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DNP 701 WS 3.1 Chapters 9, 14, 15-17 

Chapter #9 

Philosophical Position of the Nature of Human Beings—Orem’s Self-Care Deficit Nursing Theory (SCDNT)

             *Relevant to nursing education, practice, and research (Whelan, 1984)

             *Based on philosophical system of moderate realism

Six Phases Used to in the Philosophical Inquiry Process for Orem’s SCDNT (Banfield, 2008):

             *Phase one: Critical examination of Orem’s work looking for statements related to the inquiry question

             *Phase two: Examination and analysis of the statements

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Phase three: Examination and analysis of the work of individuals cited by Orem

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Phase four: Comparison of Orem’s work and those of the authors cited by Orem

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Phase five: Construction of the answer to the inquiry question

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Phase six: Evaluation of the findings

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Philosophic Position on Nature of Human Beings (Banfield, 2008):

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Description:    Unitary beings that exist in their environments

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Influence and are influenced by the world

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Strive to develop through developmental process

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Possess free will

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Awareness of self and environment

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Find meaning with experiences

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Possess ability to act deliberately

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Ability to love and bond with others

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Desire to know

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Desire for happiness

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Love of God

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Moderate Realism

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Demonstrated by Orem’s view of nature of reality and human beings

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     What is real is distinguished from what is rational or logical—it is mind dependent and known

<p class="MsoNormal" style="text-indent:.5in"><span style="font-family:"Times New Roman",serif">              *Nature of Reality

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Humans perceive and attach meanings to perception

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Four categories of the ontology of the SCDNT:

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                                 Persons in space-time locations (nurses and patients)

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                                 Attributes or properties of person (self-care agency, therapeutic agency, and nursing)

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                                 Motion or change (performance of self-care, seeking nursing assistance, and nursing)

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                                 Products brought into being (self or dependent care systems)

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">View of Human Beings:

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Person

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Embodied unitary beings

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Coexist with others

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Individuality expressed through knowing, feeling, imagining, reflecting, valuing, and willing

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Agent

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Foundation of Orem’s SCDNT—bring about something by deliberate actions

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *User of Symbols

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Used to represent something or attach meanings

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Organism

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Developmental process

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Functional and structural differentiations

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Object Subject to Physical Forces

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Believe humans as object subject to physical forces

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Chapter 14 

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Environmental Paradigms (Kleffel, 1996):

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Egocentric

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Person—what is good for individual is good for society

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Dominant perspective for nurses

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Environment is considered the individuals surroundings

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Homocentric

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Society—Utilitarian ethic of greatest good for the greatest number of people

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Stewards and caretakers of the natural world

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Philosophical foundation—both materialism and positivism

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Qualitatively different than animals

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Human affairs are social rather than individual

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Culture continues indefinitely

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Influence for public health nurses—population based nursing

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">             *Ecocentric

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Cosmos—considered whole, living, and interconnect to environment

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         All materials are given an intrinsic value

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         New concept in nursing profession

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Potential to transform nursing beyond traditional boundaries

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Compatible with Native American traditional ideas

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Compatible with elements of Eastern philosophies and contemporary Western thought

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                         Require nurses to think about global picture while taking care of local individuals

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Environmental toxins—educate on need to recycle and proper disposable of toxic items

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Ozone depletion—warn of sun exposure and need for sun screen

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">                                     Recurring infectious diseases—nurses working with other nurses worldwide to make a difference

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<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Chapter 15: Nursing Science: The Transformation of Practice 

<p class="MsoNormal"><span style="font-family:     "Times New Roman",serif">Nursing is changing from a base with traditional medicine with an applied science base to a science that is unique to nursing, but the applied science/ medical-model is still dominating. This nursing model currently focuses on the nursing practice and considers judgments made by nurses to be objective, and tasks are clearly defined. <p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Based on this theory, the nursing process is based on the medical model and is not appropriate for changes in nursing.
 * <span style="font-family:     "Times New Roman",serif">There is now a push to move nursing as a basic science with the push for healthcare reform and reform of global health.
 * <span style="font-family:     "Times New Roman",serif">The simultaneity paradigm poses that the human is “in mutual process with the universe and that health is a process and a set of values.” P 162.
 * <span style="font-family:     "Times New Roman",serif">Human becoming theory
 * <span style="font-family:      "Times New Roman",serif">The research is based on universal lived experiences such as values, quality of life, grieving, changing, and hope.
 * <span style="font-family:      "Times New Roman",serif">The study of the lived experience gains understanding of the human being, therefore expanding the knowledge of nursing.
 * <span style="font-family:      "Times New Roman",serif">Nurses focus on not only ill people, but also on families and communities.
 * <span style="font-family:      "Times New Roman",serif">The community is the universe; it is how humans connect.
 * <span style="font-family:      "Times New Roman",serif">Documentation includes the person’s description of their experiences, their views, and their hopes and intents, and is always from the person’s, family’s or community’s perspective.
 * <span style="font-family:      "Times New Roman",serif">This paradigm honors the person’s views and does not aim to push standardized care on them.
 * <span style="font-family:      "Times New Roman",serif">True presence nursing: recognize that humans change their views and values over time on health patterns and quality of life
 * <span style="font-family:       "Times New Roman",serif">Nonjudgmental
 * <span style="font-family:       "Times New Roman",serif">Abide by person’s wishes
 * <span style="font-family:       "Times New Roman",serif">No standardized care- Nurse does not tell people what to do
 * <span style="font-family:       "Times New Roman",serif">Health education is directed by the person, the nurse will answer questions when asked by the person. No standardized educational process.

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Chapter 16: A Dialectical Examination of Nursing Art  <p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Ability to grasp meaning in patient encounters
 * <span style="font-family:     "Times New Roman",serif">Article that aim was to study to better understand the art of nursing
 * <span style="font-family:     "Times New Roman",serif">Some works on nursing as art include Nightingale’s Notes on Nursing and Benner’s from Novice to Expert.
 * <span style="font-family:     "Times New Roman",serif">There are many differences in opinion related to the art of nursing, and not much literature evaluating other scholar’s differences.
 * <span style="font-family:     "Times New Roman",serif">Study was aimed to find common ground among different opinions of art of nursing.
 * <span style="font-family:     "Times New Roman",serif">Author used a method by Adler to examine and analyze the current literature about the art of nursing to attempt to find similarities and oppositions among concepts.
 * <span style="font-family:     "Times New Roman",serif">The author examined 41 authors from different time periods.
 * <span style="font-family:     "Times New Roman",serif">They found five separate concepts of nursing art.
 * <span style="font-family:      "Times New Roman",serif">“The nurse’s ability to grasp meaning in patient encounters.”
 * <span style="font-family:      "Times New Roman",serif">“The nurse’s ability to establish a meaningful connection with the patient.”
 * <span style="font-family:      "Times New Roman",serif">“The nurse’s ability to skillfully perform nursing activities.”
 * <span style="font-family:      "Times New Roman",serif">“The nurse’s ability to rationally determine an appropriate course of nursing action.”
 * <span style="font-family:      "Times New Roman",serif">“The nurse’s ability to morally conduct his or her nursing practice.”

<p class="MsoNormal" style="margin-left:1.0in;text-indent:-.25in;mso-list:l8 level1 lfo4"> o      <span style="font-family:"Times New Roman",serif">Done by perception, perhaps intuition- use of external senses/ imagination

<p class="MsoNormal" style="margin-left:1.0in;text-indent:-.25in;mso-list:l8 level1 lfo4"> o      <span style="font-family:"Times New Roman",serif">Pertain to a specific patient and situation

<p class="MsoNormal" style="margin-left:1.0in;text-indent:-.25in;mso-list:l8 level1 lfo4"> o      <span style="font-family:"Times New Roman",serif">Unable to be fully described

<p class="MsoNormal" style="margin-left:1.0in;text-indent:-.25in;mso-list:l8 level1 lfo4"> o      <span style="font-family:"Times New Roman",serif">It is developed and tweaked over time by experience and foreknowledge

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Ability to establish a meaningful connection with the patient <p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Ability to skillfully perform nursing activities <p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Ability to determine rationally an appropriate course of nursing action <p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Ability to conduct one’s nursing practice morally. <p class="MsoNormal"><span style="font-family:"Times New Roman",serif">  <span style="font-family:"Times New Roman",serif">Chapter 17: A Conceptual Framework for Person-Centered Practice with Older People 
 * <span style="font-family:     "Times New Roman",serif">Expressed in the nurse’s actions or behaviors
 * <span style="font-family:     "Times New Roman",serif">Expressive- may show in emotions- may show compassion and caring
 * <span style="font-family:     "Times New Roman",serif">There is a connectedness between one human being to another human being, there is a genuine relationship
 * <span style="font-family:     "Times New Roman",serif">The nurse is genuine and sincere
 * <span style="font-family:     "Times New Roman",serif">The nurse not only knows what is to be done but how to do it.
 * <span style="font-family:     "Times New Roman",serif">Activities are manual and verbal
 * <span style="font-family:     "Times New Roman",serif">Learned by practice and repetition
 * <span style="font-family:     "Times New Roman",serif">Actions are focused on doing rather than knowing
 * <span style="font-family:     "Times New Roman",serif">Art of nursing is judged by movement, coordination, timing, strength, efficiency.
 * <span style="font-family:     "Times New Roman",serif">Practical
 * <span style="font-family:     "Times New Roman",serif">Underlying scientific knowledge and acknowledge that nursing is a profession
 * <span style="font-family:     "Times New Roman",serif">Nurses understand what is ahead and what they need to do
 * <span style="font-family:     "Times New Roman",serif">Logical reasoning- Theories applied to practice
 * <span style="font-family:     "Times New Roman",serif">Judged by whether goals are attained.
 * <span style="font-family:     "Times New Roman",serif">Nursing is directed towards the good of the patient
 * <span style="font-family:     "Times New Roman",serif">Nurse must be competent in their practice- even in difficult situations
 * <span style="font-family:     "Times New Roman",serif">Nurse is motivated by concern for others

<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Paper that provides a conceptual framework for person-centered in older people emphasizing partnerships between nurses and older people <p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Authentic consciousness <p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Imperfect duties <p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Nurse is facilitator of authentic consciousness <p class="MsoNormal"><span style="font-family:"Times New Roman",serif">
 * <span style="font-family:     "Times New Roman",serif">Person –centeredness is a holistic approach incorporating values
 * <span style="font-family:     "Times New Roman",serif">Research approach derived from hermeneutic philosophy of Gadamer
 * <span style="font-family:      "Times New Roman",serif">Data is interpreted from interactive dialogue between researcher and participant.
 * <span style="font-family:     "Times New Roman",serif">“consideration of the person’s life as a whole in order to help sustain meaning in life.” (p. 190).
 * <span style="font-family:     "Times New Roman",serif">Aware of the beliefs and values of the person
 * <span style="font-family:     "Times New Roman",serif">Considers the patient’s authenticity
 * <span style="font-family:     "Times New Roman",serif">Opposite of “perfect duties”—which are strict and enforceable
 * <span style="font-family:     "Times New Roman",serif">Aware of emotional factors of decision making
 * <span style="font-family:     "Times New Roman",serif">Imperfect because a person might have to decide between two duties
 * <span style="font-family:     "Times New Roman",serif">Imperfect duties include:
 * <span style="font-family:      "Times New Roman",serif">Informed flexibility—putting new information into current practices
 * <span style="font-family:      "Times New Roman",serif">Mutuality—others values are equal
 * <span style="font-family:      "Times New Roman",serif">Transparency—make clear intentions and motivations
 * <span style="font-family:      "Times New Roman",serif">Negotiation—patient participation in care and honoring their views
 * <span style="font-family:      "Times New Roman",serif">Sympathetic presence—recognizing uniqueness of individual
 * <span style="font-family:     "Times New Roman",serif">Role of person-centered nurse is to allow the patient to make own decisions while offering support
 * <span style="font-family:     "Times New Roman",serif">May lead to ethical dilemmas—nurse will contemplate options and reassess values

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<p align="center" class="MsoNormal" style="text-align:center"><span style="font-family:"Times New Roman",serif">References

<p class="MsoNormal" style="margin-left:.5in;text-indent:-.5in;line-height:200%"><span style="font-family:"Times New Roman",serif">Banfield, B. (2008). Philosophic position on nature of human beings foundational to Orem's Self-Care Deficit Nursing Theory. Self-Care, Dependent-Care & Nursing, 16(1), 33-40.

<p class="MsoNormal" style="margin-left:.5in;text-indent:-.5in;line-height:200%"><span style="font-family:"Times New Roman",serif">Kleffel, D. (1996). Environmental paradigms: Moving toward an ecocentric perspective. Advances in Nursing Science, 18(4), 1-10.

<p class="MsoNormal" style="margin-left:.5in;text-indent:-.5in;line-height:200%"><span style="font-family:"Times New Roman",serif">Whelan, E. G. (1984). Analysis and application of Dorothea Orem's Self-Care Practice Model. The Journal of Nursing Education, 23(8), 342-345.