory Middle range theory Micro theory or partial theory,Grand Theories宏观理论,Broadest in ScopeConceptual structures Substantively nonspecificBeing made up of relatively abstract concepts that lack operational definition,Not developed by empirical research,but by thoug
25、htful and insightful appraisal of existing ideas or creative leaps beyond existing knowledge.,Grand Theories,OremLevineRogersJohnsonRoyNeumanKingRoper,Logan,and Tierney,Middle Range Nursing Theories次宏观理论（中层理论）,Substantively specific;Encompassing a limited number of concepts;Limited aspect of the rea
26、l 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 interve
27、ntion,and the proposed outcome,Middle Range Nursing Theories,PeplauOrlandoTravelbeeRiehlErickson,Tomlin,&SwainMercerBarnardLeiningerParseFitzpatrickNewmanAdamPender,2按照护理理论的着重点不同，可以将 护理理论分为以下四种类型：以需要及问题为中心的理论 以护患关系为中心的理论 以系统为中心的理论 以能量源为中心的护理理论,Nursing Theories Categorized by concepts,PersonTravelbee
28、(1966)-person,family,community for whom illness has a special 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)-indiv
29、iduals have ability to perceive,think,feel,choose,set goals and make decisionsBenner&Wrubel(1989)-individual is self-interpreting being engaged by human capacities in the world,Nursing Theories Categorized by concepts,EnvironmentNightingale(1860)-environment is central conceptTravelbee(1966)-environ
30、ment 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 reflected in
31、movement-space-time patterns of consciousness,Nursing Theories Categorized by concepts,HealthHall(1966)-self-actualization,self loveHenderson(1966)-independent functionLevine(1967)-maintaining holism/conservationOrem(1971)-self-care agencyPaterson&Zderad(1976)-authentic awarenessRoy(1976)-continual
32、adaptationNewman(1986)-expanding consciousness,Nursing Theories Categorized by concepts,NursingPeplau(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;va
33、lidationLevine(1967)-supportive and therapeuticWatson(1985)-human science and an art based on the moral ideal and value of caring,六、护理理论在护理实践中的应用,1护理理论与科研2护理理论与护理实践3护理理论与护理管理 4护理理论与教育,Cyclical Nature of Theory,Practice and Research,Practice,Research,Theory,Concepts,七.issues and trends（问题及趋势）,Why Nur
34、sing Theories?,（一）问题（issues),1.Nursing：art or science?2.Nursing theoryBorrowed or Unique?For Nursing or of nursing?Single or multiple nursing theory?3.Nursing science:basic or applied?,（二）趋势(trends),1.Credibility of theory will be tested by empirical evidence or data(from the outcomes of nursing car
35、e)2.Paths to knowledge developmentScientific methods:inductive or deductive Nonscientific methods:historical and philosophical methods3.More theories will be developed,specific to culture,第五节 理论的分析与评价Analysis and evaluation of nursing theory,一、Analysis（分析）1.Theorist（Background,especially practice areas)2.Theory goal3.Theory scope,4.Theory context5.Theory content二、评价（Evaluation）1.Clarity2.Internal consistency3.Logical adequacy4.Parsimony,5.Testability6.Empirical adequacy7.Pragmatic adequacy8.Generality9.Significance and usefulness,THANK YOU!,
