UNDERSTANDING THE WORK OF NURSE THEORISTS

……………..   A 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.

Theory is used to:

• Describe

• Explain

• Predict

• Prescribe

• 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

• Metatheory

• Grand Theory

• Middle Range Theory

• Practice Theory

In Nursing there are four types of theories:

• Needs

• Interaction

• Outcome

• Humanistic

• 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

• 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.

• Provide a general focus for curriculum design.

• Guide curricular decision making

• 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.

• 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.

All experiences and events a practicing nurse encounters in the process of providing nursing care.

• 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.

• How nursing practice contributes to the process of theory development..

• How theory contributes to nursing practice…

• 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.

• 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 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

• "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.

• Nurses enter into a personal relationship with an individual when a felt need is present

• Henderson conceptualized the nurse’s 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 one’s 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

Roger’s 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 person’s 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

Orem’s general theory of nursing

• Orem’s 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 individual’s abilities to meet current and future demands.

King’s goal attainment theory

• King’s theory offers insight into nurses’ interactions with individuals and groups within the environment. It highlights the importance of client’s participation in decision that influence care and focuses on both the process of nurse-client interaction and the outcomes of care.

Neuman’s systems model

• The model is based on the individual’s 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.

Roy’s 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).

Watson’s 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.

• Watson’s theory of human caring has receiving worldwide recognition and is a major force in redefining nursing as a caring-healing health model.

Parse’s human becoming theory

• Parse’s model of human becoming emphasizes how individuals choose and bear responsibility for patterns of personal health.

Leininger’s 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.

Orem’s general theory of nursing

• Involves collecting data about the client’s capacities (knowledge, skills, and motivation) to perform universal, developmental, and health-deviation self-care requisites. Determine self-care deficits.

• Stated in terms of the client’s limitations for maintaining self care (a deficit in self-care agency)

• Involves considering and designing, with the client’s 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

• Assisting the client

• Determining the client’s level of achievement

References

1. 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.