Nursing Theories

NURSING THEORIES: NURSING THEORIES: AN OVERVIEWAN OVERVIEW

PREPARED BY: VESA LARA MALAINE P. RAGA, RNPREPARED BY: VESA LARA MALAINE P. RAGA, RN

INTRODUCTIOINTRODUCTIONN

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ERLINGERERLINGER views theories as a set of interrelated views theories as a set of interrelated

concepts that give a systematic view of a concepts that give a systematic view of a

phenomenon (an observable fact or event) that is phenomenon (an observable fact or event) that is

explanatory and predictive in nature. explanatory and predictive in nature.

Theories are composed of Theories are composed of CONCEPTSCONCEPTS, ,

DEFINITIONSDEFINITIONS, , MODELSMODELS , , PROPOSITIONSPROPOSITIONS and are and are

based on based on ASSUMPTIONSASSUMPTIONS. .

They are derived through TWO PRINCIPAL METHODS: They are derived through TWO PRINCIPAL METHODS:

1) 1) DEDUCTIVE REASONING DEDUCTIVE REASONING - - is reasoning which constructs or evaluates is reasoning which constructs or evaluates

deductive arguments. Deductive arguments are attempts to show that a deductive arguments. Deductive arguments are attempts to show that a

conclusion necessarily follows from a set of premises. A deductive argument is conclusion necessarily follows from a set of premises. A deductive argument is

valid if the conclusion does follow necessarily from the premises, i.e., if the valid if the conclusion does follow necessarily from the premises, i.e., if the

conclusion must be true provided that the premises are true. A deductive conclusion must be true provided that the premises are true. A deductive

argument is sound if its premises are true. Deductive arguments are valid or argument is sound if its premises are true. Deductive arguments are valid or

invalid, sound or unsound, but are never true or false.invalid, sound or unsound, but are never true or false.

2) 2) INDUCTIVE REASONING INDUCTIVE REASONING - is a kind of reasoning that allows for the possibility - is a kind of reasoning that allows for the possibility

that the conclusion is false even where all of the premises are true. The premises that the conclusion is false even where all of the premises are true. The premises

of an inductive logical argument indicate some degree of support (inductive of an inductive logical argument indicate some degree of support (inductive

probability) for the conclusion but do not entail it; i.e. they do not ensure its truth.probability) for the conclusion but do not entail it; i.e. they do not ensure its truth.

Nursing theorists use both of these methods. Nursing theorists use both of these methods.

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ursing Theory: Barnum(1998)ursing Theory: Barnum(1998) - "attempts to describe or - "attempts to describe or

explain the phenomenon (process, occurrence and event) explain the phenomenon (process, occurrence and event)

called called NURSINGNURSING""

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heories are for professional nursing.heories are for professional nursing.

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HEORYHEORY is "a creative and rigorous structuring of ideas that is "a creative and rigorous structuring of ideas that

projects a tentative, purposeful, and systematic view of projects a tentative, purposeful, and systematic view of

phenomena" .phenomena" .

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theory makes it possible to "organize the relationship theory makes it possible to "organize the relationship

among the concepts to describe, explain, predict, and control among the concepts to describe, explain, predict, and control

practice"practice"

DEFINITIONSDEFINITIONSCC

ONCEPTSONCEPTS - are basically vehicles of thought that - are basically vehicles of thought that

involve images.involve images.

- building blocks of theories.- building blocks of theories.

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ONCEPTSONCEPTS are words that describe objects , are words that describe objects ,

properties, or events and are basic components of properties, or events and are basic components of

theory. theory.

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ONCEPTUAL FRAMEWORKONCEPTUAL FRAMEWORK – is a group of related – is a group of related

ideas, statements or concepts.ideas, statements or concepts.

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he term he term CONCEPTUAL MODELCONCEPTUAL MODEL is often used is often used

interchangeably with interchangeably with CONCEPTUAL FRAMEWORKCONCEPTUAL FRAMEWORK, ,

and sometimes with and sometimes with GRAND THEORIESGRAND THEORIES, those , those

that articulate a broad range of the significant that articulate a broad range of the significant

relationships among the concepts of a discipline.relationships among the concepts of a discipline.

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ODELSODELS - are representations of the interaction - are representations of the interaction

among and between the concepts showing among and between the concepts showing

patterns. patterns.

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ROPOSITIONSROPOSITIONS - are statements that explain the - are statements that explain the

relationship between the concepts. relationship between the concepts.

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ROCESSROCESS - it is a series of actions , changes or - it is a series of actions , changes or

functions intended to bring about a desired functions intended to bring about a desired

result.result.

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uring a process one takes systemic and continuous steps to meet a uring a process one takes systemic and continuous steps to meet a

goal and uses both assessments and feedback to direct actions to goal and uses both assessments and feedback to direct actions to

the goal.the goal.

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particular theory or conceptual frame work directs how these particular theory or conceptual frame work directs how these

actions are carried out . The delivery of nursing care within the actions are carried out . The delivery of nursing care within the

nursing process is directed by the way specific conceptual nursing process is directed by the way specific conceptual

frameworks and theories define the person (patient), the frameworks and theories define the person (patient), the

environment, health and nursing.environment, health and nursing.

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he terms ‘model’ and ‘theory’ are often wrongly used he terms ‘model’ and ‘theory’ are often wrongly used

interchangeably, which further confounds matters. interchangeably, which further confounds matters.

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n Nursing, models are often designed by theory authors to depict n Nursing, models are often designed by theory authors to depict

the beliefs in their theory (Lancaster and Lancaster, 1981). the beliefs in their theory (Lancaster and Lancaster, 1981).

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hey provide an overview of the thinking behind the hey provide an overview of the thinking behind the

theory and may demonstrate how theory can be theory and may demonstrate how theory can be

introduced into practice, for example, through specific introduced into practice, for example, through specific

methods of assessment. methods of assessment.

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odels are useful as they allow the concepts in nursing odels are useful as they allow the concepts in nursing

theory to be successfully applied to nursing practice theory to be successfully applied to nursing practice

(Lancaster and Lancaster, 1981). (Lancaster and Lancaster, 1981).

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heir main limitation is that they are only as accurate heir main limitation is that they are only as accurate

or useful as the underlying theory. or useful as the underlying theory.

IMPORTANCE OF IMPORTANCE OF NURSING THEORIESNURSING THEORIES

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ursing theory aims to describe, predict and explain the phenomenon of ursing theory aims to describe, predict and explain the phenomenon of

nursing (Chinn and Jacobs, 1978). nursing (Chinn and Jacobs, 1978).

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t should provide the foundations of nursing practice, help to generate t should provide the foundations of nursing practice, help to generate

further knowledge and indicate in which direction nursing should further knowledge and indicate in which direction nursing should

develop in the future (Brown , 1964). develop in the future (Brown , 1964).

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heory is important because it helps us to decide what we know and heory is important because it helps us to decide what we know and

what we need to know (Parsons, 1949). what we need to know (Parsons, 1949).

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t helps to distinguish what should form the basis of practice by t helps to distinguish what should form the basis of practice by

explicitly describing nursing. explicitly describing nursing.

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he benefits of having a defined body of theory in nursing include he benefits of having a defined body of theory in nursing include

better patient care, enhanced professional status for nurses, better patient care, enhanced professional status for nurses,

improved communication between nurses, and guidance for improved communication between nurses, and guidance for

research and education (Nolan, 1996). In addition, because the research and education (Nolan, 1996). In addition, because the

main exponent of nursing – caring – cannot be measured, it is main exponent of nursing – caring – cannot be measured, it is

vital to have the theory to analyze and explain what nurses do. vital to have the theory to analyze and explain what nurses do.

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s medicine tries to make a move towards adopting a more s medicine tries to make a move towards adopting a more

multidisciplinary approach to health care, nursing continues to multidisciplinary approach to health care, nursing continues to

strive to establish a unique body of knowledge. strive to establish a unique body of knowledge.

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his can be seen as an attempt by the nursing profession to his can be seen as an attempt by the nursing profession to

maintain its professional boundaries. maintain its professional boundaries.

CHARACTERISTICS OF CHARACTERISTICS OF THEORIESTHEORIES

TheoriesTheories

••Interrelate concepts in such a way as to create a different way of Interrelate concepts in such a way as to create a different way of

looking at a particular phenomenon. looking at a particular phenomenon.

••Are logical in nature. Are logical in nature.

••Are generalizable. Are generalizable.

••Are the bases for hypotheses that can be tested. Are the bases for hypotheses that can be tested.

••Increase the general body of knowledge within the discipline Increase the general body of knowledge within the discipline

through the research implemented to validate them. through the research implemented to validate them.

••Are used by the practitioners to guide and improve their practice. Are used by the practitioners to guide and improve their practice.

••Are consistent with other validated theories, laws, and principles Are consistent with other validated theories, laws, and principles

but will leave open unanswered questions that need to be but will leave open unanswered questions that need to be

investigated investigated

BASIC PROCESSES IN THE BASIC PROCESSES IN THE DEVELOPMENT OF NURSING DEVELOPMENT OF NURSING

THEORIESTHEORIESNN

ursing theories are often based on and influenced by broadly applicable ursing theories are often based on and influenced by broadly applicable

processes and theories. Following theories are basic to many nursing processes and theories. Following theories are basic to many nursing

concepts. concepts.

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. . GENERAL SYSTEM THEORYGENERAL SYSTEM THEORY: :

••It describes how to break whole things into parts and then to learn how It describes how to break whole things into parts and then to learn how

the parts work together in " systems". the parts work together in " systems".

••These concepts may be applied to different kinds of systems, e.g.. These concepts may be applied to different kinds of systems, e.g..

Molecules in chemistry , cultures in sociology, organs in Anatomy and Molecules in chemistry , cultures in sociology, organs in Anatomy and

health in Nursing. health in Nursing.

B. B. ADAPTATION THEORY ADAPTATION THEORY

••It defines adaptation as the adjustment of living It defines adaptation as the adjustment of living

matter to other living things and to environmental matter to other living things and to environmental

conditions. conditions.

••Adaptation is a continuously occurring process that Adaptation is a continuously occurring process that

effects change and involves interaction and response. effects change and involves interaction and response.

••Human adaptation occurs on Human adaptation occurs on THREE LEVELSTHREE LEVELS::

--- --- THE INTERNAL THE INTERNAL ( self ) ( self )

--- --- THE SOCIAL THE SOCIAL (others) (others)

--- and --- and THE PHYSICALTHE PHYSICAL ( biochemical reactions ) ( biochemical reactions )

C. C. DEVELOPMENTAL THEORY DEVELOPMENTAL THEORY

••It outlines the process of growth and It outlines the process of growth and

development of humans as orderly and development of humans as orderly and

predictable, beginning with conception and ending predictable, beginning with conception and ending

with death. with death.

••The progress and behaviors of an individual The progress and behaviors of an individual

within each stage are unique. within each stage are unique.

••The growth and development of an individual are The growth and development of an individual are

influenced by heredity , temperament, emotional, influenced by heredity , temperament, emotional,

and physical environment, life experiences and and physical environment, life experiences and

health status. health status.

THE METAPARADIGM IN THE METAPARADIGM IN NURSINGNURSING

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our major concepts (collectively known as METAPARADIGM) common in nursing theory our major concepts (collectively known as METAPARADIGM) common in nursing theory

that influence and determine nursing practice are:that influence and determine nursing practice are:

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ERSONERSON 

* *

Recipient of nursing care, including physical, spiritual, psychological, and Recipient of nursing care, including physical, spiritual, psychological, and

sociocultural components.sociocultural components.

* *

Individuals, families, groups or communities.Individuals, families, groups or communities.

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NVIRONMENTNVIRONMENT

* All * All

internal and external conditions, circumstances, and influences affecting the person.internal and external conditions, circumstances, and influences affecting the person.

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EALTH EALTH

* Degree of wellness or well-being experienced by the client.* Degree of wellness or well-being experienced by the client.

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URSINGURSING

* Actions, characteristics and attributes of the nurse providing care on * Actions, characteristics and attributes of the nurse providing care on

behalf of, or in conjunction with, the client.behalf of, or in conjunction with, the client.

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ach of these concepts is usually defined and described by a nursing ach of these concepts is usually defined and described by a nursing

theorist , Often uniquely; although these concepts are common to all theorist , Often uniquely; although these concepts are common to all

nursing theories. nursing theories.

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f the four concepts , the most important is that of the person. The focus f the four concepts , the most important is that of the person. The focus

of nursing , regardless of definition or theory , is the person.of nursing , regardless of definition or theory , is the person.

CLASSIFICATION OF CLASSIFICATION OF NURSING THEORIESNURSING THEORIES

DEPENDING ON THE GENERALISABILITY OF THEIR PRINCIPLESDEPENDING ON THE GENERALISABILITY OF THEIR PRINCIPLES

METATHEORYMETATHEORY: the theory of theory. Identifies specific : the theory of theory. Identifies specific

phenomena through abstract concepts. phenomena through abstract concepts.

GRAND THEORYGRAND THEORY: provides a conceptual framework under which : provides a conceptual framework under which

the key concepts and principles of the discipline can be identified. the key concepts and principles of the discipline can be identified.

MIDDLE RANGE THEORYMIDDLE RANGE THEORY: is more precise and only analyses a : is more precise and only analyses a

particular situation with a limited number of variables. particular situation with a limited number of variables.

PRACTICE THEORYPRACTICE THEORY: explores one particular situation found in : explores one particular situation found in

nursing. It identifies explicit goals and details how these goals nursing. It identifies explicit goals and details how these goals

will be achieved. will be achieved.

THEORIES CAN ALSO BE CATEGORISED AS:THEORIES CAN ALSO BE CATEGORISED AS:

""NEEDSNEEDS" theories. " theories.

""INTERACTIONINTERACTION" theories. " theories.

""OUTCOMEOUTCOME" theories. " theories.

""HUMANISTICHUMANISTIC" theories" theories

These categories indicate the basic These categories indicate the basic

philosophical underpinnings of the theories.philosophical underpinnings of the theories.

"NEEDS" THEORIES"NEEDS" THEORIESThese theories are based around helping These theories are based around helping

individuals to fulfill their physical and mental needs. individuals to fulfill their physical and mental needs.

The basis of these theories is well-illustrated in The basis of these theories is well-illustrated in

Roper, Logan and Tierney’s Model of Nursing (1980). Roper, Logan and Tierney’s Model of Nursing (1980).

Needs theories have been criticized for relying too Needs theories have been criticized for relying too

much on the medical model of health and placing much on the medical model of health and placing

the patient in an overtly dependent position. the patient in an overtly dependent position.

"INTERACTION" THEORIES"INTERACTION" THEORIESAs described by Peplau (1988), these As described by Peplau (1988), these

theories revolve around the theories revolve around the

relationships nurses form with patients.relationships nurses form with patients.

Such theories have been criticized for Such theories have been criticized for

largely ignoring the medical model of largely ignoring the medical model of

health and not attending to basic health and not attending to basic

physical needs. physical needs.

"OUTCOME" THEORIES"OUTCOME" THEORIESThese portray the nurse as the changing These portray the nurse as the changing

force, who enables individuals to adapt to force, who enables individuals to adapt to

or cope with ill health (Roy 1980). or cope with ill health (Roy 1980).

Outcome theories have been criticized as Outcome theories have been criticized as

too abstract and difficult to implement in too abstract and difficult to implement in

practice (Aggleton and Chalmers 1988). practice (Aggleton and Chalmers 1988).

"HUMANISTIC" THEORIES"HUMANISTIC" THEORIESHumanistic theories developed in response to the Humanistic theories developed in response to the

psychoanalytic thought that a person’s destiny was psychoanalytic thought that a person’s destiny was

determined early in life. determined early in life.

Humanistic theories emphasize a person’s capacity for self Humanistic theories emphasize a person’s capacity for self

actualization . actualization .

Humanists believes that the person contains within himself Humanists believes that the person contains within himself

the potential for healthy and creative growth. the potential for healthy and creative growth.

Carl Rogers developed a person –centered model of Carl Rogers developed a person –centered model of

psychotherapy that emphasizes the uniqueness of the psychotherapy that emphasizes the uniqueness of the

individual. individual.

The major contribution that Rogers added to nursing practice The major contribution that Rogers added to nursing practice

is the understanding that each client is a unique individual, so is the understanding that each client is a unique individual, so

person-centered approach now practice in Nursing. person-centered approach now practice in Nursing.

THE ENDTHE END

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VERY MUCH!!!VERY MUCH!!!vlmpr2010vlmpr2010