Nursing Theories INTRODUCTION TO NURSING THEORIES INTRODUCTION Nursing has made phenomenal achievement in the last century that has lead to the recognition of nursing as an academic discipline and a profession. A move towards theory-based practice has made contemporary nursing more meaningful and significant by shifting nursing’s focus from vocation to an organised profession. The need for knowledge-base to guide professional nursing practice had been realised in the first half of the twentieth century and many theoretical works have been contributed by nurses ever since, first with the goal of making nursing a recognised profession and later with the goal of delivering care to patients as professionals. A theory is a group of related concepts that propose action that guide practice. A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing.. Based on the knowledge structure levels the theoretical works in nursing can be studied under the following headings: • Metaparadigm (Person, Environment, Health & Nursing) – (Most abstract) • Nursing philosophies. • Conceptual models and Grand theories.
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Nursing Theories
Nursing TheoriesINTRODUCTION TO NURSING THEORIESINTRODUCTIONNursing has made phenomenal achievement in the last century that has lead to the recognition of nursing as an academic discipline and a profession. A move towards theory-based practice has made contemporary nursing more meaningful and significant by shifting nursings focus from vocation to an organised profession. The need for knowledge-base to guide professional nursing practice had been realised in the first half of the twentieth century and many theoretical works have been contributed by nurses ever since, first with the goal of making nursing a recognised profession and later with the goal of delivering care to patients as professionals.
A theory is a group of related concepts that propose action that guide practice. A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing..
Based on the knowledge structure levels the theoretical works in nursing can be studied under the following headings:
Metaparadigm (Person, Environment, Health & Nursing) (Most abstract)
Nursing philosophies.
Conceptual models and Grand theories.
Nursing theories and Middle range theories (Least abstract)
NURSING PHILOSOPHIESTheoryKey emphasis
Florence Nightingales Legacy of caringFocuses on nursing and the patient environment relationship.
Ernestine Wiedenbach: The helping art of clinical nursingHelping process meets needs through the art of individualizing care.
Nurses should identify patients need-for help by:
Observation
Understanding client behaviour
Identifying cause of discomfort
Determining if clients can resolve problems or have a need for help
Virginia Hendersons Definition of NursingPatients require help towards achieving independence.
Derived a definition of nursing
Identified 14 basic human needs on which nursing care is based.
Faye G.AbedellahsTypology of twenty one Nursing problemsPatients problems determine nursing care
Lydia E. Hall :Care, Cure, Core modelNursing care is person directed towards self love.
JeanWatsonsPhilosophy and Science of caringCaring is moral ideal: mind -body soul engagement with one and other.
Caring is a universal, social phenomenon that is only effective when practiced interpersonally considering humanistic aspects and caring.
Patricia Benners Primacy of caring Caring is central to the essence of nursing. It sets up what matters, enabling connection and concern. It creates possibility for mutual helpfulness.
Caring creates - possibilities of coping possibilities for connecting with and concern for others, possibilities for giving and receiving help
Described systematically five stages of skill acquisition in nursing practice novice, advanced beginner, competent, proficient and expert.
CONCEPTUAL MODELS AND GRAND THEORIES
Dorothea E. OremsSelf care deficit theory in nursingSelfcare maintains wholeness.
Three Theories:
Theory of Self-Care
Theory of Self-Care Deficit
Theory of Nursing Systems
Wholly compensatory (doing for the patient)
Partly compensatory (helping the patient do for himself or herself)
Supportive- educative (Helping patient to learn self care and emphasizing on the importance of nurses role
Myra Estrin Levines: The conservation modelHolism is maintained by conserving integrity
Proposed that the nurses use the principles of conservation of:
Client Energy
Personal integrity
Structural integrity
Social integrity
A conceptual model with three nursing theories
Conservation
Redundancy
Therapeutic intention
Martha E.Rogers: Science of unitary human beingsPerson environment are energy fields that evolve negentropically
Martha proposed that nursing was a basic scientific discipline
Nursing is using knowledge for human betterment.
The unique focus of nursing is on the unitary or irreducible human being and the environment (both are energy fields) rather than health and illness
Dorothy E.Johnsons Behavioural system model Individuals maintain stability and balance through adjustments and adaptation to the forces that impinges them.
Individual as a behavioural system is composed of seven subsystems.
Attachment, or the affiliative subsystems is the corner stone of social organisations.
Behavioural system also includes the subsystems of dependency, achievement, aggressive, ingestive-eliminative and sexual.
Disturbances in these causes nursing problems.
Sister Callista: Roys Adaptation modelStimuli disrupt an adaptive system
The individual is a biopsychosocial adaptive system within an environment.
The individual and the environment provide three classes of stimuli-the focal, residual and contextual.
Through two adaptive mechanisms, regulator and cognator, an individual demonstrates adaptive responses or ineffective responses requiring nursing interventions
Betty Neumans:Health care systems modelReconstitution is a status of adaptation to stressors
A conceptual model with two theories Optimal patient stability and prevention as intervention
Neumans model includes intrapersonal, interpersonal and extrapersonal stressors.
Nursing is concerned with the whole person.
Nursing actions (Primary, Secondary, and Tertiary levels of prevention) focuses on the variables affecting the clients response to stressors.
Imogene KingsGoal attainment theoryTransactions provide a frame of reference toward goal setting.
A conceptual model of nursing from which theory of goal attainment is derived.
From her major concepts (interaction, perception, communication, transaction, role, stress, growth and development) derived goal attainment theory.
Perceptions, Judgments and actions of the patient and the nurse lead to reaction, interaction, and transaction (Process of nursing).
Nancy Roper, WW.Logan and A.J.Tierney A model for nursing based on a model of livingIndividuality in living.
A conceptual model of nursing from which theory of goal attainment is derived.
Living is an amalgam of activities of living (ALs).
Most individuals experience significant life events which can affect ALs causing actual and potential problems.
This affects dependence independence continuum which is bi-directional.
Nursing helps to maintain the individuality of person by preventing potential problems, solving actual problems and helping to cope.
Hildegard E. Peplau: Psychodynamic Nursing TheoryInterpersonal process is maturing force for personality.
Stressed the importance of nurses ability to understand own behaviour to help others identify perceived difficulties.
The four phases of nurse-patient relationships are:
1. Orientation
2. Identification
3. Exploitations
4. Resolution
The six nursing roles are:
1. Stranger
2. Resource person
3. Teacher
4. Leader
5. Surrogate
6. Counselor
Ida Jean Orlandos Nursing Process TheoryInterpersonal process alleviates distress.
Nurses must stay connected to patients and assure that patients get what they need, focused on patients verbal and non verbal expressions of need and nurses reactions to patients behaviour to alleviate distress.
Elements of nursing situation:
1. Patient
2. Nurse reactions
3. Nursing actions
Joyce Travelbees Human To Human Relationship ModelTherapeutic human relationships.
Nursing is accomplished through human to human relationships that began with: The original encounter and then progressed through stages of
Emerging identities
Developing feelings of empathy and sympathy, until the nurse and patient attained rapport in the final stage.
Kathryn E. Barnards Parent Child Interaction ModelGrowth and development of children and motherinfant relationships
Individual characteristics of each member influence the parentinfant system and adaptive behaviour modifies those characteristics to meet the needs of the system.
Ramona T.Mercers :Maternal Role AttainmentParenting and maternal role attainment in diverse populations
A complex theory to explain the factors impacting the development of maternal role over time.
Katharine Kolcabas Theory of comfortComfort is desirable holistic outcome of care.
Health care needs are needs for comfort, arising from stressful health care situations that cannot be met by recipients traditional support system.
These needs include physical, psycho spiritual, social and environmental needs.
Comfort measures include those nursing interventions designed to address the specific comfort needs.
Madeleine Leiningers
Transcultural nursing, culture-care theoryCaring is universal and varies transculturally.
Major concepts include care, caring, culture, cultural values and cultural variations
Caring serves to ameliorate or improve human conditions and life base.
Care is the essence and the dominant, distinctive and unifying feature of nursing
Rosemarie Rizzo Parses :Theory of human becomingIndivisible beings and environment co-create health.
A theory of nursing derived from Rogers conceptual model.
Clients are open, mutual and in constant interaction with environment.
The nurse assists the client in interaction with the environment and co creating health
Nola J.Penders :The Health promotion; modelPromoting optimum health supersedes disease prevention.
Identifies cognitive, perceptual factors in clients which are modified by demographical and biological characteristics, interpersonal influences, situational and behavioural factors that help predict in health promoting behaviour
CONCLUSIONThe conceptual and theoretical nursing models help to provide knowledge to improve practice, guide research and curriculum and identify the goals of nursing practice. The state of art and science of nursing theory is one of continuing growth. Using the internet the nurses of the world can share ideas and knowledge, carrying on the work begun by nursing theorists and continue the growth and development of new nursing knowledge. It is important the nursing knowledge is learnt, used, and applied in the theory based practice for the profession and the continued development of nursing and academic discipline
REFERENCES George B. Julia , Nursing Theories- The base for professional Nursing Practice, 3rd ed. Norwalk, Appleton & Lange.
Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott.
Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott.
Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts Process & Practice 3rd ed. London Mosby Year Book.
Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002
Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby, Philadelphia, 2002.
DEVELOPMENT OF NURSING THEORIESIntroductionTheories are a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory & predictive in nature. Theories are composed of concepts, definitions, models, propositions & are based on assumptions. They are derived through two principal methods; deductive reasoning and inductive reasoning. Nursing theorists use both of these methods. Theory is a creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena. A theory makes it possible to organize the relationship among the concepts to describe, explain, predict, and control practice
Definition Concepts are basically vehicles of thought that involve images. Concepts are words that describe objects, properties, or events & are basic components of theory.
Types: Empirical concepts
Inferential concepts
Abstract concepts
Models are representations of the interaction among and between the concepts showing patterns.
Propositions are statements that explain the relationship between the concepts.
Process it is a series of actions, changes or functions intended to bring about a desired result. During a process one takes systemic & continuous steps to meet a goal & uses both assessments & feedback to direct actions to the goal.
A particular theory or conceptual frame work directs how these actions are carried out. The delivery of nursing care within the nursing process is directed by the way specific conceptual frameworks & theories define the person (patient), the environment, health & nursing.
The terms model and theory are often wrongly used interchangeably, which further confounds matters.
In nursing, models are often designed by theory authors to depict the beliefs in their theory (Lancaster and Lancaster 1981).
They provide an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice, for example, through specific methods of assessment.
Models are useful as they allow the concepts in nursing theory to be successfully applied to nursing practice (Lancaster and Lancaster 1981).
Their main limitation is that they are only as accurate or useful as the underlying theory.
Importance of nursing theories1. Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs1978).
2. It should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964).
3. Theory is important because it helps us to decide what we know and what we need to know (Parsons1949).
4. It helps to distinguish what should form the basis of practice by explicitly describing nursing.
5. The benefits of having a defined body of theory in nursing include better patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education (Nolan 1996). In addition, because
6. The main exponent of nursing caring cannot be measured, it is vital to have the theory to analyze and explain what nurses do.
7. As medicine tries to make a move towards adopting a more multidisciplinary approach to health care, nursing continues to strive to establish a unique body of knowledge.
8. This can be seen as an attempt by the nursing profession to maintain its professional boundaries.
The characteristics of theoriesTheories are
interrelating concepts in such a way as to create a different way of looking at a particular phenomenon.
logical in nature.
generalizable.
bases for hypotheses that can be tested.
increasing the general body of knowledge within the discipline through the research implemented to validate them.
used by the practitioners to guide and improve their practice.
consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated.
Basic processes in the development of nursing theoriesNursing theories are often based on & influenced by broadly applicable processes & theories. Following theories are basic to many nursing concepts.
General System TheoryIt describes how to break whole things into parts & then to learn how the parts work together in systems. These concepts may be applied to different kinds of systems, e.g. Molecules in chemistry, cultures in sociology, and organs in Anatomy & Health in Nursing.
Adaptation Theory It defines adaptation as the adjustment of living matter to other living things & to environmental conditions.
Adaptation is a continuously occurring process that effects change & involves interaction & response.
Human adaptation occurs on three levels :
1. The internal (self)
2. The social (others) &
3. the physical (biochemical reactions)
Developmental Theory 1. It outlines the process of growth & development of humans as orderly & predictable, beginning with conception & ending with death.
2. The progress & behaviors of an individual within each stage are unique.
3. The growth & development of an individual are influenced by heredity, temperament, emotional, & physical environment, life experiences & health status.
Common concepts in nursing theoriesFour concepts common in nursing theory that influence & determine nursing practice are:
The person (patient).
The environment
Health
Nursing (goals, roles, functions)
Each of these concepts is usually defined & described by a nursing theorist, often uniquely; although these concepts are common to all nursing theories. Of the four concepts, the most important is that of the person. The focus of nursing, regardless of definition or theory, is the person.
Historical perspectives and key concepts Nightingale (1860): To facilitate the bodys reparative processes by manipulating clients environment
Peplau 1952: Nursing is; therapeutic interpersonal process.
Henderson 1955: The needs often called Hendersons 14 basic needs
Abdellah 1960: The nursing theory developed by Faye Abdellah et al (1960) emphasizes delivering nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family.
Orlando 1962: To Ida Orlando (1960), the client is an individual; with a need; that, when met, diminishes distress, increases adequacy, or enhances well-being.
Johnsons Theory 1968: Dorothy Johnsons theory of nursing 1968 focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. The goal of nursing to reduce stress so that; the client can move more easily through recovery.
Rogers 1970: to maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through humanistic science of nursing
Orem1971: This is self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs.
King 1971: To use communication to help client reestablish positive adaptation to environment.
Neuman 1972: Stress reduction is goal of system model of nursing practice.
Roy 1979: This adaptation model is based on the physiological, psychological, sociological and dependence-independence adaptive modes.
Watsons Theory 1979: Watsons philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the; humanistic aspects of life.
Classification of nursing theoriesDepending On Function (Polit et al 2001)
DescriptiveTo identify the properties and workings of a discipline
ExplanatoryTo examine how properties relate and thus affect the discipline
PredictiveTo calculate relationships between properties and how they occur
Prescriptive
To identify under which conditions relationships occur
Depending on the Generalisability of their principles
Metatheory: the theory of theory. Identifies specific phenomena through abstract concepts.
Grand theory: provides a conceptual framework under which the key concepts and
Principles of the discipline can be identified.
Middle range theory: is more precise and only analyses a particular situation with a limited number of variables.
Practice theory: explores one particular situation found in nursing. It identifies explicit goals and details how these goals will be achieved.
Based on the philosophical underpinnings of the theories
Needs theories.
Interaction theories.
Outcome theories.
Humanistic theories.
Needs theories These theories are based around helping individuals to fulfill their physical and mental needs. The basis of these theories is well-illustrated in Roper, Logan and Tierneys Model of Nursing (1980).
Needs theories have been criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position.
Interaction theories As described by Peplau (1988), these theories revolve around the relationships nurses form with patients.
Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs.
Outcome theories These portray the nurse as the changing force, who enables individuals to adapt to or cope with ill health (Roy 1980).
Outcome theories have been criticized as too abstract and difficult to implement in practice (Aggleton and Chalmers 1988).
Humanistic Theories Humanistic theories developed in response to the psychoanalytic thought that a persons destiny was determined early in life.
Humanistic theories emphasize a persons capacity for self-actualization.
Humanists believe that the person contains within himself the potential for healthy & creative growth.
Carl Rogers developed a person centered model of psychotherapy that emphasizes the uniqueness of the individual.
The major contribution that Rogers added to nursing practice is the understandings that each client is a unique individual, so, person-centered approach now practice in nursing.
Models of nursing Until fairly recently, nursing science was derived principally from social, biologic, and medical science theories.
However, from the 1950s to the present, an increasing number of nursing theorists have developed models of nursing that provide bases for the development of nursing theories and nursing knowledge.
A model, as an abstraction of reality, provides a way to visualize reality to simplify thinking.
A conceptual model shows how various concepts are interrelated and applies theories to predict or evaluate consequences of alternative actions.
According to Fawcett (2000),
A conceptual model gives direction to the search for relevant questions about the phenomena of central interest to a discipline and suggests solutions to practical problems
Four concepts are generally considered central to the discipline of nursing: the person who receives nursing care (the patient or client); the environment (society); nursing (goals, roles, functions); and health. These four concepts form a metaparadigm of nursing.
The term metaparadigm comes from the Greek prefix meta, which means more comprehensive or transcending, and the word Greek word paradigm, which means a philosophical or theoretical framework of a discipline upon which all theories, laws, and generalizations are formulated (Merriam-Websters Collegiate Dictionary, 1994).
Growth and Stability Models of Change There are two major differences in philosophical beliefs, or world views, about the nature of change.
The world view of change uses the growth metaphor, and the persistence view focuseson stability (Fawcett, 1989,).
Within the change world view, change and growth are continual and desirable, progress is valued, and realization of ones potential is emphasized (Fawcett).
Persistence is endurance in time
Persistence world view emphasizes equilibrium and balance.
Categories of Conceptual Models Ten conceptual models of nursing have been classified according to two criteria:
the world view of change reflected by the model (growth or stability); and
the major theoretical conceptual classification with which the model seems most consistent (systems, stress/adaptation, caring, or growth/development).
Systems Theory as a Framework Systems theory is concerned with changes caused by interactions among all the factors (variables)
General systems theory is emphasized
A system is defined as a whole with interrelated parts, in which the parts have a function and the system as a totality has a function (Auger, 1976,
A general systems approach allows for consideration of the subsystems levels of the human being, as a total human being, and as a social creature who networks himself with others in hierarchically arranged human systems of increasing complexity. Thus the human being, from the level of the individual to the level of society, can be conceptualized as the client and becomes the target system for nursing intervention (Sills & Hall, 1977).
An example of systems interaction Input (Diet teaching)
Throughput (Assimilation of information)
Output (Food intake)
Feedback (Weight record, Hb estimation etc.)
Two nursing models based on systems theory:
Imogene Kings systems interaction model, and
Betty Neumans health care systems model.
Major Concepts as Defined in Kings Model
Person (human being)A personal system that interacts with interpersonal and social systems
EnvironmentA context within which human beings grow, develop, and perform daily activities
Healthdynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of ones resources to achieve maximum potential for daily living
NursingA process of human interaction
Imogene Kings Systems Interaction Model In interaction model, the purpose of nursing is to help people attain, maintain, or restore health. Kings model conceptualizes three levels of dynamic interacting systems.
1. Individuals are called personal systems.
2. Groups (two or more persons) form interpersonal systems.
3. Society is composed of social systems.
As the person interacts with the environment, he or she must continuously adjust to stressors in the internal and external environment (King, 1981).
Health assumes achievement of maximum potential for daily living and an ability to function in social roles. It is the dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of ones resources to achieve maximum potential for daily living (King, 1981,).
Illness is a deviation from normal, that is, an imbalance in a persons biological structure or in his psychological makeup, or a conflict in a persons social relationships (King, 1989).
The goal of nursing is to help individuals and groups attain, maintain, and restore health
Stress: a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance
Betty Neumans Health Care Systems Model Betty Neuman specifies that the purpose of nursing is to facilitate optimal client system stability.
Normal line of defense: an adaptational level of health considered normal for an individual
Lines of resistance: protection factors activated when stressors have penetrated the normal line of defense
Neumans model, organized around stress reduction, is concerned primarily with how stress and the reactions to stress affect the development and maintenance of health.
The person is a composite of physiologic, psychological, sociocultural, developmental, and spiritual variables considered simultaneously.
Ideally the five variables function harmoniously or are stable in relation to internal and external environmental stressor influences (Neuman, 2002).
A person is constantly affected by stressors from the internal, external, or created environment.
Stressors are tension-producing stimuli that have the potential to disturb a persons equilibrium or normal line of defense.
This normal line of defense is the persons usual steady state.
It is the way in which an individual usually deals with stressors.
Stressors may be of three types:
Intrapersonal: forces arising from within the person
Interpersonal: forces arising between persons
Extrapersonal: forces arising from outside the person
Resistance to stressors is provided by a flexible line of defense, a dynamic protective buffer made up of all variables affecting a person at any given moment the persons resistance to any given stressor or stressors.
If the flexible line of defense is no longer able to protect the person against a stressor, the stressor breaks through, disturbs the persons equilibrium, and triggers a reaction. The reaction may lead toward restoration of balance or toward death.
Neuman intends for the nurse to assist clients to retain, attain, or maintain optimal system stability (Neuman, 1996).
Thus, health (wellness) seems to be related to dynamic equilibrium of the normal line of defense, where stressors are successfully overcome or avoided by the flexible line of defense.
Neuman defines illness as a state of insufficiency with disrupting needs unsatisfied (Neuman, 2002).
Illness appears to be a separate state when a stressor breaks through the normal line of defense and causes a reaction with the persons lines of resistance.
Stress/Adaptation Theory as a Framework In contrast to systems theory, stress and adaptation theories view change caused by personenvironment interaction in terms of cause and effect.
The person must adjust to environmental changes to avoid disturbing a balanced existence. Adaptation theory provides a way to understand both how the balance is maintained and the possible effects of disturbed equilibrium.
This theory has been widely applied to explain, predict, and control biologic (physiologic and psychological) phenomenon.
A unique body of knowledge The drive for a unique body of knowledge is based on the assumption that borrowed knowledge is less worthy.
However, nurse education is based on theory borrowed from other disciplines, such as sociology and psychology.
It has been argued that applying knowledge from different disciplines only serves to dilute nursing practice.
Nevertheless, as the occupation is focused on humans, perhaps it is inevitable that nursing uses knowledge from other social sciences.
It has been argued that no knowledge is exclusive, and because of nursings diverse nature it is impossible for it to have a unique body of knowledge and one unified body of theory (Castledine 1994, Levine 1995).
Criticisms of nursing theoriesTo understand why nursing theory is generally neglected on the wards it is necessary to take a closer look at the main criticisms of nursing theory and the role that nurses play in contributing to its lack of prevalence in practice.
Use of language Scott (1994) states that the crucial ingredients of nursing theory should be accessibility and clarity. However, one of the main criticisms of nursing theory is its use of overtly complex language (Kenny 1993). It is important that the language used in the development of nursing theory be used consistently.
Not part of everyday practice Despite theory and practice being viewed as inseparable concepts, a theory-practice gap still exists in nursing (Upton 1999). Yet despite the availability of a vast amount of literature on the subject, nursing theory still means very little to most practicing nurses. Perhaps this is because the majority of nursing theory is developed by and for nursing academics (Lathlean 1994). It has been recognised that traditionally nurses are used to speaking with their hands (Levine 1995). Therefore, many nurses have not had the training or experience to deal with the abstract concepts presented by nursing theory. This makes it difficult for the majority of nurses to understand and apply theory to practice (Miller 1985).
Summarization1. Definition
2. Importance of Nursing Theories
3. The characteristics of theories:
4. Basic Processes in the Development Of Nursing Theories:
5. Nursing theories are often based on & influenced
6. ANA definition of Nursing Practice
7. Common concepts in Nursing Theories:
8. Historical Perspectives & Key Concepts
9. Clasification of Nursing Theories
10. Models Of Nursing
11. Growth and Stability Models of Change
12. Betty Neumans Health Care Systems Model
13. Stress/Adaptation Theory as a Framework
14. A unique body of knowledge
15. Criticisms of nursing theories
ConclusionLittlejohn (2002) comments that, irrespective of nursing theories nurses will continue to exhibit a caring response to the sick and troubled. If this is true, perhaps nurses are nursing without the knowledge of theories and theory is irrelevant. However, theory and practice are related, and if nursing is to continue to develop, the concept of theory must be addressed. If nursing theory does not drive the development of nursing, it will continue to develop in the footsteps of other disciplines such as medicine
Reference George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott.
Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott.
Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts Process & Practice 3rd ed. London Mosby Year Book.
Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225
Nursing Theorists
Definitions Theory- a set of related statements that describes or explains phenomena in a systematic way
Concept-a mental idea of a phenomenon
Construct- a phenomena that cannot be observed and must be inferred
Proposition- a statement of relationship between concepts
Conceptual model- made up of concepts and propositions
Nursing Theorists
Florence Nightingale,
Hildegard Peplau
Virginia Henderson
Fay Abdella
Ida Jean Orlando
Dorothy Johnson
Martha Rogers
Dorothea Orem
Imogene King
Betty Neuman
Sister Calista Roy,
Jean Watson
Rosemary Rizzo Parse
Madeleine Leininger
Patricia Benner
Concepts in the nursing
Metaparadigm Person
Recipient of care, including physical, spiritual, psychological, and sociocultural components
Individual, family, or community
Environment
All internal and external conditions, circumstances, and influences affecting the person
Health
Degree of wellness or illness experienced by the person
Nursing
Actions, characteristics and attributes of person giving care
Florence Nightingale- Environmental Theory First nursing theorist
Unsanitary conditions posed health hazard (Notes on Nursing, 1859)
5 components of environment
ventilation, light, warmth, effluvia, noise
External influences can prevent, suppress or contribute to disease or death
Nightingales Concepts
Person
Patient who is acted on by nurse
Affected by environment
Has reparative powers
Environment
Foundation of theory. Included everything, physical, psychological, and social
Health
Maintaining well-being by using a persons powers
Maintained by control of environment
Nursing
Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate persons reparative process
Hildegard Peplau -Interpersonal Relations Model Based on psychodynamic nursing
using an understanding of ones own behavior to help others identify their difficulties
Applies principles of human relations
Patient has a felt need
Peplaus Concepts Person
An individual; a developing organism who tries to reduce anxiety caused by needs
Lives in instable equilibrium
Environment- Not defined
Health
Implies forward movement of the personality and human processes toward creative, constructive, productive, personal, and community living
Nursing
A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible
Involves problem-solving
Virginia Henderson -The Nature of Nursing"The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. She must in a sense, get inside the skin of each of her patients in order to know what he needs".
Fay Abdella- Topology of 21 Nursing Problems A list of 21 nursing problems
Condition presented or faced by the patient or family.
Problems are in 3 categories
physical, social and emotional
The nurse must be a good problem solver
Abdellas Concepts Nursing
A helping profession
A comprehensive service to meet patients needs
Increases or restores self-help ability
Uses 21 problems to guide nursing care
Health
Excludes illness
No unmet needs and no actual or anticipated impairments
Person
One who has physical, emotional, or social needs
The recipient of nursing care.
Environment
Did not discuss much
Includes room, home, and community
Ida Jean Orlando- Deliberative Nursing Process The deliberative nursing process is set in motion by the patients behavior
All behavior may represent a cry for help. Patients behavior can be verbal or non-verbal.
The nurse reacts to patients behavior and forms basis for determining nurses acts.
Perception, thought, feeling
Nurses actions should be deliberative, rather than automatic
Deliberative actions explore the meaning and relevance of an action.
Dorothy Johnson-Behavioral Systems Model The person is a behavioral system comprised of a set of organized, interactive, interdependent, and integrated subsystems
Constancy is maintained through biological, psychological, and sociological factors.
A steady state is maintained through adjusting and adapting to internal and external forces.
Johnsons 7 Subsystems Affiliative subsystem
social bonds
Dependency
helping or nuturing
Ingestive
food intake
Eliminative
excretion
Sexual
procreation and gratification
Aggressive
self-protection and preservation
Achievement
efforts to gain mastery and control
Johnsons Concepts Person
A behavioral system comprised of subsystems constantly trying to maintain a steady state
Environment
Not specifically defined but does say there is an internal and external environment
Health
Balance and stability.
Nursing
External regulatory force that is indicated only when there is instability.
Martha Rogers -Unitary Human Beings Energy fields
Fundamental unity of things that are unique, dynamic, open, and infinite
Unitary man and environmental field
Universe of open systems
Energy fields are open, infinite, and interactive
Pattern
Characteristic of energy field
A wave that changes, becomes complex and diverse
Pandimensionality
A nonlinear domain with out time or space
Rogers Definitions Integrality
Continuous and mutual interaction between man and environment
Resonancy
Continuous change longer to shorter wave patterns in human and environmental fields
Helicy
Continuous, probabilistic, increasing diversity of the human and envrionmental fields.
Characterized by nonrepeating rhymicities
Change
Dorothea Orem- Self-Care Model Self-care comprises those activities performed independently by an individual to promote and maintain person well-being
Self care agency is the individuals ability to perform self care activities
Self- care deficit occurs when the person cannot carry out self-care
The nurse then meets the self-care needs by acting or doing for; guiding, teaching, supporting or providing the environment to promote patients ability
Wholly compensatory nursing system-Patient dependent
Partially compensatory- Patient can meet some needs but needs nursing assistance
Supportive educative-Patient can meet self care requisites, but needs assistance with decision making or knowledge
Imogene King-Goal Attainment Theory Open systems framework
Human beings are open systems in constant interaction with the environment
Personal System
individual; perception, self, growth, development, time space, body image
Interpersonal
Society
Personal System
Individual; perception, self, growth, development, time space, body image
Interpersonal
Socialization; interaction, communication and transaction
Society
Family, religious groups, schools, work, peers
The nurse and patient mutually communicate, establish goals and take action to attain goals
Each individual brings a different set of values, ideas, attitudes, perceptions to exchange
Betty Neuman - Health Care Systems Model The person is a complete system, with interrelated parts
maintains balance and harmony between internal and external environment by adjusting to stress and defending against tension-producing stimuli
Focuses on stress and stress reduction
Primarily concerned with effects of stress on health
Stressors are any forces that alter the systems stability
Flexible lines of resistance
Surround basic core
Internal factors that help defend against stressors
Normal line of resistance
Normal adaptation state
Flexible line of defense
Protective barrier, changing, affected by variables
Wellness is equilibrium
Nursing interventions are activates to:
strengthen flexible lines of defense
strengthen resistance to stressors
maintain adaptation
Sister Calista Roy - Adaptation Model Five Interrelated Essential Elements
Patiency- The person receiving care
Goal of nursing- Adapting to change
Health-Being and becoming a whole person
Environment
Direction of nursing activities- Facilitating adaptation
The person is an open adaptive system with input (stimuli), who adapts by processes or control mechanisms (throughput)
The output can be either adaptive responses or ineffective responses
Jean Watson - Philosophy and Science of Caring Caring can be demonstrated and practiced
Caring consists of carative factors
Caring promotes growth
A caring environment accepts a person as he is and looks to what the person may become
A caring environment offers development of potential
Caring promotes health better than curing
Caring is central to nursing
Watsons 10 Carative Factors Forming humanistic-altruistic value system
Instilling faith-hope
Cultivating sensitivity to self and others
Developing helping-trust relationship
Promoting expression of feelings
Using problem-solving for decision making
Promoting teaching-learning
Promoting supportive environment
Assisting with gratification of human needs
Allowing for existential-phenomenological forces
Watsons Concepts Person
Human being to be valued, cared for, respected, nurtured, understood and assisted
Environment
Society
Health
Complete physical, mental and social well-being and functioning
Nursing
Concerned with promoting and restoring health, preventing illness
Rosemary Parse - Human Becoming Theory Human Becoming Theory includes Totality Paradigm
Man is a combination of biological, psychological, sociological and spiritual factors
Simultaneity Paradigm
Man is a unitary being in continuous, mutual interaction with environment
Originally Man-Living-Health Theory
Parses Three Principles Meaning
Mans reality is given meaning through lived experiences
Man and environment cocreate
Rhythmicity
Man and environment cocreate ( imaging, valuing, languaging) in rhythmical patterns
Cotranscendence
Refers to reaching out and beyond the limits that a person sets
One constantly transforms
Person
Open being who is more than and different from the sum of the parts
Environment
Everything in the person and his experiences
Inseparable, complimentary to and evolving with
Health
Open process of being and becoming. Involves synthesis of values
Nursing
A human science and art that uses an abstract body of knowledge to serve people
Madeleine Leininger - Culture Care Diversity and Universality Based on transcultural nursing, whose goal is to provide care congruent with cultural values, beliefs, and practices
Sunrise model consists of 4 levels that provide a base of knowledge for delivering cultural congruent care
Modes of nursing action
Cultural care preservation
help maintain or preserve health, recover from illness, or face death
Cultural care accommodation
help adapt to or negotiate for a beneficial health status, or face death
Cultural care re-patterning
help restructure or change lifestyles that are culturally meaningful
Patricia Benner - From Novice to Expert Described 5 levels of nursing experience and developed exemplars and paradigm cases to illustrate each level
Levels reflect:
movement from reliance on past abstract principles to the use of past concrete experience as paradigms
change in perception of situation as a complete whole in which certain parts are relevant
Novice
Advanced beginner
Competent
Proficient
Expert
Importance of Theoretical Frameworks1. Foundation of any profession is the development of a specialized body of knowledge. Theories should be developed in nursing, not borrow theories form other disciplines
2. Responsibility of nurses to know and understand theorists
3. Critically analyze theoretical frameworks
Reference Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby, Philadelphia, 2002.
Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002.
George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton and Lange.
Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williamsand wilkins.
Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development and Progress 3rd ed. Philadelphia, Lippincott.
Taylor Carol,Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed. Philadelphia, Lippincott.
Potter A Patricia, Perry G Anne (1992)Fundamentals Of Nursing Concepts Process and Practice 3rd ed. London Mosby Year Book.
NURSING THEORIES: AN OVERVIEWTheoryKerlinger ---views theories as a set of interrelated concepts that give a systematic view of a phenomenon ( an observable fact or event ) that is explanatory and predictive in nature. Theories are composed of concepts, definitions, models , propositions and are based on assumptions. They are derived through two principal methods: 1) Deductive reasoning 2) Inductive reasoning. Nursing theorists use both of these methods. Nursing Theory: Barnum(1998)---- " attempts to describe or explain the phenomenon (process, occurrence and event) called nursing"
Theories for Professional Nursing
Theory is "a creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena"
A theory makes it possible to "organize the relationship among the concepts to describe, explain, predict, and control practice"
Definition
Concepts--- are basically vehicles of thought that involve images. Concepts are words that describe objects , properties, or events and are basic components of theory .
Types : Empirical concepts Inferential concepts Abstract concepts. Models ----- are representations of the interaction among and between the concepts showing patterns.
Propositions---- are statements that explain the relationship between the concepts.
Process ---- it is a series of actions , changes or functions intended to bring about a desired result . During a process one takes systemic and continuous steps to meet a goal and uses both assessments and feedback to direct actions to the goal.
A particular theory or conceptual frame work directs how these actions are carried out . The delivery of nursing care within the nursing process is directed by the way specific conceptual frameworks and theories define the person (patient), the environment , health and nursing.
The terms model and theory are often wrongly used interchangeably, which further confounds matters.
In nursing, models are often designed by theory authors to depict the beliefs in their theory (Lancaster and Lancaster 1981).
They provide an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice, for example, through specific methods of assessment.
Models are useful as they allow the concepts in nursing theory to be successfully applied to nursing practice (Lancaster and Lancaster 1981).
Their main limitation is that they are only as accurate or useful as the underlying theory.
Importance of Nursing Theories
Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs1978).
It should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964).
Theory is important because it helps us to decide what we know and what we need to know (Parsons1949).
It helps to distinguish what should form the basis of practice by explicitly describing nursing.
The benefits of having a defined body of theory in nursing include better patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education (Nolan 1996). In addition, because the main exponent of nursing caring cannot be measured, it is vital to have the theory to analyze and explain what nurses do.
As medicine tries to make a move towards adopting a more multidisciplinary approach to health care, nursing continues to strive to establish a unique body of knowledge.
This can be seen as an attempt by the nursing profession to maintain its professional boundaries.
The characteristics of theoriesTheories:
interrelate concepts in such a way as to create a different way of looking at a particular phenomenon.
are logical in nature.
are generalizable.
are the bases for hypotheses that can be tested.
increase the general body of knowledge within the discipline through the research implemented to validate them.
are used by the practitioners to guide and improve their practice.
are consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated
Basic Processes in the Development Of Nursing Theories:
Nursing theories are often based on and influenced by broadly applicable processes and theories. Following theories are basic to many nursing concepts.
General System Theory: It describes how to break whole things into parts and then to learn how the parts work together in " systems". These concepts may be applied to different kinds of systems, e.g.. Molecules in chemistry , cultures in sociology, organs in Anatomy and health in Nursing.
Adaptation Theory
It defines adaptation as the adjustment of living matter to other living things and to environmental conditions. Adaptation is a continuously occurring process that effects change and involves interaction and response . Human adaptation occurs on three levels:
--- the internal ( self )
--- the social (others)
--- and the physical ( biochemical reactions )
Developmental Theory
It outlines the process of growth and development of humans as orderly and predictable , beginning with conception and ending with death.
The progress and behaviors of an individual within each stage are unique.
The growth and development of an individual are influenced by heredity , temperament , emotional, and physical environment , life experiences and health status.
Common concepts in Nursing Theories:
Four concepts common in nursing theory that influence and determine nursing practice are
-- The person( patient) .
--- The environment
-- Health
--- Nursing (goals, roles, functions)
Each of these concepts is usually defined and described by a nursing theorist , Often uniquely; although these concepts are common to all nursing theories.
Of the four concepts , the most important is that of the person. The focus of nursing , regardless of definition or theory , is the person.
Historical Perspectives and Key Concepts
Nightingale (1860): To facilitate "the bodys reparative processes" by manipulating clients environment
Paplau 1952: Nursing is; therapeutic interpersonal process.
Henderson 1955: The needs often called Hendersons 14 basic needs
Abdellah 1960: The nursing theory developed by Faye Abdellah et al (1960) emphasizes delivering nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family.
Orlando 1962: To Ida Orlando (1960), the client is an individual; with a need; that, when met, diminishes distress, increases adequacy, or enhances well-being.
Johnsons Theory 1968: Dorothy Johnsons theory of nursing 1968 focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. The goal of nursing to reduce stress so that; the client can move more easily through recovery.
Rogers 1970: to maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through "humanistic science of nursing" Orem1971: This is self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs.
King 1971: To use communication to help client reestablish positive adaptation to environment.
Neuman 1972: Stress reduction is goal of system model of nursing practice.
Roy 1979: This adaptation model is based on the physiological, psychological, sociological and dependence-independence adaptive modes.
Watsons Theory 1979: Watsons philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the; humanistic aspects of life.
Classification of Nursing TheoriesDepending On The Generalisability Of Their Principles Metatheory: the theory of theory. Identifies
specific phenomena through abstract concepts.
Grand theory: provides a conceptual framework under which the key concepts and
principles of the discipline can be identified.
Middle range theory: is more precise and only analyses a particular situation with a limited number of variables.
Practice theory: explores one particular situation found in nursing. It identifies explicit goals and details how these goals will be achieved.
Theories can also be categorised as: "Needs "theories.
"Interaction" theories.
"Outcome "theories.
"Humanistic theories"
These categories indicate the basic philosophical underpinnings of the theories "Needs" theories These theories are based around helping individuals to fulfill their physical and mental needs. The basis of these theories is well-illustrated in Roper, Logan and Tierneys Model of Nursing (1980). Needs theories have been criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position. "Interaction" theories As described by Peplau (1988), these theories revolve around the relationships nurses form with patients. Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs. "Outcome" theories These portray the nurse as the changing force, who enables individuals to adapt to or cope with ill health (Roy 1980). Outcome theories have been criticized as too abstract and difficult to implement in practice (Aggleton and Chalmers 1988). "Humanistic" Theories: Humanistic theories developed in response to the psychoanalytic thought that a persons destiny was determined early in life.
Humanistic theories emphasize a persons capacity for self actualization .
Humanists believes that the person contains within himself the potential for healthy and creative growth. Carl Rogers developed a person centered model of psychotherapy that emphasizes the uniqueness of the individual. The major contribution that Rogers added to nursing practice is the understanding that each client is a unique individual, so person-centered approach now practice in Nursing. MODELS OF NURSING Until fairly recently, nursing science was derived principally from social, biologic, and medical science theories. However, from the 1950s to the present, an increasing number of nursing theorists have developed models of nursing that provide bases for the development of nursing theories and nursing knowledge.
A model, as an abstraction of reality, provides a way to visualize reality to simplify thinking.
A conceptual model shows how various concepts are interrelated and applies theories to predict or evaluate consequences of alternative actions. According to Fawcett (2000), A conceptual model "gives direction to the search for relevant questions about the phenomena of central interest to a discipline and suggests solutions to practical problems" . Four concepts are generally considered central to the discipline of nursing: the person who receives nursing care (the patient or client); the environment (society); nursing (goals, roles, functions); and health.
These four concepts form a metaparadigm of nursing. The term metaparadigm comes from the Greek prefix "meta," which means more comprehensive or transcending,
and the word Greek word "paradigm," which means a philosophical or theoretical framework of a discipline upon which all theories, laws, and generalizations are formulated (Merriam-Websters Collegiate Dictionary, 1994).
Growth and Stability Models of Change There are two major differences in philosophical beliefs, or world views, about the nature of change. "The world view of change uses the growth metaphor, and the persistence view focuseson stability" (Fawcett, 1989,).
Within the change world view, change and growth are continual and desirable, "progress is valued, and realization of ones potential is emphasized" (Fawcett).
Persistence is endurance in time
persistence world view emphasizes equilibrium and balance. Categories of Conceptual Models Ten conceptual models of nursing have been classified according to two criteria:
the world view of change reflected by the model (growth or stability); and
the major theoretical conceptual classification with which the model seems most consistent (systems, stress/adaptation, caring, or growth/development).
Systems Theory as a Framework Systems theory is concerned with changes caused by interactions among all the factors (variables) General systems theory is emphasized
A system is defined as "a whole with interrelated parts, in which the parts have a function and the system as a totality has a function" (Auger, 1976)
A general systems approach allows for consideration of the subsystems levels of the human being, as a total human being, and as a social creature who networks himself with others in hierarchically arranged human systems of increasing complexity. Thus the human being, from the level of the individual to the level of society, can be conceptualized as the client and becomes the target system for nursing intervention. (Sills and Hall, 1977).
An example of systems interaction
1. Input (Diet teaching)
Throughput (Assimilation of information)
Output (Food intake)
Feedback (Weight record ,Hb estimation etc.)
Two nursing models based on systems theory:2. Imogene Kings systems interaction model, and
3. Betty Neumans health care systems model.
Imogene Kings Systems Interaction Model interaction model, the purpose of nursing is to help people attain, maintain, or restore health
Kings model conceptualizes three levels of dynamic interacting systems.
1. Individuals are called "personal systems."
2. Groups (two or more persons) form "interpersonal systems."
3. Society is composed of "social systems."
As the person interacts with the environment, he or she must continuously adjust to stressors in the internal and external environment (King, 1981).
Health assumes achievement of maximum potential for daily living and an ability to function
in social roles. It is the "dynamic life experiences of a human being, which implies continuous
adjustment to stressors in the internal and external environment through optimum use of ones resources to achieve maximum potential for daily living" (King, 1981,). "Illness is a deviation from normal, that is, an imbalance in a persons biological structure or in his psychological makeup, or a conflict in a persons social relationships" (King, 1989). "The goal of nursing is to help individuals and groups attain, maintain, and restore health"
Stress: "a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance"
Betty Neumans Health Care Systems Model Betty Neuman specifies that the purpose of nursing is to facilitate optimal client system stability. Normal line of defense: an adaptational level of health considered normal for an individual
Lines of resistance: protection factors activated when stressors have penetrated the normalline of defense
Neumans model, organized around stress reduction, is concerned primarily with how stress and the reactions to stress affect the development and maintenance of health. The person is a composite of physiologic, psychological, sociocultural, developmental, and spiritual variables considered simultaneously. "Ideally the five variables function harmoniously or are stable in relation to internal and external environmental stressor influences" (Neuman, 2002). A person is constantly affected by stressors from the internal, external, or created environment.
Stressors are tension-producing stimuli that have the potential to disturb a persons equilibrium or normal line of defense.
This normal line of defense is the persons "usual steady state."
It is the way in which an individual usually deals with stressors. Stressors may be of three types:
Intrapersonal: forces arising from within the person
Interpersonal: forces arising between persons
Extrapersonal: forces arising from outside the person
Resistance to stressors is provided by a flexible line of defense, a dynamic protective buffer made up of all variables affecting a person at any given moment the persons resistance to any given stressor or stressors.
If the flexible line of defense is no longer able to protect the person against a stressor, the stressor
breaks through, disturbs the persons equilibrium, and triggers a reaction. The reaction may lead
toward restoration of balance or toward death. Neuman intends for the nurse to "assist clients to retain, attain, or maintain optimal system stability" (Neuman, 1996).
Thus, health (wellness) seems to be related to dynamic equilibrium of the normal line of defense, where stressors are successfully overcome or avoided by the flexible line of defense.
Neuman defines illness as "a state of insufficiency with disrupting needs unsatisfied" (Neuman, 2002). Illness appears to be a separate state when a stressor breaks through the normal line of defense and causes a reaction with the persons lines of resistance.
Stress/Adaptation Theory as a Framework In contrast to systems theory, stress and adaptation theories view change caused by personenvironment interaction in terms of cause and effect. The person must adjust to environmental changes to avoid disturbing a balanced existence. Adaptation theory provides a way to understand
both how the balance is maintained and the possible effects of disturbed equilibrium.
This theory has been widely applied to explain, predict, and control biologic (physiologic and psychological)
A unique body of knowledge The drive for a unique body of knowledge is based
on the assumption that borrowed knowledge is
less worthy.
However, nurse education is based on theory borrowed from other disciplines, such as sociology and psychology. It has been argued that applying knowledge from different disciplines only serves to dilute nursing practice.
Nevertheless, as the occupation is focused on
humans, perhaps it is inevitable that nursing uses
knowledge from other social sciences.
It has been argued that no knowledge is exclusive, and because of nursings diverse nature it is impossible for it to have a unique body of knowledge and one unified body of theory (Castledine 1994, Levine 1995). Criticisms of nursing theories To understand why nursing theory is generally neglected on the wards it is necessary to take a closer look at the main criticisms of nursing theory and the role that nurses play in contributing to its lack of prevalence in practice.
Use of language Scott (1994) states that the crucial ingredients of nursing theory should be accessibility and clarity. However, one of the main criticisms of nursing theory is its use of overtly complex language (Kenny 1993).
It is important that the language used in the
development of nursing theory be used consistently.
Not part of everyday practice Despite theory and practice being viewed as inseparable concepts, a theory-practice gap still exists in nursing (Upton 1999).
Yet despite the availability of a vast amount of literature on the subject, nursing theory still means very little to most practicing nurses. Perhaps this is because the majority of nursing theory is developed by and for nursing academics (Lathlean 1994).
It has been recognised that traditionally nurses are used to speaking with their hands (Levine 1995). Therefore, many nurses have not had the training or experience to deal with the abstract concepts presented by nursing theory. This makes it difficult for the majority of nurses to understand and apply theory to practice (Miller 1985).
Summary Definition
Importance of Nursing Theories
The characteristics of theories:
Basic Processes in the Development Of Nursing Theories:
Nursing theories are often based on and influenced
ANA definition of Nursing Practice
Common concepts in Nursing Theories:
Historical Perspectives and Key Concepts Classification of Nursing Theories
Models Of Nursing Growth and Stability Models of Change
Betty Neumans Health Care Systems Model
Stress/Adaptation Theory as a Framework A unique body of knowledge
Criticisms of nursing theories
Conclusion:Littlejohn (2002) comments that irrespective of nursing theories, nurses will continue to exhibit a caring response to the sick and troubled. If this is true, perhaps nurses are nursing without the knowledge of theories and theory is irrelevant. However, theory and practice are related, and if nursing is to continue to develop, the concept of theory must be addressed. If nursing theory does not drive the development of nursing, it will continue to develop in the footsteps of other disciplines such as medicine
Reference:1. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton and Lange.
2. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williamsand wilkins.
3. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development and Progress 3rd ed. Philadelphia, Lippincott.
4. Taylor Carol,Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed. Philadelphia, Lippincott.
5. Potter A Patricia, Perry G Anne (1992)Fundamentals Of Nursing Concepts Process and Practice 3rd ed. London Mosby Year Book.
UNDERSTANDING THE WORK OF NURSE THEORISTS
Creative Beginning
Theories of Nursing Theory is "an internally consistent group of relational statements (concepts, definitions and propositions) that present a systematic view about a phenomenon and which is useful for description, explanation, prediction and control".
Theories are road maps that provide a framework for selecting and organizing information:
What to ask
What to observe
What to focus on
What to think about
Nursing theory is an organized and systematic articulation of a set of statements related to questions in the discipline of nursing.
Uses of TheoryTheory is used to:
Describe
Explain
Predict
Prescribe
Uses of Nursing Theory Define relationships among the variables of a given field of inquiry
Guide research, practice and communication
Allow the prediction of the consequences of care
Allow the prediction of a range of patient responses
Levels of TheoryThere are four levels of theory
Metatheory
Grand Theory
Middle Range Theory
Practice Theory
Types of TheoryIn Nursing there are four types of theories:
Needs
Interaction
Outcome
Humanistic
Practice value of theory Enhances understanding and explanation for events
Influence our behavior.
Makes to think differently about a problem or a situation
Helps to try new approaches or altering behavior.
We can gain a new perspective of events
Basis for challenge of its speculative tenets or propositions
Challenges subsequent discovery of new ideas or knowledge that might explain and predict events not yet understood
In practice Assist nurses to describe, explain, and predict everyday experiences.
Serve to guide assessment, intervention, and evaluation of nursing care.
Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation.
Help to establish criteria to measure the quality of nursing care
Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed and words defined.
Enhance autonomy (independence and self-governance) of nursing by defining its own independent functions.
In education Provide a general focus for curriculum design.
Guide curricular decision making
In research Offer a framework for generating knowledge and new ideas.
Assist in discovering knowledge gaps in specific field of study.
Offer a systematic approach to identify questions for study, select variables, interpret findings, and validate nursing interventions.
An illustrationThe germ theory Explains the phenomenon of disease transmission
Means of speculative explanation and prediction of certain observable events
Allows us to effectively function to prevent transmission of communicable disease.
Viable basis upon which to make decisions about how to prevent certain illnesses.
There are phenomena we do not understand that are related to germ transmission,
Example-the communicability of cancer.
"Nursing Practice."All experiences and events a practicing nurse encounters in the process of providing nursing care.
Events.. Some may be experienced by the client,
Others by the nurse
Some may be observed in the environment
May be observed in the nurse-client interaction.
In situations of daily work or living,
..but as long as they are observable during the process of providing direct nursing care, they are considered part of nursing practice.
Approaches to inter relationships between practice and theory How nursing practice contributes to the process of theory development..
How theory contributes to nursing practice
Contribution of practice to theory development Theory development within nursing occurs in the context of practice.
Two activities contribute significantly to the overall process of developing theory in nursing.
Concept analysis and
Practical validation of theory.
Concept analysis
Identify and verify abstract concepts
"what events in practice can be linked with abstract concept x"
Application of theory in practice
Nursing process operation of analysis of assessment data.
Used as scientific rationale supporting judgments in nursing care plans.
Concepts Concepts may be (a) readily observable, or concrete, ideas such as thermometer, rash, and lesion; (b) indirectly observable, or inferential, ideas such as pain and temperature; or c) non-observable, or abstract, ideas such as equilibrium, adaptation, stress, and powerlessness
nursing theories address and specify relationships among four major abstract concepts referred to as the metaparadigm of nursing.
Four concepts are considered to be central to nursing :
Person or client, the recipient of nursing care (includes individuals, families, groups, and communities).
Environment, the internal and external surroundings that affect the client. This includes people in the physical environment, such as families, friends, and significant others.
Health, the degree of wellness or well-being that the client experiences.
Nursing, the attributes, characteristics, and actions of the nurse providing care on behalf of, or in conjunction with, the client
Nightingales environmental theory "the act of utilizing the environment of the patient to assist him in his recovery"
She linked health with five environmental factors :
Pure or fresh air
Pure water
Efficient drainage
Cleanliness
Light, especially direct sunlight
Deficiencies in these five factors produced lack
Of health or illness.
Peplaus interpersonal relations model Nurses enter into a personal relationship with an individual when a felt need is present
Hendersons definition of nursing Henderson conceptualized the nurses role as assisting sick or well individuals to gain independence in meeting 14 fundamental needs (Henderson)
Breathing normally
Eating and drinking adequately
Eliminating body wastes
Moving and maintaining a desirable position
Sleeping and resting
Selecting suitable clothes
Maintaining body temperature within normal range by adjusting clothing and modifying the environment.
Keeping the body clean and well groomed to protect the integument.
Avoiding dangers in the environment and avoiding injuring others
Communicating with others in expressing emotions, needs, fears, or opinions
Worshipping according to ones faith
Working in such a way that one feels a sense of accomplishment
Playing or participating in various forms of recreation.
Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities
Rogers science of unitary human beings She states that humans are dynamic energy fields in continuous exchange with environmental fields, both of which are infinite.
Nurses applying Roger's theory in practice (a) focus on the persons wholeness, (b) seek to promote symphonic interaction between the two energy fields (human and environment) to strengthen the coherence and integrity of the person, c) coordinate the human field with the rhythmicities of the environmental field, and (d) direct and redirect patterns of interaction between the two energy fields to promote maximum health potential
Orems general theory of nursing Orems self-care deficit theory explains not only when nursing is needed but also how people can be assisted through five methods of helping: acting or doing for, guiding, teaching, supporting, and providing an environment that promotes the individuals abilities to meet current and future demands.
Kings goal attainment theory Kings theory offers insight into nurses interactions with individuals and groups within the environment. It highlights the importance of clients participation in decision that influence care and focuses on both the process of nurse-client interaction and the outcomes of care.
Neumans systems model The model is based on the individuals relationship to stress, the reaction to it, and reconstitution factors that are dynamic in nature.
Betty Neuman's model of nursing is applicable to a variety of nursing practice settings involving individuals, families, groups, and communities.
Roys adaptation model Roy focuses on the individual as a biopsychosocial adaptive system that employs a feedback cycle of input (stimuli), throughput (control processes), and output (behaviors or adaptive responses).
Watsons human caring theory Jean Watson (1979) believes the practice of caring is central to nursing; it is the unifying focus for practice.
Nursing interventions related to human care are referred to as carative factors.
Watsons theory of human caring has receiving worldwide recognition and is a major force in redefining nursing as a caring-healing health model.
Parses human becoming theory Parses model of human becoming emphasizes how individuals choose and bear responsibility for patterns of personal health.
Leiningers cultural care diversity and universality theory She emphasizes that human caring, although a universal phenomenon, varies among cultures in its expressions, processes, and patterns; it is largely culturally derived.
Orems general theory of nursingAssessing Involves collecting data about the clients capacities (knowledge, skills, and motivation) to perform universal, developmental, and health-deviation self-care requisites. Determine self-care deficits.
Diagnosing Stated in terms of the clients limitations for maintaining self care (a deficit in self-care agency)
Planning Involves considering and designing, with the clients participation, an appropriate nursing system (wholly compensatory, partially compensatory, supportive-educative, or a mix) that will help the client achieve an optimal level of self care
Implementing Assisting the client
Evaluating1. Determining the clients level of achievement
References1. Phipps J Wilma, Sands K Judith. Medical Surgical Nursing: concepts & clinical practice.6th edition. Philadelphia. Mosby publications. 1996.
2. Black M. Joice, Hawks hokanson Jane. Medical Surgical Nursing: Clinical Management for positive outcomes. St Lois, Missouri. 2005.
3. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002
4. Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby, Philadelphia, 2002.
THEORIES & NURSING RESEARCHIntroduction RESEARCH Process of inquiry THEORY Product of knowledge SCIENCE Result of the relationship between research & theory To effectively build knowledge to research process should be developed within some theoretical structure that facilities analysis and interpretation of findings. Relationship between theory and research in nursing is not well understood. It may be give to the relative youth of the discipline and debates over philosophical world views. (Empiricism, constructivism, etc) Need to Link Theory and Research Research without theory results in discreet information or data which does not add to the accumulated knowledge of the discipline. Theory guides the research process, forms the research questions, aids in design, analysis and interpretation. It enables the scientist to weave the facts together.Theories from Nursing or Other Disciplines? Nursing science is blend of knowledge that is unique to nursing and knowledge that is borrowed from other disciplines. Debate is whether the use of borrowed theory has hindered the development of the discipline. It has contributed to problems connecting research and theory in nursing.Historical Overview of Research and Theory in Nursing Florence Nightingale supported her theoretical propositions through research, as statistical data and prepared graphs were used to depict the impact of nursing care on the health of British soldiers. Afterwards, for almost century reports of nursing research were rare. Research and theory developed separately in nursing. Between 1928 and 1959 only 2 out of 152 studies reported a theoretical basis for the research design. In 1970s growing number of nurse theorists were seeking researchers to test their models in research and clinical application Grand nursing theories are still not widely used. In 1990s borrowed theories were used more. Now the focus of research and theory have moved more towards middle range theoriesPurpose of Theory in Research To identify meaningful and relevant areas for study. To propose plausible approaches to health problems. To develop or refine theories Define the concepts and proposed relationships between concepts. To interpret research findings To develop clinical practice protocols. Generate nursing diagnosis.Types of theory and corresponding research Type of theoryType of research
Descriptive Explanatory Predictive Descriptive or explanatory Co relational Experimental
How Theory is used in Research
Causal theory of planned behaviour
Theory Generating Research It is designed to develop and describe relationships between and among phenomena without imposing preconceived notations. It is inductive and includes field observations and phenomenology. During the theory generating process, the researcher moves by logical thought from fact to theory by means of a proposition stated as an empirical generalization.Grounded Theory Research Inductive research technique developed by Glazer and Strauss (1967) Grounded theory provides a way to describe what is happening and understanding the process of why it happens. Methodology The researcher observes, collects data, organizes data and forms theory from the data at the same time. Data may be collected by interview, observation, records or a combination of these techniques. Data are coded in preparation for analysis. Category development Categories are identified and named Category saturation Comparison of similar characteristics in each of the categories Concept development Defines the categories Search for additional categories Continues to examine the data for additional categories Category reduction Higher order categories are selected Linking of categories The researcher seeks to understand relationships among categories Selective sampling of the literature Emergence of the core variable Central theme are focus of the theory Concept modification and integration Explaining the phenomenal Theory testing research In theory testing research, theoretical statements are translated into questions and hypothesis. It requires a deductive reasoning process. The interpretation determines whether the study supports are contradicts the propositional statement. If a conceptual model is used as a theoretical framework for research it is not theory testing. Theory testing requires detailed examination of theoretical relationships.Theory as a conceptual framework Problem being investigated is fit into an existing theoretical framework, which guides the study and enriches the value of its findings. The conceptual definitions are drawn from the framework The data collection instrument is congruent with the framework. Findings are interpreted in light of explanations provided by the framework. Implications are based on the explanatory power of a framework.A Typology of Research Testing Analyzing Experimentation Deducting Deductive research Quantitative research The scientific method Theory / hypothesis testing Assaying Refining
Interpreting
Reflecting
Inducing
Inductive research
Qualitative research
Phenomenological research
Theory generation
Divining; heuristic research
Guidelines for writing about a research studys theoretical framework
In the studys problem statement1. Introduce the framework2. Briefly explain why it is a good fit for the research problem area3. At the end of the literature review4. Thoroughly describe the framework and explain its application to the present study.5. Describe how the framework has been used in studies about similar problems6. In the studys methodology section7. Explain how the framework is being operationalized in the studys design.8. Explain how data collection methods (such as questionnaire items) reflect the concepts in the framework.9. In the studys discussion section10. Describe how study findings are consistent (or inconsistent) with the framework.11. Offer suggestions for practice and further research that are congruent with the frameworks concepts and propositions.Conclusion
The relationship between research and theory is undeniable, and it is important to recognize the impact of this relationships on the development of nursing knowledge. So interface theory and research by generating theories, testing the theories and by using it as a conceptual framework that drives the study. Reference George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton and Lange. Polit DF, Hungler BP. Nursing Research: Principles and Methods. Philadelphia: JB Lippincott Company; 1998. Burns N, Grove SK. The practice of Nursing Research. 4th Ed. Philadelphia: WB Saunders Publications; 2001. Treece JW, Treece EW. Elements of Research in Nursing (3rded.). St. Louis: Mosby; 1982.
VIRGINIA HENDERSONS NEED THEORYNursing theories mirror different realities, throughout their development; they reflected the interests of nurses of that time.
Introduction The Nightingale of Modern Nursing
Modern-Day Mother of Nursing.
"The 20th century Florence Nightingale."
"little Miss 3x5"
Born in Kansas City, Missouri, in 1897 and is the 5th child of a family of 8th children but spent her formative years in Virginia
Received a Diploma in Nursing from the Army School of Nursing at Walter Re
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