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NURSING THEORIES: AN
OVERVIEW
Theory
Kerlinger ---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
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Theory is "a creative and rigorous structuring of
ideas that projects a tentative, purposeful, and
systematic view of phenomena"
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A theory makes it possible to "organize the
relationship among the concepts to describe,
explain, predict, and control practice"
Definition
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Types : Empirical concepts
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Inferential concepts
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Abstract concepts.
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Models ----- are representations of the
interaction among and between the concepts showing
patterns.
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Propositions---- are statements that
explain the relationship between the concepts.
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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.
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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.
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The terms ‘model’ and ‘theory’ are often wrongly used interchangeably, which further confounds matters.
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In nursing, models are often designed by theory
authors to depict the beliefs in their theory
(Lancaster and Lancaster 1981).
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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.
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Models are useful as they allow the concepts in
nursing theory to be successfully applied to
nursing practice (Lancaster and Lancaster 1981).
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Their main limitation is that they are only as
accurate or useful as the underlying theory.
Importance of Nursing Theories
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Nursing theory aims to describe, predict and
explain the phenomenon of nursing (Chinn and
Jacobs1978).
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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).
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Theory is important because it helps us to decide
what we know and what we need to know
(Parsons1949).
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It helps to distinguish what should form the basis
of practice by explicitly describing nursing.
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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.
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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.
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This can be seen as an attempt by the nursing
profession
to maintain its professional boundaries.
The
characteristics of theories
Theories:
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interrelate concepts in such a way as to create
a different way of looking at a particular
phenomenon.
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are logical in nature.
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are generalizable.
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are the bases for hypotheses that can be tested.
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increase the general body of knowledge within
the discipline through the research implemented
to validate them.
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are used by the practitioners to guide and
improve their practice.
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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)
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Each of these concepts is usually defined and
described by a nursing theorist , Often uniquely;
although these concepts are common to all nursing
theories.
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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
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Nightingale (1860): To facilitate "the body’s reparative
processes" by manipulating client’s environment
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Paplau 1952: Nursing is; therapeutic interpersonal
process.
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Henderson 1955: The needs often called Henderson’s 14 basic
needs
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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.
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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.
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Johnson’s Theory 1968: Dorothy Johnson’s 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.
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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.
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King 1971:
To use communication to help client reestablish
positive adaptation to environment.
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Neuman 1972:
Stress reduction is goal of system model of nursing
practice.
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Roy 1979:
This adaptation model is based on the physiological,
psychological, sociological and
dependence-independence adaptive modes.
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Watson’s Theory 1979:
Watson’s philosophy of caring 1979 attempts to
define the outcome of nursing activity in regard to
the; humanistic aspects of life.
Classification of Nursing Theories
Depending On The Generalisability Of Their
Principles
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Metatheory: the theory of theory.
Identifies
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specific phenomena through
abstract concepts.
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Grand theory: provides a
conceptual framework under which the key concepts
and
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principles of the discipline can
be identified.
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Middle range theory: is more
precise and only analyses a particular situation
with a limited number of variables.
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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
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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 Tierney’s
Model of Nursing (1980).
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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
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As described by Peplau (1988), these theories
revolve around the relationships nurses form with
patients.
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Such theories have been criticized for largely
ignoring the medical model of health and not
attending to basic physical needs.
"Outcome" theories
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These portray the nurse as the changing force, who
enables individuals to adapt to or cope with ill
health (Roy 1980).
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Outcome theories have been criticized as too
abstract and difficult to implement in practice (Aggleton
and Chalmers 1988).
"Humanistic" Theories:
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Humanistic theories developed in response to the
psychoanalytic thought that a person’s destiny was
determined early in life.
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Humanistic theories emphasize a person’s capacity
for self actualization .
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Humanists believes that the person contains within
himself the potential for healthy and creative
growth.
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Carl Rogers developed a person –centered model of
psychotherapy that emphasizes the uniqueness of
the individual.
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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
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Until fairly recently, nursing science was derived
principally from social, biologic, and medical
science theories.
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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.
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A model, as an abstraction of reality, provides a
way to visualize reality to simplify thinking.
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A conceptual model shows how various concepts are
interrelated and applies theories to predict or
evaluate consequences of alternative actions.
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According to Fawcett (2000),
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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"
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. 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.
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These four concepts form a metaparadigm of
nursing.
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The term metaparadigm comes from the Greek prefix
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"meta," which means more comprehensive or
transcending,
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and the word Greek word "paradigm," which means a
philosophical or theoretical framework of a
discipline
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upon which all theories, laws, and generalizations
are formulated (Merriam-Webster’s Collegiate
Dictionary, 1994).
Growth and Stability Models of Change
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There are two major differences in philosophical
beliefs, or world views, about the nature of
change.
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"The world view of change uses the growth
metaphor, and the persistence view focuses
on stability" (Fawcett, 1989,).
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Within the change world view, change and growth
are continual and desirable, "progress is valued,
and realization of one’s potential is emphasized"
(Fawcett).
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Persistence is endurance in time
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persistence world view emphasizes equilibrium and
balance.
Categories of Conceptual Models
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Ten conceptual models of nursing have been
classified according to two criteria:
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the world view of change reflected by the model
(growth or stability); and
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the major theoretical conceptual classification
with which the model seems most consistent
(systems, stress/adaptation, caring, or
growth/development).
Systems Theory as a Framework
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Systems theory is concerned with changes caused by
interactions among all the factors (variables)
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General systems theory is emphasized
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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)
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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
Two nursing models based on systems theory:
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Imogene King’s systems interaction model, and
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Betty Neuman’s health care systems model.
Imogene King’s Systems Interaction Model
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interaction model, the purpose of nursing is to
help people attain, maintain, or restore health
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King’s model conceptualizes three levels of
dynamic interacting systems.
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1. Individuals are called "personal systems."
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2. Groups (two or more persons) form
"interpersonal systems."
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3. Society is composed of "social systems."
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As the person interacts with the environment, he
or she must continuously adjust to stressors in
the internal and external environment (King,
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