THE NURSE, NURSING, AND SOCIETY

The nurse is a unique person who has a set of professional activities in the
health area.
There is a set of beliefs and values of the sociocultural context in which it is inserted and
from your life experience.
Has individual goals, but they must be aligned with those of the profession (without getting into
in conflict).
Nursing interacts with other professions in order to meet the needs of
patients. Nurses provide care to the patient throughout their life cycle with
aims to promote and always maintain its autonomy and functionality. As nurses
We must observe and collect information that the users communicate to us.

Autonomous interventions: making autonomous decisions taking into account my

technical-scientific knowledge.
Interdependent interventions: making decisions with knowledge sharing and
prescriptions.

To take care Treat

Provide care Treat people
Holistic model Biomedical model
Maintain comfort and try to understand Resolve the situations of a
the 'whys' practical form

NOTE: comprehensive term, we provide care to people. Currently, the national plan
health aims to promote health, promote lifestyles
healthy.

HISTORY OF NURSING
In the early days, there were only doctors (seeking solutions) and surgeons (treating).

Origin of Nursing
Source associated à provision of care maternal
(feed/dress/hygienize)
Caring for the 'other' (close person).
Care provision for those in need (healthy or ill, throughout the entire cycle
vital in order to reach its maximum functional capacity.

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 Pre-Christian era Post-Christian era

The first basic care was Concrete locations appear for the
lent first to the children, then nursing care.
my dear ones (older). Then the
Deacons - rich people who
sick (unfamiliar people).
they tried to develop care
Appearance of the wise to deal with the other, to occupy the
healers - people who had your time
conhecimentos associado ao poder
Deaconesses - have time
(widows) who provided care to
outros. E mulheres que não tinham
loved ones, connected to God and did the
provision of care.

The organized care

Religious Congregations:
Order of the Hospital of St. John of God
Order of the ministers of the sick
Daughters of Charity
These congregations still have influence in healthcare.

Hospitals in Portugal:
Queen D. Leonor: Thermal hospital of Caldas da Rainha (gave rise to the
Mercies.
- King John II: Royal Hospital of All Saints (founded the Hospital of Saint Joseph).

Protestant Reformation
The clergy committed some abuses in terms of usurpation of money that would have
purpose of using to help the most needy.
Martin Luther initiated a movement against the clergy because he defended principles/ideas.
different from those of the Church.

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This movement caused the abandonment of religious orders in providing care.
what caused the lack of people to take care of others.
As those who had knowledge in this area were expelled from the order, they sought
homeless people and prostitutes who were integrated to provide care. This was a time
in which the care became decadent, the care was provided in exchange for
money, then it came to be called the DARK/BLACK PERIOD OF
Nursing.

Elizabeth Fry
He was born in 1780 in Norfolk and had 6 brothers and sisters.

She did not feel integrated as a child and was shy.

I didn't know what to do with my life, so I dedicated myself to helping the poor by taking...
clothes, food, and money.
With the goal of doing good and having a purpose, he overcame fear and went to the
Newgate prison see the conditions in which the inmates lived and found 'the
its purpose.
The development of care provision began with the mission to help.
the others.
⸙ Centrou-se inicialmente nas crianças e nas mulheres levando-lhes roupa e
food, and provided education to the children in order to ensure that when
if they left prison there would be a means of subsistence, given that the adults
they ended up taking advantage of this training as well.

(This was a care not associated with the disease).

Later, Queen Victoria financed his work.

Florence Nightingale (Ms. Smith)

He was born in Florence, Italy in 1820. He was a child with another kind of
games and felt a calling from God.
He/She started studying Nursing even against the will of his/her parents.

Studied in London at a Lutheran institution.

In 1853, the Crimean War began, which caused many deaths. Florence
together with 38 women were sent to war to offer
assistance to soldiers.
It managed to reduce the mortality rate from 40% to 2%. It was able to do so.
through basic care such as cleaning of spaces and soldiers,
healthier food provided more comfort to the soldiers through
a good lighting and warmth in the spaces.
She became known as 'the lady of the lamp' because she kept the
continuity of care at night. During the night (at that time it was still not
there was electricity) would make rounds to the patients to check if they needed
something, with a lamp.

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 After the war, it became very well known, but since I did not want fame and how
wanted to return to England, had to change name.
Florence was very good at statistics, so she graphically demonstrated that
There are improvements that are sensitive to nursing care.
Care associated with biopsychosocial health and well-being. (It was from here that it was launched the
nursing bases.
Gave a technical character to Nursing - for Florence, the improvements of
nursing care would have to undergo meticulous cleaning care when
environment and personnel, as well as the need for fresh air, good lighting,
of adequate heat and, to finish, of good nutrition and rest. These interventions
They made it so that mortality reduced significantly.

Nursing Care:
Compassion (desire to help);
Observation (observing physical, environmental, and psychological aspects);

Experience (we learn to deal with variables that we cannot control);

Statistical data (demonstrate the importance of care);
Hygiene and nutrition (are the foundations for promoting health).

The Legacy:
The legacy was a group of nurses to whom Florence (at the time was starting to become
(Sick) passed on his nursing knowledge so that she would not die.
Florence developed a training school (St. Thomas Hospital). In order to
to enter this school, one had to have rigorous discipline, moral qualities, and training in
1 year.
Florence also wrote the Nursing Notes.
Nursing schools in Portugal: the first nursing school appeared in 1881 in
Coimbra by Dr. Costa Simões.

MYTHS, REALITIES AND IDENTITY

Empirical Care Scientific Knowledge

They learned to take care through the Broader perspective;
experience; It spans various disciplines;
But associated
Gender with care
stereotype More associated with the Holistic model;
maternal;
⸙ Saúde era associada a trabalho de homens;
Concern about knowing 'why' and
More associated with the model
Woman at home providing care; how it happens.

Man - doctor / Woman - nurse.

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 Compassion Profession
The nurses did not marry, Nursing recognized
many were associated with orders as a profession;
religious;
Scientific knowledge for
Nursing was considered provision of care.
mission

Doubtful Moral Ethics and Deontology

Associated with the dark period of Respect for people and for
nursing care provision;
They had no morals or ethics to No value judgment is made;
provide care.
Professional secrecy.

Medical assistant Autonomous and interdependent interventions

Nurses were assisting the doctors Interdependent functions;
just to do what they do not
they wanted to do; Nurses have autonomy to
make decisions.
They only did what the doctors
mandavam.

Absence of opportunity Option

It's for nursing who doesn't Nursing school by choice;
I could be a doctor;
Nursing and medicine
complementary knowledge.

REPE - regulation of the professional practice of nursing.

Formal and legal recognition of the profession

Maintenance of health and prevention

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 (healthier lifestyles)
(promotion of the autonomy of the person/user)

Identity

Identity as a nurse is Ensures the unity of a set

integrate and understand what it is of values and beliefs, finding oneself
necessary to build against to based on social recognition.
profession identity.

Note: identity is adapted from country to country and from culture to culture.
Note: unit - nurse's functions (provision of universal care).

Identification process - where social actors integrate into vast groups,

whether they are of belonging or reference, and merges with them.

Identity process - through which individuals differentiate and become autonomous,

defining boundaries in relation to others, which may be more or less rigid.

STAGES OF NURSING PROGRESS

Afaf Ibrahim Meleis
Practice
Education
Investigation
Theoretical component
Philosophical
Integration
Interdisciplinarity
Technologies and information systems

Practical phase:
It is directly addressed to the person
Care and comfort. Nurses (hygiene care in performed actions). Person
(good nutrition and rest).
Environmental conditions space/actors
In the fresh air

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Good lighting Space Suitable for the actors.

Adequate warmth

Descriptive statements of the quality of professional practice

Essential in practice

Education and Administration Phase:

Educational nursing programs (theory)

And how of the practice (because we carry out certain procedures). The how of
teach the practice (way of explaining the why).

Tool that every general care nurse must have

Investigation Phase:
The objective was to know the domain of nursing.
⸙ Essencialmente académica
Process of formation - practice.
Through the investigation A investigation é necessary for
Florence formulated the infographics to prove fundament/ show results in relation to
your results. nursing care.

Tool to assist in making any

decision.

Theoretical Phase:

It is necessary to theorize practice (in the early days, knowledge was

empirical).
What do nurses do?
Necessary questions to guide teaching
How do nurses do it?
Why do nurses do?
To explain the 'theoretical' part of
Who do they make? nursing

Necessary tool for teaching at a level

school (paradigms-concepts emerge)

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Philosophical Phase:

Nature of nursing knowledge (philosophies of origin);

Person/professional/interaction (interpersonal relationships).

Autonomy and Health Project

Guiding lines of the discipline emerge

Integration Phase:
Encourages the discussion of the subject

As it gathers several, more options/theories emerge.

THE ALL
It is a combination of all the previous phases

Interdisciplinary Phase:
Research programs that incorporate theories and evidence from different
fields.
Integration of all subjects (holistic)
Make it possible for us to interconnect everything

ALL → different disciplines

Nursing draws from all disciplines

Phase Technology and Information Systems:

Globalization
Accessibility
Good practices
Effective monitoring
More and more, the user has access to more information.
We need to be able to revert to previous levels in order to
implement good practices
Interoperability capacity between communication systems

THE WHOLE - information - knowledge

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 Final level, more information, more knowledge

LEVELS OF STRUCTURE OF KNOWLEDGE IN NURSING

WHY?

What is the meaning of the works?

theoretical frameworks for the discipline and profession
of nursing?

For the profession the theory serves

for we can adapt
the practice, knowing what we have to do;
For the discipline it serves to guide, according to the procedures, and
to base our practice.

Knowledge - Discipline - Theories - Training - Practice

Everything connected

The academic discipline depends on the existence of nursing knowledge.

Note: it will promote development in training
Knowledge is transmitted to those who intend to train in the profession.
The profession is performed based on practices.
Note: there needs to be evolution and investigation for the practice to work.

Professional component of the discipline.

HOW IS KNOWLEDGE IN NURSING STRUCTURED?

5 components
The metaparadigm progresses towards a set of
conceptual models influenced by philosophies
Set of conceptual models leads to a
set of theories that in turn lead to a
set of empirical indicators.

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 Components
Empirical indicators: (more concrete target of the practice)

Defined as Instrument - Used to observe/measure a concept of a theory.

Produces qualitative and quantitative data.
There is no direct connection with the conceptual models, the philosophies and the
metaparadigm, so that they cannot be subject directly to empirical testing.

Theory: (a set of concepts that suggest actions to guide practice).

Theoretical statements are testable.
They come from conceptual models
Great theories - more abstract, but propose something truly real or testable.
Limited theories (e.g., reflect practices)
Mid-range theories - practical particularities (e.g.: situation or health condition,
population of patients or their age group

Conceptual models: (set of relatively abstract concepts)

They focus on a framework for systematic approaches to phenomena with
which the discipline relates to - non-observable, non-testable.

⸙ Filosofias: (influencia os metaparadigmas, ou seja, os 4 conceitos)

It serves to inform members of other disciplines and the public about the
beliefs and values of that particular discipline.
Anthological pretensions - nature of the human being, the environment, health and
nursing and the objectives of nursing.
Epistemic claims - existing knowledge and what is necessary to obtain about the
human being, …, to provide care.
Ethical claims - values that guide the nurse-human relationship, to the character of
nurses and the values that regulate nursing practice. that regulate practice
of nursing.

Metaparadigms: (underlying concept of quality)

Nuclear content of a subject.
Global concepts that identify phenomena of interest for nursing, the
propositions that describe concepts and propositions that establish relationships
between concepts.
Human beings (Person)
Environment
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 Health
Nursing Care

General Perspective of Theoretical Nursing Works

Philosophies
It serves to inform about the beliefs and values of the discipline in
particular. They can be:
Ontological pretensions - nature of human beings, the environment, health and
nursing and its objectives.
Epistemic claims – knowledge necessary to provide
care; existing knowledge and what needs to be developed about
two human beings, the environment, health and nursing.
Ethical claims - values inherent to the profession in relation to people and to
environment; values that guide nurse-human relationships, to the character of
nurse and the values that govern nursing practice.

Florence Nightingale
THE FOCUS - Environment

The main concern is hygiene and environmental structures (beds, furniture,

light, temperature)
Environment Sick
Patients must be in the best possible physical and psychological condition for the
nature acts and heals them.
Natural defenses must be in the best condition for the disease to progress to
health.
The nurses did not cure; they placed people in the best environmental conditions.
so that nature could act upon him.
Assumptions - Environmentalist Theory

Health
Environment
Feel good and make the most of it
Controlled element in a way all your capabilities.
external, as it affects both health
preventing the disease as a patient
to transmit the disease. Nursing
Take responsibility for
Person sick individuals changing aspects
Perspective of the disease. unhealthy in the environment.

I assumed the person was ill.

is not an active element in your plan
of health.
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Virginia Henderson
THE FOCUS - independence of the person in meeting their needs.
But directed at the person
Basic human needs
Environment Sick
Empathetic relationship - when the nurse puts themselves in someone else's shoes to try
to understand, but never to replace.
It is part of the therapeutic relationship (non-emotional)

Privileges autonomy
The nurse identifies the necessary conditions for assistance through the conditions.
physiological and pathological of the person.

The patient continued to be passive.

Assumptions - Theory of Needs
Nursing

Person
Health Environment
Perspective
The abilitydirected at each
of the person to be Set of all conditions and
person.
independent in the 14 needs external influences that affect the
basic human rights defined. person.
Individual who requires
assistance to obtain health or
independence or peaceful death.
Note: peaceful death - through the processes
physiological and pathophysiological, it is known that there is nothing to be done, one has to accept it, and
Consequently, we only have to meet their needs.
Peaceful death ≠ Dignified death

The 14 needs are:

Breathing Rest and sleep Safe environment

Elimination Appropriate clothing Communication

Food and Temperature Worship

drink corporal Work
Movement Clean body and
Lazer
tegumento
Level of relationship:

The nurse performs a total replacement

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Nurse assistant - assists with care
Partner nurse - just supervise

Jean Watson
THE FOCUS - Take care

Human care Patient/Nursing

Both the nurse and the patient are active elements.
The nurse takes care
The patient is the object of care

Transpersonal behavior between the patient and the nurse

the provision of care cannot be influenced by our ethical values and

morais.

Assumptions - Transpersonal Care Theory

Health Nursing

Importance of mental health Beginning of the conceptualization of

disease prevention.
Unity and harmony between mind,
body and spirit. Promote and restore health and
disease prevention.
É responsável pela prevenção da
Person and environment were not studied.

10 factors and care organized in:

Conditions for care

Knowledge for To plan and solve Purpose

to know what this is problems must be had positive result
affected scientific knowledge judged for the good-
to know what to do to be

Patricia Benner
THE FOCUS - Evolution of competence

Transformation of competence Nursing

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It is through experience and mastery that nursing care evolves.
Assumptions - Theory from Beginner to Expert

Health
Person
Absence of disease being this the
what can be relieved at a physical level Individual who defines himself over time
(wounds). of the life cycle.

Identify conditions.

Environment Nursing
Use the term situation and not Important relationship between 3
environment. elements: care, experience and
disease.
Being situated is having a past,
present and future that influence the
current situation.

Conceptual models and major theories:

Provides a framework and It comes from conceptual models and

allows observing and interpreting the proposes something true or testable.
phenomena of interest for the
discipline.

Dorothea Orem
THE FOCUS - self-care deficit
To be able to take care of oneself.

Self-care Human Being

Self-care is an action acquired by the individual in their sociocultural context.
To be able to do this, you need to adopt continuous self-care actions.

Assumptions - Self-Care Deficit Theory

Person: Health:
The individual who uses the Result of learned practices
self-care to maintain life and by individuals to maintain life
health, recover from illness and and well-being.
face your deficits.
 Environment: Nursing:
External elements with which the Aiding the promotion of
man interacts in a way to maintain self-care done by the person.
self-care.

Myra Levine
THE FOCUS - Holism
Holistic perspective
The person as a whole
Different parts = more than everything

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Assumptions - Theory of Holism

Person:
Nursing:
Express the organization of all the
Promotes adaptation and maintains the
parts.
totality.

Socially determined by
ability to continue to involved, where we live the
function normally. our lives.

Martha Rogers
THE FOCUS - Unified human being

The human being is unique, what works for one person may not
work with another.

Assumptions - Theory of the unitary being

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 Person:
Environment:
Open system, person with a Pandimensional energy field.
all biological, psychological, social,
cultural and spiritual (each person-
Health: Nursing:
Defined by culture and by Promote health and well-being of
individual. all the people in your
singularity (thinking about the
characteristics of each one)

Callista
Roy
THE FOCUS - Adaptation

Humans have different aspects to which they have to adapt and

to conjugate the aspects in order to generate specific behaviors.
Development of coping processes.

Assumptions - Adaptation Theory

Person:
Health:
Nursing: Process of being and becoming one
total and integrated person. (Result
Expand the capacity of of the adaptation
adaptation and improvement to
environmental transformation and of
Environment:
person (promote processes of
coping). Conditions, circumstances and
influences that surround and affect
the development and the
behavior of people and
Imagene King
groups.
The focus - nurse-patient interaction with
view to achieving objectives
It's important to integrate the family.

Nursing intervention plans have objectives.

The nurse has perception according to interaction, interacts with the patient and the patient.
You will make a judgment according to your perception leading to a reaction.

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Assumptions - Theory of Goal Achievement

Person: Health:
Open system in transaction with the Continuous adjustment to stress in
environment. internal and external environment through
for the use of the person's resources
achieve maximum potential.

Nursing:
Interpersonal process of action, Environment:
reaction, interaction and transaction.
Internal and external perspective of
person.

Nancy Roper; (Winifred Longan; Alison

Tierney
THE FOCUS - Life Activity
(self-care)

Organized in groups leads to 12 life activities

Currently they are more divided

(Before) (Now)
Skill Positioning and transferring

Dependency and independence taking into account the life cycle

Do everything execute
To be part to monitor
Do not do to supervise

Assumptions - Theory of Activities of Life

Person:
Nursing:
Be individual;
Helps people to prevent, relieve
Be defined in terms of the 12 activities of Environment:
life according to the state of dependence Everything that is physically external to
independence throughout the life cycle.
person.
with disability. 18
Hildegard Pepla
The FOCUS - Interpersonal Process
Understanding the established relationships.

4 nurse/patient relationships:
Guidance
Identification
Exploration (teaching)
Resolution

Roles that nursing performs:

Strange
Resource person
Professor (health education)
Leader
⸙ Substituta
Counselor

Assumptions - Psychodynamic theory

Person: Health:
Man is an organism that lives Creative life, personal construction and
in unstable equilibrium. community.

Environment:
External forces of the organism and
in the context of culture.
therapeutic.

Katharine Kolcaba
THE FOCUS - Comfort (more associated with palliative care)

Comfort for the person Defined by the patient

(patient or family)
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Comfort in different environments
Related to the definition of health (individual)
It can be felt at various levels (psychological and physical for example)

Assumptions - Theory of Comfort

Health:
Person:
Optimal functioning defined
Who receives care (individual, by the patient or group.
family, institution, community.

Nursing:
Who performs intentional appreciation
Any aspect that can be
the needs for comfort.
manipulated by the nurse or
family to provide comfort.

Madeleine Leininger
THE FOCUS - Transculturality
We must understand all cultures
We have to respect

Note: data collection can help us identify the culture.

Assumption - Transcultural Theory

Health:
Person:
Target to take care of.
Condition of culturally based well-being
defined.

Environment: Nursing:
Check the meanings of the expressions Humanistic and scientific discipline
humans. focused on caring
human.

Afaf
Meleis

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THE FOCUS - Transition

Health-disease transition processes

Understanding the transition

It can happen in different ways

Theoretical Model
The transitions occur in different types.

Facilitated or constrained

Within the transition processes, there are process indicators.

The nursing intervention focuses on

facilitating process of the transition that
promotes well-being.

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