护理理论 ppt课件.ppt

知识来源Sourceofknowledge,SuperstitionTraditionSchoollearningAuthorityTrialandErrorMediaandexperienceLogicalreasoning:deductiveandinductiveScientificMethods,学习的层次结构HierarchyofLearning,CreateEvaluateAnalyzeApplyUnderstandRemember,理论研究的层次结构Leveloftheoreticaldiscourse,Level,Worldview,Frameworks,Theories,Models,Descriptivegeneralizations,Observation,Products,Vision,Wisdom,Knowledge,Intelligence,Information,Data,NewVision:EarthRisingasseenfromtheMoon,护理理论概述IntroductiontoNursingTheory,FacultyofNursingSchoolofMedicineXianJiaotongUniversity,第一节护理理念Nursingphilosophy,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(nursingphilosophy),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。(concernedwiththevaluesandbeliefsofadisciplineandprovideaguidanceforthemembersofdiscipline)为护理人员研究护理学的四个核心概念，人、健康、环境及护理提供专业理念体系。(Providingtheframeworkforaskingquestionsaboutcentralconceptofthediscipline),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(humanisticexistentialism)(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Centralconceptsofnursing,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。,WhatisaConcept?,“Athoughtoranotionconceivedinthemind”Twotypes:Empirical-observedorexperiencedthroughsensesi.e.stethoscope,cup,chair,etc.Abstract-notobservablei.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（conceptformation),思考、科研、系统观察会形成概念。,ConceptFormation,Aconceptasathought,ideaornotion,Aconceptasanabstractideageneralizedfromparticularinstances,RelationshipoftheStimulustotheconcept,InternalStimulus,ExternalStimulus,Scope,Examples,SimpleComplex,ConcreteAbstract,ValueinScientificInquiry,四、概念与理论的关系,概念的组成部分为理论（Basicingredientsofatheory）,五.护理学的概念（Nursingconcepts)Suchashealth,caring,interaction,stress,adaptation,growth,grief,illness,needs,etc.,FourBasicConceptsofNursing,PersonEnvironmentHealthNursing,Person(description),Eachpersonisauniqueindividualviewedinholisticterms.Byholisticitmeantthattheindividualisconsideredatotalhumanbeingwithbiopsychosocialneeds.Eachpersonhastherighttodignity,respect,autonomyandtheopportunitytogrowanddeveloptotheirfullpotentialandtoachieveoptimalfunctioning.Eachpersonisseenwithinasocialcontext.,Person,Humanbeings-uniqueindividuals,familyorfriendsBio-psychosocialFunctioning-needs,strengthsRights,responsibilities,dignityCultureDevelopmental,lifespanAdaptable,self-responsible,Health(description),Healthisthemultidimensionalconceptwhichcontainsbio-psychosocialelementsonafunctionalcontinuum.Healthisintrinsicallyrelatedtonotionsofqualityoflife,harmonyandwell-being.Healthcanbedefinedobjectivelyandfromsubjectiveexperience.,Health,Well-being,qualityoflifeContinuum-health-illnessEquilibriumBiopsychosocialdimensionsAbletodothingsonewantsFeelinggoodObjectiveandsubjectiveelements,Environment(description),Theenrironmentisthemajordeterminantofthehealthofindividuals,families,andcommunities.Itprovidesthecontextfornursingpractice.Theenvironmentcanbeconsideredalongtwodimensions:Thephysicalandsocio-culturalenvironmentwhichincludessocialvalues,beliefsandcustomsandinternal/externaldimension.Theenvironmentiseverchanginginthecontextoftimeandspace.,Environment,Working,family,community,globalAnimateandinanimateTimeandspaceCultural,customs,ritualsInternalandexternalDynamic,changing,Nursing(Description),Theessenceofnursingiscaring.Nursingisapractice-basedprofessioninvolvingbothartandscience,theartistheprocessintermsofthenurse-clientrelationship.Thescienceistheknowledgeandskillsthenursecontributestonursingpractice.Theaimofnursingistopromotewell-being,preventillness,maintainandrestorehealth,andtohelppeopleattainapeacefuldeath.,Nursing,Caringforindividuals,families,communitiesPromotionofwell-beingPeacefuldeathTechnicalskillsAprocessSupportinglifePractice-basedRelationshipwithpatientandothers,第三节护理理论NursingTheory,一、有关护理理论的基本概念1、知识（Knowledge）isanawarenessorperceptionofrealityacquiredthroughlearningorinvestigation)通过学习或研究而获得的对现实世界的认识,2、科学（Science）referstoabodyofknowledge,includingfactsandtheories,generatedbytheuseofcontrolled,rigorous,andprecisemethodswithinadelimitedareaofconcern.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）,Domainistheperspectiveandtheterritoryofthediscipline.Itcontainsthesubjectmattersofadiscipline,themainagreeduponvaluesandbeliefs,thecentralconceptsthephenomenonofinterest,itscentralproblems,andthemethodsthatareusedtoprovidesomeanswersinthediscipline.（学科的主要学术价值及观点，主要问题）,4、Paradigm（科学观）,Aparadigmisaconceptualdiagram,itcanbealargestructureusedtoorganizetheory,thataresharedbyitsscientificcommunity.,5、Model(模式）,Amodelisanideathatexplainsbyusingsymbolicandphysicalvisualization.(用图示或符号对概念及其关系的解释）,6、理论（Theory）,Anabstractgeneralplanthatpresentsasystematicexplanationsandrelationshipsamongconcepts.Theoriesembodyprinciplesfordescribing,explaining,predicting,andcontrollingphenomenaUltimategoalofscienceMakescientificfindingsmeaningfulandgeneralizable,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。,MetaparadigmofNursing,ComponentsParadigmMetaparadigmPhilosophiesConceptualModelsTheoriesEmpiricalIndicators,LevelsofAbstractionMostAbstractMostConcrete,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。,CharacteristicsofaTheory,InterrelateconceptstocreatenewwayoflookingataparticularphenomenonLogicalinnatureRelativelysimpleyetgeneralizableBasesforhypothesestobetestedfortheoryexpansionContributetobodyofknowledgeofadisciplineCanbeusedbypractitionerstoguideandimprovepracticeMustbeconsistentwithothervalidatedtheories,lawsandprinciples,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、医学模式阶段(Medicalmodel)3、借用阶段(borrowedtheories)4、独特理论阶段(Uniquetheories),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(scopeofthetheory)，可以将护理理论分为以下三类：GrandtheoryMiddlerangetheoryMicrotheoryorpartialtheory,GrandTheories宏观理论,BroadestinScopeConceptualstructuresSubstantivelynonspecificBeingmadeupofrelativelyabstractconceptsthatlackoperationaldefinition,Notdevelopedbyempiricalresearch,butbythoughtfulandinsightfulappraisalofexistingideasorcreativeleapsbeyondexistingknowledge.,GrandTheories,OremLevineRogersJohnsonRoyNeumanKingRoper,Logan,andTierney,MiddleRangeNursingTheories次宏观理论（中层理论）,Substantivelyspecific;Encompassingalimitednumberofconcepts;Limitedaspectoftherealworld;Derivedfromworksinotherdisciplinesrelatedtonursing;Fromearlierworksinnursingsuchasphilosophiesandtheories,andfromnursingconceptualmodelsandgrandtheories;Specifictonursingpracticeandspecifytheareaofpractice,agerangeoftheclient,thenursingactionorintervention,andtheproposedoutcome,MiddleRangeNursingTheories,PeplauOrlandoTravelbeeRiehlErickson,Tomlin,ministrationofhelp;validationLevine(1967)-supportiveandtherapeuticWatson(1985)-humanscienceandanartbasedonthemoralidealandvalueofcaring,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,CyclicalNatureofTheory,PracticeandResearch,Practice,Resea