n 3225 professional growth iii: nursing inquiry term vii ... › ... › 200810 ›...

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N 3225

Professional Growth III: Nursing Inquiry

Term VII

JANUARY 2008

Instructor: ROBERTA JOKANOVICH RN BScN MPA Office: Library 030 Office Hours any time Phone: email is read daily E-mail:[email protected] COURSE DESCRIPTION

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In this course, various modes of nursing inquiry are addressed. Historical, philosophical and scientific modes of inquiry are investigated and the relationships between practice, theory, and knowledge are explored. Past and present contributions to nursing knowledge are discussed. ENDS-IN-VIEW The focus of this course is on the nursing profession and the processes and meanings of knowledge development for the nursing profession. The intent is to provide participants with opportunities to explore the processes of inquiry in nursing. PROCESS Praxis is the underlying process utilized in the nursing inquiry course. Students will have the opportunity the critically examine how nurses come to ‘know” and also to examine the process of inquiry in nursing. Beginning from a consideration of oneself as a knower, student will continue to explore how they gain knowledge as active participants and become knowers within the discipline of nursing. Values, beliefs, life experiences, nursing theory and critical reflection are integrated as students develop skill in the processes of both systematic analysis and critical evaluation of nursing knowledge, theory and practice. RESOURCES MAY INCLUDE: ● Selected readings and internet resources ●Audiovisual and computer resources REQUIRED TEXT Johnson, B.M., & Webber,P.B. (2005). An introduction to theory and reasoning in nursing (2nd ed.) Philadelphia: Lippincott Williams and Wilkins OVERVIEW This course is organized around the philosophical foundations of the curriculum and reflects the following concepts: -professional growth of the nurse -inquiry -knowledge -reflection -personal meaning-ontology, epistemology -ways of knowing -recognition of legitimate knowledge -assumptions -paradigm influences and world views -hegemony

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-discipline influences -philosophical influences -historical influences -ways of inquiring -theorizing -praxis -nursing theories and concepts (individuals and families -infomatics -emancipatory knowledge -moral reasoning -ethical, gendered, and socio-political ways of knowing -workplace issues related to nursing inquiry -postmoderism EVALUATION Concept Map – in class individual activity 20% Critical thinking – individual exercise 30% Theory/Theorist group presentation 35% Case Scenario - group presentations 15%

TOTAL 100%

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Concept Map Assignment

This learning activity provides you with the opportunity to visually describe a conceptual framework using conceptual mapping techniques. The intent is to create a visual representation of the concept you have used in your Literature Review. A conceptual model is: “Analogous to an architectural blueprint for a house. It is a group of interrelated concepts that fit together because of their relevance to a common theme or matrix, for example, a blueprint that provides a rational scheme or design for the architect’s vision. It reflects the philosophical stance, cognitive orientation, and research tradition of a group of scholars, rather than the beliefs, values, thoughts, and research methods of all members of a discipline.” (LoBiondo – Wood & Haber, 1998, p. 140). Resources for Concept Mapping:

1. Trochim, W. M. K. (1996) Concept Mapping 2. Hale, S. Concept Mapping 3. Gaines, B. and Shaw, M. (1995). Concept Maps as Hypermedia university Of Calgary 4. Jack Yensen, Concept Mapping 5. Or one author that you find insightful on the topic of concept mapping.

Guidelines: Read at least one of the references on concept mapping. Follow the instructions within the chosen reference, and create a comprehensive Concept Map incorporating the concepts and linkages pertinent to your Literature Review. This will be created free hand or on a lap top computer on - Size 8.5 X 14 (legal size paper) in schedualed class time. Marking Criteria and allotted maximum marks: Comprehensiveness of Conceptual Framework: ______/6.0

- use of concept theorist to present concept map -

Visual Clarity of Integrated Concepts in Literature Review: ________/6.0 - use of authors ideas and links in articles -

Relevance and Application to Nursing: ______/4.0 - practicality of map to nursing knowledge -

Use of colour, images, spatial arrangement ________/4.0 - creativity aesthetic use of nursing -

total ______/20

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Literature Review Assignment

This assignment will provide you with the opportunity to develop an indepth knowledge about a selected conceptual topic as found in the course presentation. This exercise will also facilitate the development of scholarly writing using APA. Current data based conceptual papers and publications (printed or online) are acceptable resources to use. Guidelines: This assignment has been created to augment future research proposals. A literature review will be a vital part of any proposal. You will have completed a concept map in class using the authors’ articles. Complete a thorough literature search (online recommended) for relevant literature, from the “Nursing” Literature. You may include relevant literature from other disciplines as well (e.g. medicine, psychology, physiology, etc.) to augment the nursing focus. Resources for Literature Review: Go to the literature and search for a 2 articles that discuss the concept you have identified. Summarize how the concept is defined in your chosen literature, and analyze hidden values, beliefs, and assumptions. Discuss the ways that the concept is presented and how the article might provide direction for nursing action or influence the ways that nurses know and act. Length parameter: 5 pages MAXIMUM Marking Criteria and allotted maximum marks: Conceptual framework identified and explained: ____/ 10 - clear identification of concept Suitability and relevance of literature selected: ____/ 5 - how the concept is applied to nursing Comprehensiveness and logical flow of review: _____/ 10 - details of each author and how they relate to each other Format APA (Table of Contents, Spelling, Grammar, Page Format, Sentence structure): ____/5 Total ______/30 La

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Theory/Theorist Presentation Marking Criteria and allotted maximum marks: History - theorist's education, personal history, career path, dates 5 Theory 10 -clarity of concepts and theory -background of development Research 8 - Theorists’ use of research to develop theory - how and where is the theory used in other peoples research Application to nursing practice

- how does the theory impact on nursing practice today 5 - share your own thoughts on how it may impact positively or negatively - where in the world is the theory used to teach/practice nursing

Presentation

-use of power point to augment presentation 7 -identification of teaching learning styles -professional presentation of dissemination of material -handout 1-2 pages condensed view of theorist

Total _____/35

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Community Clinical Scenario Presentation

This assignment will provide you with the opportunity to collaborate with your peers in creating a reality based community clinical practice scenario using concepts, illustrations, and insights into the ways of knowing. You will explore what you perceive as significant about the community clinical scenario and identify the values, beliefs, and assumptions of the participants. Identify 2 ways of knowing (i.e esthetic, personal, relational, empirical, ethical, historical, traditions, moral, socio-political, or intuitive) that pertain to your scenario. Reflect on how each of the two ways of knowing influences your view as the nurse. Develop a plan for further inquiry. Guidelines: Create a community clinical practice scenario from your experience in practice. Present the scenario to the class using valid information, resources, and graphics. Groups can use a number of approaches to present their ideas – skits, music, poetry, rap, stories, posters or other visual media such as a web site. Identify and discuss the two ways of knowing and how they relate to your scenario. Marking Criteria and allotted maximum marks: Introduction to the community scenario _______2 Knowledge of the ways of knowing ______ 5 -identification of the ways of knowing

-how can the ways of knowing influence your nursing care in general -participatory exercise to enhance learners knowledge

Impact on community scenario and nursing practice ______ 5 -usefulness of ways of knowing on nursing profession Plan for further inquiry _____ 3 -reflection and thoughts for the future of nursing practice total _____/15

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PRAXIS: Minimal Semester Requirements and Essential Learning Experiences

Term VII – Professional Growth III: Nursing Inquiry To Know (Epistemology)

Exploration & critique of the historical influences on nursing knowledge (WK, TT, CC)

Examination of the historical & present influences of world views on nursing inquiry (WK, TT, CC)

Exploration of the prevailing hegemony which influences how nurses question & come to know (WK, TT CC)

Examination o& critique of paradigmatic influences & how they may influence perceptions of truth, reality, etc. (Wk, TT, CC)

Exploration of the disciplinary influences on nursing inquiry (e.g., biology, psychology, anthropology, sociology, medicine, etc.) (WK, TT, CC)

Recognition of the different paradigmatic influences on subjective & objective knowing (WK, TT, CC)

Exploration & critique of the process of conceptualization & its relevance tonursing inquiry (WK, TT, CC)

Exploration of examples of unrecognized, undervalued & invisible knowledge in nursing (WK, TT, CC, PM)

Examination & critique of informatics & the influence of informatics on nursing inquiry (WK, TT, CC)

Examination & critique of the relationships between knowledge, power, education, & culture (WK, TT, CC)

Examination of the use of concepts & concept development in nursing (WK, TT, CC)

To Be (Ontology)

Is inquisitive of nursing knowledge development (PM, WK)

Questions paradigm shifts in

nursing (PM, WK) Values the process of nursing

inquiry (PM, WK, CC, TT) Is critically reflective (PM, WK,

CC, TT)

To Do

Uses strategies to increase accessibility, decrease elitism & increase participation in nursing inquiry

Identifies practice questions in nursing

Critiques questions pertaining to nursing inquiry regarding underlying beliefs, values & assumptions

Participates in the critique of the process of concept development

Begins to engage in the process of philosophical inquiry

Engages in praxis (dialogical relationship between theory & practice)

Client – Individual, Group, Family, Community/Population

Personal Meaning (PM) Ways of Knowing (WK) Time/Transitions (TT) Context/Culture (CC)

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COURSE SCHEDUALE

WEEK CONCEPTS

1

Jan 10 11

$ Orientation and course presentation review $ Knowledge Development, how do we “know”? $ Review of Text book $ Sign up for group presentations Chapter 1 and 2 Johnson and Webber

2

Jan 17 18

Knowledge Development $ Ways of knowing/patterns of knowing $ What is knowledge? $ Critical thinking/critical knowing, $ In practice, how is this operationalized? $ Personal meaning, reflection, assumptions Concepts and concept mapping – review articles Chapter 3 and 4 Johnson and Webber

3

Jan 24 25

Evaluation - Concept Map in class 20 % Chapter 5 and 6 Johnson and Webber

4

Jan 31 Feb 1

Paradigm Influence and World Views • Philosophical basis of knowing • Humanism, phenomenology, critical social theory, feminism Evaluation – Nurse Theorist Presentation – 35% Chapter 7 and 8 Johnson and Webber

5

Feb 7 8

Historical Influences $ History of development of nursing knowledge in Canada $ What is nursing knowledge? What differentiates nursing knowledge

from other knowledge? Evaluation – Nurse Theorist Presentation – 35% Chapter 7 and 8 Johnson and Webber

6 Feb 14 15

Nursing Theories and Concepts (Traditional) • Peplar, Roger, Orem Evaluation – Nurse Theorist Presentation – 35% Chapter 7 and 8 Johnson and Webber Nursing Theories (Emancipatory) • Watson, Parse, Newman • Watson, Parse, Newman

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WEEK CONCEPTS Evaluation – Nurse theorist Presentation – 35% Chapter 7 and 8 Johnson and Webber

7

Feb 21 22

READING BREAK

8

Feb 28 29

Making Meaning of Inquiry In class exercise critical thinking $ Concept and theory analysis as inquiry

9

Mar 6 7

Preparation for Clinical Scenarios

10

Mar 13 14

Recognition of Legitimate Knowledge $ Gendered knowledge $ Process of power $ Socio-political knowing Interdisciplinary Care changing roles of nurses Chapter 11 Johnson and Webber Emancipatory Knowledge $ Post-modernism $ Transformative knowledge Evaluation Clinical Scenario – 15%

11

Mar 20 21

EASTER

12

Nov 23

Nursing Praxis $ Applying theory and knowledge to practice Evaluation Clinical Scenario – 15%

13

Nov 30

Inquiry and Meaning of Nursing Practice Nursing Praxis – applying theory and knowledge to practice -self reflection methods -Where do we go from here? -Transition to next semester Chapter 10 and 12 Johnson and Webber

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N 3225 Learning Activity Week 1 Concept: Knowledge Development OVERVIEW How do we “know”? In life, we “know” facts such as our names, addresses, and phone numbers. We “know” that the world is round, hot stoves can hurt us and weighty objects fall to the ground when dropped. Now ask yourself “HOW you know?” Perhaps someone told you, perhaps you read the information or perhaps you came to “know” through doing (experiential). In nursing, there has been increasing interest, from a theoretical perspective, on valuing, identifying, examining, and analyzing different ways of knowing as an essential aspect of nursing practice.

“If we agree that there are different ways of knowing, different unknowns to be known, different propensities of knowers for knowing and different aspects to be known about the same phenomenon, then perhaps we can develop appropriate criteria for knowing from what we do know and, then, for knowing what we want to know”. ENDS-IN-VIEW (Learning Outcomes)

1. Discuss the course presentation, assignments and expectations. 2. Explore and reflect upon some of the different ways that we “know” the world

around us. 3. Discuss the relationships between theory, reasoning, and knowledge in relation

to everyday life. IN PREPARATION Read: Johnson, B.M., & Webber,P.B. (2005). An Introduction. Chapter 1 and 2 in An introduction to theory and reasoning in nursing (2nd ed.). Philadelphia: Lippincott Williams and Wilkins IN CLASS ACTIVITY In pairs, share how various ways of knowing have contributed to what you know about an area of your life. Was most of your knowing gained through study, or personal

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experience? Discuss and examine how your values, beliefs and assumptions influence the process of knowing for you. Write down your understanding of “inquiry”, what does this word mean to you? How do you think theory and reasoning relate to knowing, knowledge and inquiry? Keep these notes for a later class. Bring your ideas back to the larger group for discussion. IN REFLECTION Has discussing and examining your values, beliefs and assumptions about what and how you “know “ changed how you think about knowing and knowledge? If so, in what ways has it changed? How might this influence the ways you interact with and relate to patients? N 3225 Learning Activity Week 2

Concept: Knowledge Development

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OVERVIEW: What is knowledge? Knowledge is the awareness and understanding of facts, truths or information gained through observation, perception, and experience. What is epistemology? Epistemology is a branch of philosophy that studies the nature and limits of knowledge. The word epistemology comes from the Greek words episteme (knowledge) and logos (theory), meaning the “theory of knowledge”. Nursing Epistemology examines the structure, origin and criteria of nursing knowledge. How is it that nurses “know” what they know? Historically, the majority of nursing knowledge that was generated was empirical (scientific). The classic Carper Article (1978) introduced four “Fundamental Patterns of Knowing” which address the “art” and “science” of nursing; a) empirics, the science of nursing; b) aesthetics, the art of nursing; c) personal knowledge; and d) ethics, the moral component. These patterns encouraged nursing not only to look at the scientific component but past this to other patterns that are relevant to nursing (Carper, 1978). Over the past few decades nursing education has put an emphasis on teaching nursing students to think effectively and independently. “Critical thinking is defined as utilizing scientific facts, principles, and laws to identify, relate, understand, influence, and control actual and potential concepts and propositions” (Johnson & Webber, 2005, p. 55). Another component to thinking critically is reasoning. It is important to be able to understand how qualitative and experiential aspects of theory and practice are multidimensional and complex. ENDS-IN-VIEW (Learning Outcomes) At the end of this class students will be able to:

1 Explore and reflect upon some of the different ways that nurses “know” 2. Discuss how some nursing scholars have discussed “ways of knowing” in nursing. 3. Examine your own personal characteristics as a knower (Who am I? How do I know? What patterns of knowing do I use in my practice? 4. Examine the nature of elements of critical thinking.

IN PREPARATION Review: Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1 (1), 13-23.

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Read: White, J. (1995). Patterns of knowing: Review, critique, and update. Advances in Nursing Science, 17 (4), 73-86. Cronin, P. & Rawlings-Anderson,K. (2004). How do we know? Chapter 2 in Knowledge for contemporary nursing practice. Toronto, ON: Elsevier Mosby IN CLASS ACTIVITY In a large group, brainstorm what you believe knowledge is and discuss your own personal characteristics as a knower. In small groups, examine one of the patterns of knowing and share with the larger group their interpretation of that pattern. Each group will identify a clinical experience that relates to the pattern. If the group cannot find a lived experience then identify a case example that can be applied to the specific pattern. Discuss how White expanded on Carper’s work. Was this justifiable? Has White added to Carper’s theory? Diminished it? How? Week 2 Clinical scenario –in class group activity 15% IN REFLECTION Reflect on your own practice. How do you express the a) empirical, b) aesthetic, c) personal, and d) ethical aspects of nursing? After examining your characteristics as a knower, how can you broaden the knowledge that you receive during your nursing education? Do you envision any advantages to thinking about knowing and knowledge differently? How might this be expressed in your practice? N 3225 Learning Activity Week 3







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Concept: The Development and Differentiation of Nursing Knowledge OVERVIEW: The term “nursing science” was rarely used in the literature until the late 1950’s. Since that time there has been an increasing emphasis on the development of a body of knowledge specific to nursing. Why is it seen as important that nursing knowledge be specific and differentiated from, for example, medical knowledge? “It is necessary to study knowledge, especially disciplne specific knowledge, to ensure that the integrity of that knowledge is maintained and its development is strategic in its intent to develop the discipline (Johnson and Webber, 2005). Although there is shared knowledge between disciplines, nursing knowledge must be generated in order to move the the nursing profession forward in a manner that is useful to both the profession itself as well as society. Nursing knowledge is unique to nursing, but what makes it different? Is nursing an academic or a practice discipline, or both? ENDS-IN-VIEW:

1. Recognize the historical and traditional foundation of legitimate knowledge in nursing. 2. Begin to appreciate ethics and aesthetics as significant sources of knowing for nursing 3. Develop understanding of philosophical thought and its influence on development of knowledge in nursing.

IN PREPARATION: Review: Potter, P., Perry, A., Ross-Kerr,J., & Wood, M. (2006). Theoretical Foundations of Nursing Practice. Chapter 5 in Canadian Fundamentals of Nursing (3rd ed.). Toronto, ON: Elsevier Mosby. Read: Cronin, P. & Rawlings-Anderson,K. (2004). Why is philosophy relevant to nursing? Chapter 1 in Knowledge for contemporary nursing practice. Toronto, ON: Elsevier Mosby

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Johnson, B.M., & Webber,P.B. (2005). Language, Meaning and Structure. Chapter 2 in An introduction to theory and reasoning in nursing (2nd ed.) (pages 9-15). Philadelphia: Lippincott Williams and Wilkins IN CLASS ACTIVITY: In groups of 3-4, on flip chart paper, outline the key points of either epistemology, ontology, value-enquiry, or logic and prepare a short oral presentation to the class on how this branch of philosophy has significantly influenced knowledge development in nursing. Be prepared to defend your presentation with quotes from your readings. Develop at least one question for the class to extend their thinking relating to knowledge development in nursing. For example, a question might be, “What is a nurse?” “What is nursing practice?” IN REFLECTION Consider the implications for practice depending on how you view yourself as a nurse. Ask your friends and family to tell you what a nurse is or what a nurse does. Are there similarities and differences? What are the major influences informing your view? What do you think are the major influences informing their views?













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N 3225 Learning Activity Week 4 Concept: Paradigm Influence and World Views: Philosophical basis of knowing: Humanism, phenomenology, critical social theory and feminism OVERVIEW World views, and paradigm influences, are philosophical beliefs about the world. World views and paradigm influences helps us in organizing the information and data for the process of inquiry. In addition, world views help shape development of nursing as well as other disciplinary knowledge. Nursing education and clinical practice makes an examination of an individual’s world view, spontaneous and essential. In order for nurses to deliver nursing care in a meaningful and phenomenological way, it important for them to first analyze and articulate particular world views of caring and being. Paradigms of nursing, including humanism, phenomonology, critical social theory, and feminism, have gone through revolutionary changes over the last few decades. It is enlightening for nurses to witness paradigms and world views, and identify the ones that enhance and empower them to deliver care in effective and healing ways. ENDS-IN-VIEW (Learning Outcomes) At the end of the class the students will be able to: 1 Examine some of the world views that shape development of nursing and other disciplinary knowledge. 2.Discuss the world views of humanism, phenomenology, feminism(s) and critical social theory. 3.Describe assumptions, values, and underlying interests of humanism, phenomenology, feminism(s) and critical social theory . 4. Describe how these world views might shape the ways we ‘know’ our patients and interpret our reality. 5. Discuss some of the paradigms that underlie knowledge development in and beyond nursing . 6.Develop a ‘critical lens’ to reading and applying different world views to interpreting specific clinical situations and experience. 7. Practice critical thinking and knowing, by examining the world views, and comparing their strengths and limitations in guiding nursing practice and knowledge development.

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IN PREPARATION Read or Review: -the philosophical foundations in the Collaborative Curriculum Overview, Part Two pages 2-5 to 2-17 on phenomenology, feminism, critical social theory and humanism. Read : Browne, A. J. (2000). The potential contributions of critical social theory to nursing science. Canadian Journal of Nursing Research, 32(2), 35-55. Van Sell, S. L. (2202). Nursing: Receding and evolving paradigms (editorial). ICUs and Nursing Web Journal (10), April-June. http://search.earthcam.com/search_cam.php?cat=SOC&sub=t Additional Recommended Readings: Brown, H. (1997). Tanner’s story: A phenomenological stance towards newborn death. Canadian Journal of Nursing Research, 29(4), 21-31. Campbell, J. C., & Bunting, S. (1991). Voices and paradigms: Perspectives on critical and feminist theory in nursing. Advances in Nursing Science, 13(3), 1-15. IN CLASS ACTIVITY Small groups of students will each be assigned a philosophical paradigm. They will discuss how these paradigms influence nursing and nursing inquiry. Each group member, as comfortable, will describe his/her own feelings related to his/her own world views. Groups will create a concept map linking the various parts of one’s world view, including the influence on nursing inquiry, research and practice. Week 4 Concept Map – in class group activity 20% IN REFLECTION As you read, reflect and observe your own world views in action, think about how your world view has changed over the course of your nursing program. How is it different since the beginning of Term VII of your nursing program?



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N 3225 Learning Activity Week 5 Concept: Paradigm Influence and World Views: Disciplinary Influence and

Changing Roles- nurse practitioner, midwife, male/female roles OVERVIEW

Historically, the nursing profession has incorporated various “borrowed” theories from other disciplines. Medicine, anthropology, sociology, biology and psychology have all been involved in shaping the existing knowledge of nursing. Disciplines such as medicine have historically dominated and influenced nursing. In fact power of medical field has dis-empower nursing. However, more recently there has been a rapid expansion of roles and a development of formal advanced education in nursing. Nurses’ roles have expanded, becoming essential for recovery as well as for the treatment of chronic illnesses (Hillenbrand, 2004). Nursing roles have evolved, giving nurses autonomy and enabling them to take a holistic approach to providing care. According to the Canadian Nurses Association’s (2003) position statement, a nurse practitioner (NP) is an advanced practice nurse, who is able to work autonomously to diagnosis, treat and prescribe medication and work in collaboration with other health care providers.

The role of a midwife has changed in the last decade and has become prominent in the field of women’s health. Midwives play an important role in low-risk pregnancy, childbirth, post-partum and care of newborn infant. In addition, midwife is involved in health education and counseling, not only for the woman but also within the family and community. Midwifery is now regulated and funded in four provinces of Canada.

Another role that has been evolving is that of the male nurse. Historically, there is evidence of men choosing nursing as a possible profession; however, male nurses’ contributions have been perceived as negligible due to nursing being female dominated profession ( Mackintosh, 1997).

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ENDS-IN-VIEW (Learning Outcomes)

At the end of the class the students will be able to:

1. Explore historical disciplinary influences on nursing.

2. Describe the expanding role of nurses such nurse practitioner, midwife and male nurses.

3. Understand the reason for the role change.

IN PREPARATION

Read or review: Canadian Nurses association. (2003). Position Statement: The Nurse Practitioner.

Mundinger, M.O., Kane, R.L., Lenz, E. R., Totten, A. M., Tsai, W., Cleary, P. D., et al. (2000). Primary care outcome in patients treated by nurse practitioner or physicians: A randomized trail.JAMA, 283, 59-68.

Hillenbrand, A. (2004). The changing roles of nurses. http://radford.edu/rumag/backissues/2004-s/pages/nurse.html

Lupton, B. (2006). Explaining Men’s Entry into Female-Concentrated Occupations: Issues of Masculinity and Social Class. Gender, Work and organization 13:2, 103-128

Evans, J. (2004). Men nurses: a historical and feminist perspective. Journal of Advanced Nursing 47:3, 321-328.

Benoit, C.(1989). Traditional Midwifery Practice: Limits of Occupational Autonomy. The Canadian Review of Sociology and Anthropology 26 (4): 663-649.

Rice, J. A. (1997). Becoming Regulated: The Re-emergence of Midwifery in British Columbia. In F. Shroff, (ed.) The New Midwifery: Reflections on Renaissance and Regulation, pp. 149-180. Women’s Press, Toronto.

Recommended Reading: Farquhar, M., Camilleri-ferrante, C. & Todd, C (2000). Continuity of care in maternity services: women's views of one team midwifery scheme. Midwifery, 16(1) . 35-47



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http://radford.edu/rumag/backissues/2004-s/pages/nurse.html


Benoit, C. (2005). Understanding the social organisation of maternity care systems: midwifery as a touchstone. Sociology of Health & Illness, 27(6). 722

IN CLASS ACTIVITY In class, there will be a panel of a nurse practitioner, a midwife and a male nurse. The panel presentation will be lead by student inquiry,therefore, all students are to come prepared to question the panel. Questions are to be thought provoking and challenging. Students may work in groups of four to generate their questions.

IN REFLECTION As you reflect on what you have read and heard from the panel experts, think about how nursing was and how the roles have changed. What do you think influenced this? Why? Is this a positive and important change? How is it important? How is it positive? Look at your own nursing role since the start of the program, how is it different for you?

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N 3225 Learning Activity Week 6

CONCEPT: Nursing Theories and Concepts (Traditional)

OVERVIEW With the constant advancement in nursing education and the requirement for evidence based practice it is important to have an understanding of the significance of theory for nursing as a discipline and profession. However, it is not to dismiss the argument that professional nursing existed since Florence Nightingale’s era but the profession was not studied and theories were not developed until nursing became a science in the mid twentieth century (Tomey & Allingood, 2002). Although nursing theories and models can be used to measure outcomes of nursing practice and support evidence based practice, we must examine their current usefulness in our ever changing society of multiculturalism, complex health challenges, and the constant advancement in technological health care delivery. To this end we will examine the history of nursing theory, the terminology of theories and the theories of Orem, Rogers, and Peplau. Orem developed the general self care deficit theory of nursing from three related theories, which are self-care, self-care deficit, and nursing systems. Roger’s theory of ‘the science of unitary human beings” suggests that when humans are subjected to negative environmental influences and pathological changes, their outcomes can still attain unity with nature and an evolutionary becoming. And Pepalu developed the theory of interpersonal relations by suggesting that the relationship has different phases and as such requires different actions. (Tomey & Allingood, 2002). ENDS-IN-VIEW (Learning Outcomes) At the end of this class students will be able to:

1.Describe the historical perspective of the development of nursing theories. 2.Identify the terminology used to describe nursing theories. 3.Identify the main concepts of Orem, Rogers, and Peplau theories. 4. Describe their understanding of Orem, Rogers, and Peplau theories. 5. Identify the types of clients/patients/ populations, and communities that

these theorist theories can be applied to. 6. Identify which theorist or theorists’ theory can be applied to their current

clinical practice.



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IN PREPARATION Read: Cronin, P. & Rawlings-Anderson,K. (2004). What is nursing theory? Chapter 3 in Knowledge for contemporary nursing practice. Toronto, ON: Elsevier Mosby Johnson, B.M., & Webber,P.B. (2005). Nursing Theory. Chapter 7 in An introduction to theory and reasoning in nursing (2nd ed.) Philadelphia: L Lippincott Williams and Wilkins IN CLASS ACTIVITY In small groups students will be assigned a theorist work to discuss and each group member will identify one clinical practice experience that relates to the theorist’s work. If this experience was not lived, then identify a case example that the theory can be applied to and evaluate its effectiveness. Work through the case example at the end of each chapter of their reading. They will then report back to the large group for discussion. IN REFLECTION As you read reflect on your understanding of these theories. Are there similarities? If so what are they? Do you agree with what the authors have said about the theories and how they work? Why or why not? Are the theories applicable in today’s practice? Why or why not? Have you seen any of these theories in practice? If so in which populations and was it visible? How was it evaluated? If you have not seen them in practice why do you think this is so? Please write you responses to these questions and bring it to class for discussion.




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N 3225 Learning Activity Week 7 CONCEPT: Nursing Theories and Concepts (Emancipatory) OVERVIEW Building on last week’s class and readings, we will examine the theories of Watson, Newman, and Parse’s as well as the state of the art and the science of nursing theory. Watson’s (1988) theory of Human Caring focuses on nurse-patient interactions and is based on spiritual-existential and phenomenological orientations. The spiritual dimension in her theory is the elaboration of the soul which, is identified as the inner-self and the spiritual self. She emphasizes that an empathetic caring relationship facilitates the patient’s movement towards a higher state of spiritual awareness. Betty Neuman Systems Model is based in general system theory and reflects the nature of living organisms as open systems” (Tomey & Allingood, 2002, p. 300). Her model suggests the all systems are interrelated and therefore is dependent on each other. Margaret Newman’s (1995) model of health encompasses health, pattern and consciousness. She viewed humans as unique patterns of consciousness. Implicit in her notion of human consciousness was its movement towards a higher level of insight that facilitates a transcendence of the spatial-temporal self to a spiritual realm. Parse’s ‘theory of human becoming’ is based on nine philosophical assumptions of which three are of human becoming. The basic principles of human becoming are attributes of spirituality including meaning, value, and becoming ENDS-IN-VIEW (Learning Outcomes) At the end of this session students will be able to:

1. Identify the main concepts of the nursing theories of Watson, Newman, and Parse theories.

2. Describe their understanding of the above theorists’ theories. 3. Identify the types of clients/patients/ populations, and communities that

these theorist theories can be applied to. 4. Identify which theorist or theorists’ theory can be applied to their current

clinical practice. 5. Develop an understanding of the art and science of nursing theory.


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IN PREPARATION: Review: Johnson, B.M., & Webber,P.B. (2005). Nursing Theory. Chapter 7 in An introduction to theory and reasoning in nursing (2nd ed.),. Philadelphia: Lippincott Williams and Wilkins IN CLASS ACTIVITY: In small groups students choose a theorist’s work to discuss and each group member will identify one clinical practice experience that relates to the theorist’s work. If this experience was not lived, then identify a case example that the theory can be applied to. Work through the case example at the end of each chapter of their reading. They will then report back to the large group for discussion. IN REFLECTION As you read reflect on your understanding of these theories. Are there similarities? If so what are they? Do you agree with what the authors have said about the theories and how they work? Why or why not? Are the theories applicable in today’s practice? Why or why not? Have you seen any of these theories in practice? If so in which populations and was it visible? How was it evaluated? If you have not seen them in practice why do you think this is so? What was your thinking of the state of the art and science of nursing before you did the reading on this and what is it now after your reading? Please write your responses to these questions and bring it to class for discussion.




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N 3225 Learning Activity Week 8 CONCEPT : Making Meaning of Inquiry: Concept Analysis OVERVIEW: What are concepts in nursing? A concept may be defined “as ‘a label used to describe a phenomenon or group of phenomena’. Therefore, a concept is not a real entity-it merely provides a name for a phenomenon and refers to the phenomenon’s properties. Just as the concept ‘home’ conjures up in our minds the phenomena of being comfortable and secure, it is simply a label representing a range of pleasant phenomena. Concepts therefore are our special vocabulary denoting things, events and activites of importance to our occupation or our lives.” Meleis, A.I. (1991). Theoretical nursing: development and progress, (2nd ed.). Philadelphia,PA: Lippincott., p 4. ENDS-IN-VIEW:

1. Define concept and conceptual analysis 2. Recognize linkages between concepts, theory, knowledge, reasoning and

the process of nursing inquiry 3. Apply conceptual analysis as a form of inquiry to a case story

IN PREPARATION: Review: Johnson, B.M., & Webber,P.B. (2005). Language, meaning and structure . Chapter 2 in An introduction to theory and reasoning in nursing (2nd ed.) Philadelphia: Lippincott Williams and Wilkins Read: Johnson, B.M., & Webber,P.B. (2005). Operationalizing Relationships and Theory and Reasoning , Chapters 3 and 4 in An introduction to theory and reasoning in nursing (2nd ed.) Philadelphia: Lippincott Williams and Wilkins Cronin, P. & Rawlings-Anderson,K. (2004). How do we use concepts in practice? Chapter 5 in Knowledge for contemporary nursing practice.Toronto, ON: Elsevier Mosby





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Selected readings TBD IN CLASS ACTIVITY: Individually, think of 2-3 concepts that we use in nursing. Some examples are caring, hope, suffering, can you think of others? Write down your idea of the concept’s meaning, attributes, and characteristics. Partiticpate in class discussion on how these are conceptualized and the challenges of multiple meanings and clarity. Discuss how concept clarification is related to nursing theory, nursing knowledge and the process of inquiry. In small groups, utilize the selected articles and case stories given out in class to analyze a concept as a strategy to guide practice theory development and subsequent decision making and interventions in nursing practice. IN REFLECTION: Consider the meanings attached to the concepts discussed in class. How will you use the process of conceptualizing in your nursing practice?








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N 3225 Learning Activity Week 9 CONCEPT : Ethical Knowing and Moral Reasoning OVERVIEW: All nursing decisions may be viewed as moral decisions. Although the nurse may know how to undertake a nursing action, the decision as to whether it should or should not be done with the aim of benefiting the client, is a moral decision. Schrock (as cited in Johnson & Webber, 2005) states that “moral reasoning must be based on a rational foundation, and an ability to articulate one’s moral position in a coherent and logical way (p. 31). Moral knowing is then, clearly linked to personal knowing in which knowing ‘self’ in relation to others is considered key to interpersonal encounters. ENDS-IN-VIEW:

1. Develop an understanding of how philosophy is related to nursing ethics 2. Explore the nature of nursing’s unique ethical perspective 3. Begin to understand embodied knowing within the context of ethical

decision making. IN PREPARATION: Review: Cronin, P. & Rawlings-Anderson,K. (2004). How do we know? Chapter 5 in Knowledge for contemporary nursing practice. (pp.30-31). Toronto, ON: Elsevier Mosby. Read: Johnson, J.L. (2004). Philosophical contributions to nursing ethics. Chapter 3 in J. Storch, P. Rodney, & R. Starzomski (Eds.) toward a moral horizon:nursing ethics for leadership and practice (pp. 42-55). Toronto, ON: Pearson Prentice Hall. Doane, G. (2004). Being an ethical practitioner:The embodiment of mind, emotion and action. Chapter 21 in J. Storch, P. Rodney, & R. Starzomski (Eds.) toward a moral horizon:nursing ethics for leadership and practice (pp. 433-444).Toronto, ON: Pearson Prentice Hall. Selected readings TBD




















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IN CLASS ACTIVITY: In small groups, consider whether you agree that nursing has a unique ethical perspective, what are the most important aspects of ethical practice? What contextual factors enhance, or detract from, ethical practice in nursing? Participate in class discussion related to embodied knowing and the process of nursing inquiry. IN REFLECTION: Consider your thoughts on the nature of nursing, What is the nursing’s purpose and goal? Think about the implications of your point of view on your own nursing practice and the nursing profession as a whole. Reflect upon ethical knowing and moral reasoning in relation to nursing inquiry, how are they related?




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N 3225 Learning Activity Week 10 CONCEPT: Recognition of Legitimate Knowledge OVERVIEW Power:

“Knowledge imparts power, but power is also fundamental to that which is inclusive in knowledge” (Kasman, 2003, p. 20). “Most fundamental in any profession, including nursing, is power derived from expert knowledge” (Hegyary, 2003, p. 104). “Those who are in authority dictate, rather than those who are an authority, in determining what is considered important” (Cronin & Rawlings-Anderson, 2004, p. 5). Gender:

Being credible becomes a matter of being a certain sort of person, quite

frequently a masculine sort of person who is unemotional, detached, rational, and impartial. Credibility then, is something secured in the context of certain regulatory norms, images, and ideals that tend to exclude women and that have the consequences of working to disqualify nurses, even in advance of their claiming to know anything in particular, from the company of credible knowers. (Ceci, 2004. p. 79)

Socio-political knowing:

The pattern of socio-political knowing addresses the ‘wherein’. It lifts the gaze of the nurse from the introspective nurse-patient relationship and situates it within the broader context in which nursing and health care take place. It causes the nurse to question the taken-for-granted assumptions about practice, the profession, and health policies. (White, 1995, p. ) ENDS-IN-VIEW The student will critically examine what influences the development of knowledge and how this impacts nursing knowledge.


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IN PREPARATION: Read: Mantzoukas, S. & Jasper, M. (2004). Reflective practice and daily ward routine: A covert power game. Journal of Issues in Clinical Nursing, 13, 925-933. Manias, E. & Street, A. (2000). Legitimation of nurses’ knowledge through policies and protocols in clinical practice. Journal of Advanced Nursing, 32(6), 1467-1475. IN CLASS ACTIVITY: Consider the quotes above and think about what you consider to be legitimate nursing knowledge. Think about what influences knowledge development in the world today and in nursing. .Participate in a discussion of what power is and develop a definition of power. Consider who is in power now in the world and in nursing. Discuss how power and knowledge are linked and identify both current and historical examples. Review the two articles above in class and consider their relevance for the development of and recognition of legitimate knowledge. Do gender and socio-political knowing have a role in the experiences described in the articles? IN REFLECTION: Think about your clinical experiences so far in the nursing program. Have you experienced anything similar to what is described in the two articles?


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N 3225 Learning Activity Week 11 Concept: Emancipatory Knowledge OVERVIEW Emancipatory knowledge is based on emotion and free from oppression or restraint and it is acquired through critical self-reflection (Cranton, 1996). Individuals question assumptions, values, beliefs, feelings, norms, and perspectives of their own and of society. By seeking an understanding the learner’s thinking can be transformed (Mezirow, 1991). This type of knowledge is considered empowering as it allows for individuals ways of being/viewing their situations and or challenge ‘taken for granted’ practices. This encourages individuals to examine alternatives to situations, experience personal and professional growth and develop deeper understandings of themselves and the world around them . Science has not been able to answer many of the questions faced by nursing therefore nursing has turned to other disciplines as discussed previously. Postmodernism is based on the above knowledge. Postmodernism theory focuses on acquiring information based on an individual’s experiences. ENDS-IN-VIEW (Learning Outcomes) At the end of this session students will be able to:

1.Explore and reflect upon situations that you have been in that you feel were emancipatory in nature. 2.Recognize the historical and traditional foundation of transformative knowledge in education and nursing. 3.Discuss and examine how self-reflection, values, beliefs and assumptions can shape the way we interpret information and experiences. How might this influence the ways we interact with and relate to patients. 4.Discuss the theory of postmodernism and how it has influenced nursing


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IN PREPARATION Review: Cronin, P. & Rawlings-Anderson,K. (2004). Why is philospophy relevant to nursing? Chapter 1 in Knowledge for contemporary nursing practice. (pp.11-12). Toronto, ON: Elsevier Mosby. Read: Selected readings TBD IN CLASS ACTIVITY In small groups, discuss an example of a situation in which transformative learning occurred, and share with the larger group. On a piece of paper write down a value or an assumption that you have/believe. Then share this with the class. Provide an explanation for why you hold this value/assumption. Are there others in the class who think differently or the same, and why? In a large group discuss postmodernist theory and the relationsahip to emancipatory knowledge in nursing. IN REFLECTION As you read, reflect on your understanding of how we acquire knowledge and the benefits of the knowledge. Think about what critical self awareness and reflection means to you. Think critically about your values, beliefs, assumptions, feelings, norms and perspectives. Where do they originate from? Think of situations in which nurses can and do improve situations/conditions of their patients.




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N 3225 Learning Activity Week 12 CONCEPT: Praxis: Applying theory, knowledge, and inquiry to practice

OVERVIEW Praxis is the dialogical relationship between theory and practice. It is important to understand and be able to apply different ways of theoretical knowing to nursing practice. Examples of different ways of knowing have been articulated in this course, however, it is understood that there are multiple ways of knowing and it is not intended to suggest that any one way of knowing is adequate or complete in isolation of other ways of knowing. It is understood that students come to know from a compilation of various ways of knowing and are constantly growing as knowers as they question and critique their worlds. As self-reflective practitioners students are encouraged to be self-evaluative in their nursing actions and critically reflect on their nursing practice as important strategies to build on their nursing knowledge. “The future of nursing as a science is related to the continuing development and use of relevant, practice-based knowledge” (Johnson & Webber, 2005, p.343). ENDS-IN-VIEW 1. Further develop an understanding of being a self-reflective, self-evaluative,

and accountable practitioner 2. Describe the role of purposeful observation, intuition, questioning and

comparing/contrasting in making decisions for nursing practice based on the process of nursing inquiry.

. IN PREPARATION: Read: Johnson, B.M., & Webber, P.B. (2005). Theory and Practice. Chapter 10 in An introduction to theory and reasoning in nursing (2nd ed.). Philadelphia: Lippincott Williams and Wilkins Johnson, B.M., & Webber, P.B. (2005). The Future. Chapter 12 in An introduction to theory and reasoning in nursing (2nd ed.). Philadelphia: Lippincott Williams and Wilkins

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IN CLASS ACTIVITY: In pairs, develop or describe a clinical scenario for the class that demonstrates and operationalizes one or more of the skills of purposeful observation, intuition, questioning and comparing/contrasting as strategies to develop an inquiry based practice. Share your scenario with the class and be prepared to discuss your understanding of these skills in a clear, articulate manner. . IN REFLECTION: As the complexity of client care increases, an important skill for nurses to acquire is the art of developing questioning skills. One method of doing this is to seek out and engage fellow students, family and others who may have different views than you and initiating discussions.











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N 3225 Learning Activity Week 13 Concept: Inquiry and Meaning OVERVIEW: The focus of this course was on the processes and meanings of knowledge development for the nursing profession as a whole and for application in nursing practice. The intent was to provide students with opportunities to discuss and explore the processes of inquiry in nursing. Various modes of nursing inquiry were addressed including Historical, philosophical and scientific modes of inquiry and the relationships between practice, theory, and knowledge were explored. IN PREPARATION: Review: N 3225 Course Syllabus and any previously assigned readings IN CLASS ACTIVITY In the second week of this course you were asked to write down your understanding of and personal meaning of “ inquiry”. You were also asked to think about how theory and reasoning relate to knowing, knowledge, and inquiry. Participate in class discussion on how your thinking about the process of inquiry may have changed over the weeks. IN REFLECTION When you are in practice, think about your underlying beliefs, values and assumptions about nursing knowledge and inquiry and yourself as a knower. Reflect on how you have, and will continue to, develop nursing knowledge and how this knowledge guides and informs your practice. Consider how you use the process of inquiry , both in your everyday interactions in life and in your nursing practice. How will your enhanced understanding of nursing inquiry be expressed in your nursing practice, how will it look or sound? Week 13 Theory/Theorist Paper-individual 35 %







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N 3225 Learning Activity Week 12 Concept: Workplace Issues: Magnet Hospitals, the RN role, Quality Improvement, Accreditation

OVERVIEW The workplace has changed since Florence Nightingale’s time! There are new roles and responsibilities. Nurses work with others who can do many of the same skills. Nurses have a responsibility to ensure that the most appropriate professional is the one providing care (CRNBC, 2006). Nurses also have the responsibility to work with their employers to ensure that quality practice environments are established and maintained (CRNBC, 2006). In this week’s class we will examine in detail the workplace issues that impact nurses. ENDS-IN-VIEW At the end of our work together this week, students will be able to: 1. Describe the differences and the similarities between RNs and LPNs. 2. Identify when an RN is needed to provide care. 3. Explain what magnet hospitals are and how they affect nurses’ work. 4. Define quality improvement and the RN’s role in it. 5. Define accreditation and the RN’s role in it. IN PREPARATION Read: Potter, P., Perry, A., Ross-Kerr, J., & Wood, M. (2006). Chapter 10: Client care: Leadership, delegation a

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nd Quality management, pages 149-164. Explore the Canadian Council on Health Services Accreditation website. http//www.cchas.ca Review the CLPNBC website and look at the practice documents. http://www.clpnbc.org/

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IN CLASS ACTIVITY Work in a small group to identify the clients that LPNS can currently provide care for. Then describe what would indicate the need for an RN to provide care. Share your experiences with LPNs with the class. Participate in a discussion concerning magnet hospitals. Develop a list of the positives and negatives of these sites for nurses according to the internet research you did. Participate in a discussion of accreditation and quality improvement. IN REFLECTION Have you been a part of any quality improvement activities as a student? What role do you think you could have in the accreditation process?


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n 3225 professional growth iii: nursing inquiry term vii ... › ... › 200810 ›...

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