There is a reciprocal relationship between conceptual models of nursing and nursing practice Conceptual models

influence clinical nursing practice by specifying standards for and purposes of practice, identifying relevant clinical

problems, settings for practice, legitimate recipients of nursing care, and the content for the nursing process,

suggesting methods for delivery of nursing services, and by providing frameworks for clinical information systems,

patient classifications systems and quality assurance programmes Nursing practice, in turn, provides data that can be

used to determine the credibility of the conceptual models Sources of data from clinical practice for credibility

determination include evaluations of nursing interventions, the recipient's perspective of nursing care and quality

assurance reviews

A conceptual model of nursing and health policy was proposed by the authors in 2001. Revisions in the model have been made, and the model has been used to guide the evolution of a nursing doctoral program and doctoral dissertation research. The revised model provides a framework for analysis and evaluation of public, organizational, and professional polices influencing the quality, cost, and access to nursing and other health care services, as well as for nursing-discipline specific and health services research at any one of four interacting levels: Level 1—efficacy of nursing practice processes; Level 2—effectiveness of nursing practice processes and effectiveness and efficiency of health care delivery subsystems; Level 3—equity of access to effective and efficient nursing practice processes and efficient nursing practice delivery systems, and equity in distribution of costs and burdens of care delivery; Level 4—justice and the social changes and market interventions addressing equity.

Introduction to Nursing TheoriesThis page was last updated on February 21, 2011

INTRODUCTION

Each discipline has a unique focus for knowledge development that

directs its inquiry and distinguishes it from other fields of study.

(Smith & Liehr, 2008).

Nursing knowledge is the inclusive total of the philosophies,

theories, research, and practice wisdom of the discipline.As a

professional discipline this knowledge is important for guiding

practice.(Smith & Liehr, 2008).

Theory-guided, evidence-based practice is the hallmark

of any professional discipline.

Nursing is a professional discipline (Donaldson & Crowley, 1978).

Nursing theory is the term given to the body of knowledge that is

used to support nursing practice

Almost 90% of all Nursing theories are generated in the last 20

years. 

Nursing models are conceptual models, constructed of theories

and concepts

M E T A P A R A D I G M S I N N U R S I N G

1. Person

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

sociocultural components.

Individual, family, or community

2.  Environment

All internal and external conditions, circumstances, and influences

affecting the person

3. Health

Degree of wellness or illness experienced by the person

4. Nursing

Actions, characteristics and attributes of person giving care

COMPONENTS OF A THEORY

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)

DEFINITIONS

D e f i n i t i o n s

Theory

o a set of related statements that describes or explains

phenomena in a systematic way

Concept

o a mental idea of a phenomenon

o Concepts are the building blocks—the primary elements—

of a theory.

Construct-

o a phenomena that cannot be observed and must be

inferred

o Constructs are concepts developed or adopted for use in a

particular theory. The key concepts of a given theory are

its constructs.

Proposition

o a statement of relationship between concepts

Conceptual model-

o made up of concepts and propositions

o They epresent ways of thinking about a problem or ways of

representing how complex things work the way that they

do.

o Different Frameworks will emphasize different variables

and outcomes and their interrelatedness.( Bordage, 2009)

o Models may draw on a number of theories to help

understand a particular problem in a certain setting or

context. They are not always as specified as theory.

Variables

o Variables are the operational forms of constructs. They

define the way a construct is to be measured in a specific

situation.

o Match variables to constructs when identifying what needs

to be assessed during evaluation of a theory-driven

program.

NURSING PHILOSOPHIES

Theory Key emphasis

Florence Nightingale’s Legacy of caring

Focuses on nursing and the patient environment relationship.

Ernestine Wiedenbach: The helping art of clinical nursing 

Helping 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 Henderson’s   Definition of Nursing

Patients require help towards achieving independence.

Derived a definition of nursing

Identified 14 basic human needs on which nursing care is based. 

Faye G.Abedellah’s Typology of twenty one Nursing problems 

Patient’s problems determine nursing care

Lydia E. Hall :Care, Cure, Core model

Nursing care is person directed towards self love.

Jean Watson’s Philosophy and Science of caring

Caring 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 Benner’s 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. Orem’s Self care deficit theory in nursing

Self–care 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 Levine’s: The conservation model

Holism 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.Roger’s: Science of unitary  human beings

Person 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.Johnson’s 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: Roy‘s  Adaptation model

Stimuli 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 Neuman’s : Health care systems model

Reconstitution is a status of adaptation to stressors

A conceptual model with two theories “Optimal patient stability and prevention as intervention”

Neuman’s 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 client’s response to

stressors.

Imogene King’s Goal attainment theory

Transactions 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 living

Individuality 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 Theory

Interpersonal 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 Orlando’s Nursing Process Theory

Interpersonal process alleviates distress.

Nurses must stay connected to patients and assure that patients get what they need, focused on patient’s verbal and non verbal expressions of need and nurse’s reactions to patient’s behaviour to alleviate distress.

Elements of nursing situation:   

1. Patient

2. Nurse reactions

3. Nursing actions

Joyce Travelbee’s Human To Human Relationship Model

Therapeutic 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. Barnard’s Parent Child Interaction Model

Growth and development of children and mother–infant  relationships

Individual characteristics of each member influence the parent–infant system and adaptive behaviour modifies those characteristics to meet the needs of the system.

Ramona T.Mercer’s :Maternal Role Attainment

Parenting and maternal role attainment in diverse populations

A complex theory to explain the factors impacting the development of maternal role over time. 

Katharine Kolcaba’s Theory of comfort

Comfort 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 Leininger’s Caring is universal and varies transculturally.

Transcultural nursing, culture-care theory 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 Parse’s :Theory of human becoming

Indivisible beings and environment co-create health.

A theory of nursing derived from Roger’s 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.Pender’s :The Health promotion; model

Promoting 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

CONCLUSION

The 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

1. Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing.

Nursing Outlook, 26, 113–120.

2. Smith, M. J., & Liehr, P. R. (2008). Middle range theory for nursing.

New York: Springer Publishing.

3. George B. Julia , Nursing Theories- The base for professional

Nursing Practice, 3rd ed. Norwalk, Appleton & Lange.

4. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for

Nursing Philadelphia. Lippincott Williams& wilkins.

5. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development &

Progress 3rd ed. Philadelphia,  Lippincott.

6. Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care

4th ed. Philadelphia,  Lippincott.

7. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –

Concepts Process & Practice 3rd ed. London Mosby Year Book.

8.  Tomey AM, Alligood. MR. Nursing theorists and their work. (5th

ed.).  Mosby,  Philadelphia, 2002

9.  Alligood M.R, Tomey. A.M. Nursing theory utilization and

application. 2nd Ed. Mosby,  Philadelphia, 2002. 

N u r s i n g T h e o r i e s a n d R e s e a r c h

This page was last updated on March 6, 2011

===

Introduction

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.

Relationship Between 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.

The relationship is direct and positive

The choice of a research design depends on the question asked and the

current state of theory development. (Kaiser Permanente, 2009)

Theory and its associated research design may be

o Descriptive

o Correlational

o Experimental

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 1970’s 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 1990’s borrowed theories

were used more.

Now the focus of research and theory have moved more towards middle range

theories

Purpose 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.

To generate nursing diagnosis.

Bordage (2009) explainsuse of conceptual frameworks in research

Allow researchers to build upon one another’s work; thereby building a body of

knowledge

Programmatic, conceptually based research helps accumulate deeper

understanding over time and this moves a discipline (such as nursing)

forward.

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 study’s theoretical framework 

In the study’s problem statement

Introduce the framework

Briefly explain why it is a good fit for the research problem area

At the end of the literature review

Thoroughly describe the framework and explain its application to the present

study.

Describe how the framework has been used in studies about similar problems

In the study’s methodology section

Explain how the framework is being operationalized in the study’s design.

Explain how data collection methods (such as questionnaire items) reflect the

concepts in the framework.

In the study’s discussion section

Describe how study findings are consistent (or inconsistent) with the

framework.

Offer suggestions for practice and further research that are congruent with the

framework’s 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.

References

1. George B. Julia , Nursing Theories- The base for professional Nursing

Practice , 3rd ed. Norwalk, Appleton and Lange.

2. Polit DF, Hungler BP. Nursing Research: Principles and Methods.

Philadelphia: JB Lippincott Company; 1998.

3. Burns N, Grove SK. The practice of Nursing Research. 4th Ed. Philadelphia:

WB Saunders Publications; 2001.  

4. Treece JW, Treece EW. Elements of Research in Nursing (3rded.). St. Louis:

Mosby; 1982.

5. Nursing Research Series. Essentials of Science: Methods, Appraisal and

Utilization. Kaiser Permanente. Northern and Southern California Nursing

Research, 2009. Available

at http://nursingpathways.kp.org/scal/research/resources/researchseries/

index.html

Publications on Nursing Research and Theories

1. The relationship of nursing theory and research: the state of the art

2. Middle range theory: spinning research and practice to create knowledge for

the new millennium

D e v e l o p m e n t o f N u r s i n g T h e o r i e s

This page was last updated on November 4, 2010

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Introduction

Theories 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.

Theory gives planners tools for moving beyond intuition to design and

evaluate health behavior and health promotion interventions based on

understanding of behavior.[Robert T. Croyle (2005)].

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:

1. Empirical concepts

2. Inferential concepts

3. Abstract concepts

Definitions

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 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).

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 theories

Theories 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 theories

Nursing theories are often based on & influenced by broadly applicable processes &

theories. Following theories are basic to many nursing concepts.

General System Theory

It 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

It outlines the process of growth & development of humans as orderly &

predictable, beginning with conception & ending with death.

The progress & behaviors of an individual within each stage are unique.

The growth & development of an individual are influenced by heredity,

temperament, emotional, & physical environment, life experiences & health

status.

Common concepts in nursing theories

Four 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

1. Nightingale (1860): To facilitate “the body’s reparative processes” by

manipulating client’s environment

2. Peplau 1952: Nursing is; therapeutic interpersonal process.

3. Henderson 1955: The needs often called Henderson’s 14 basic needs

4. 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.

5. 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.

6. 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.

7. Rogers 1970: to maintain and promote health, prevent illness, and care for

and rehabilitate ill and disabled client through “humanistic science of

nursing”

8. Orem1971: This is self-care deficit theory. Nursing care becomes necessary

when client is unable to fulfill biological, psychological, developmental, or

social needs.

9. King 1971: To use communication to help client reestablish positive

adaptation to environment.

10. Neuman 1972: Stress reduction is goal of system model of nursing practice.

11. Roy 1979: This adaptation model is based on the physiological,

psychological, sociological and dependence-independence adaptive modes.

12. 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

A. Depending On Function (Polit et al 2001)

1. Descriptive-to identify the properties and workings of a discipline

2. Explanatory-to examine how properties relate and thus affect the discipline

3. Predictive-to calculate relationships between properties and how they

occur

4. Prescriptive -to identify under which conditions relationships occur

B. Depending on the Generalisability of their principles

1. Metatheory: the theory of theory. Identifies specific phenomena through

abstract concepts.

2. Grand theory: provides a conceptual framework under which the key

concepts and

C. Principles of the discipline can be identified.

1. Middle range theory: is more precise and only analyses a particular

situation with a limited number of variables.

2. Practice theory: explores one particular situation found in nursing. It

identifies explicit goals and details how these goals will be achieved.

D. Based on the philosophical underpinnings of the theories

1. “Needs “theories.

2. “Interaction” theories.

3. “Outcome “theories.

4. Humanistic theories.

1. “Needs” theories

These theories are based around helping individuals to fulfill their physical and mental

needs. Needs theories have been criticized for relying too much on the medical

model of health and placing the patient in an overtly dependent position.

2.“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.

3. “Outcome” theories"

Oucome theories portray the nurse as the changing force, who enables

individuals to adapt to or cope with ill health.

Outcome theories have been criticized as too abstract and difficult to

implement in practice.

4. “Humanistic” Theories

Humanistic theories developed in response to the psychoanalytic thought that a

person’s destiny was determined early in life.

Humanistic theories emphasize a person’s 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

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-Webster’s Collegiate Dictionary, 1994).

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).

1.Systems Theory as a Framework

Systems theory is concerned with changes caused by interactions among

all the factors (variables)

General systems theory states

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”.

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:

1. Imogene King’s systems interaction model, and

2. Betty Neuman’s health care systems model.

Major Concepts as Defined in King’s 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”

Health

dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of one’s resources to achieve maximum potential for daily living”

Nursing A process of human interaction

Imogene King’s Systems Interaction Model

In interaction model, the purpose of nursing is to help people attain, maintain, or

restore health. King’s 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 one’s resources

to achieve maximum potential for daily living” (King, 1981,).

“Illness is a deviation from normal, that is, an imbalance in a person’s

biological structure or in his psychological makeup, or a conflict in a

person’s 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 Neuman’s 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

Neuman’s 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

person’s equilibrium or normal line of defense.

This normal line of defense is the person’s “usual steady state.”

It is the way in which an individual usually deals with stressors.

Stressors may be of three types:

1. Intrapersonal: forces arising from within the person

2. Interpersonal: forces arising between persons

3. 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 person’s

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 person’s 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 person’s lines of resistance.

Stress/Adaptation Theory as a Framework

In contrast to systems theory, stress and adaptation theories view change caused by

person–environment 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.

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.

Summarization

Definition

Importance of Nursing Theories

The characteristics of theories:

Basic Processes in the Development Of Nursing Theories:

Nursing theories are often based on & influenced

ANA definition of Nursing Practice

Common concepts in Nursing Theories:

Historical Perspectives & Key Concepts

Clasification of Nursing Theories

Models Of Nursing

Growth and Stability Models of Change

Betty Neuman’s Health Care Systems Model

Stress/Adaptation Theory as a Framework

A unique body of knowledge

Criticisms of nursing theories

Conclusion

Theory and practice are related. A theory presents a systematic way of understanding

events or situations.It is a set of concepts, definitions, and propositions that explain or

predict these events or situations by illustrating the relationships between

variables.Theories must be applicable to a broad variety of situations. They are, by

nature, abstract, and don’t have a specified content or topic area. Like empty coffee

cups, theories have shapes and boundaries, but nothing inside. They become useful

when filled with practical topics, goals, and problems. [Robert T. Croyle (2005)]

Reference

1. Robert T. Croyle (2005). Theory at a Glance: Application to Health

Promotion and Health Behavior (Second Edition). U.S. Department of

Health and Human Services, National Institutes of Health. Available at

www.thecommunityguide.org.

2. George B. Julia , Nursing Theories- The base for professional Nursing

Practice , 3rd ed. Norwalk, Appleton & Lange.

3. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing

Philadelphia. Lippincott Williams& wilkins.

4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress

3rd ed. Philadelphia, Lippincott.

5. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed.

Philadelphia, Lippincott.

6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –

Concepts Process & Practice 3rd ed. London Mosby Year Book.

7. Vandemark L.M. Awareness of self & expanding consciousness: using

Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul;

27(6) : 605-15

8. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006

Jul;19(3):22

Middle - Range Nursing TheoriesCriteria and a number of views on mid-range theory is available on the University of San Diego Hahn School of Nursing And Health Science web site: Click Here!

Evelyn Adam  - Conceptual Model for Nursing

Jeanine Roose Auger  - Behavioral systems and nursing.

Dr Phil Barker  - Tidal Theory Kathryn E. Barnard  - Parent-Child

Interaction Model. Dr. Mary Bennett  -  PNI Nursing Theory Carrie Jo Braden  - Learned Response to

Chronic Illness Theory Jeanine M. Carr  - Nursing theory of

Vigilance Dr. Marion Conti-O'Hare  - Theory of The

Nurse As Wounded Healer Cheryl Cox  - Interaction Model of Client

Health Behavior. Eakes, Burke & Hainsworth  -  Middle

Range Theory: Chronic Sorrow Marion Good & Shirley Moore  -  Acute

Pain Management (Adults) Eugenie Hildebrandt & Cynthia Armstrong

Persily - Theory of Community Empowerment

M.M. Huth   & Shirley Moore  -  Prescriptive theory ofacute pain management in infants and children

Jean Johnson  - Sensation Theory Dr.   Katharine Kolcaba  - The Comfort

Theory June H Larrabee  - Quality of Nursing

Care Madelaine M Leininger  -  Transcultural

Nursing.

E. Lenz and L. Pugh  - The Theory of

Ramona T. Mercer  - Role Attainment: Chronically ill children: how families adjust.

Blanche Mikhail  - Utilization of Health Belief Model

Merle Mishel  - Uncertainty in Illness Theory

Kathleen O'Connell  - Theory of Self Control Strength.

Joanne K.   Olson &   E   Hanchett  -  Nurse - expressed empathy and patient outcomes.

Ida Jean Orlando  - The Deliberative Nursing Process.

Dr. Nola J. Pender  - Health Promotion Model

Hildegard E. Peplau  - Interpersonal Relations.

Susan E. Pollock  - Health-related Hardiness

Sue Popkess-Vawter  - Holistic self-care model for permanent weight control

Larry D. Purnell  - Purnell's Model for Cultural Competence

Pamela Reed  - Self Transcendence Barbara Resnick  - Middle Range Nursing

Theory of Self-efficacy Gayle M. Roux  - Theory of Inner Strength

in Women Reva Rubin  - Theory of Maternal Identity. Cornelia Maria Ruland  -  End of Life Care  Hollie Shaner  - Environmentally

Responsible Clinical Practice Model.

Unpleasant Symptoms

Patricia Liehr   &   Mary Jane Smith -  Attentively Embracing Story

Geri LoBiondo-Wood  - The Theory of Family Stress and Adaptation

Rozzano Locsin  - Advancing Technology, Caring and Nursing

K risten   M .   Swanson  - Theory of Caring (1991)

Ann L. Whall  - Disruptive Behavior. Janet B. Younger  - A Theory: Mastery of

Stress

Nursing TheoryNURSING THEORY

To be a nursing theory, the theory must be about nursing-related concepts. The metaparadigm concepts of person, environment, health, and nursing serve as an umbrella for other concepts that may be present in a nursing theory. Nursing theories vary in their scope and level of abstraction. The following are types of nursing theories.

Conceptual Model or Conceptual Framework - A conceptual model is a group of concepts that flow from the same paradigm perspective. It describes a certain approach and view of the discipline. Although it may contain more than one concept, the relationships among concepts are not clearly delineated and not testable. A conceptual model is intended as an organizing framework from which a more concrete theory will be derived.

Grand Theory - A grand theory is similar to a conceptual model in that it describes a certain viewpoint that is applicable across many different fields within nursing. A grand theory is broad in scope; it is composed of related concepts but the relationships are not concrete. A grand theory is a highly abstract description of proposed truth. Although grand theory is testable, the concepts and relationships involved make testing difficult. Martha Rogers’ science of unitary human beings proposes ideas about humans that are highly abstract and difficult to test using accepted research methods.

Theory – A theory is less abstract than a grand theory and has a narrower scope. A theory applies to a specific aspect or practice area of nursing, but is not as limited as a middle range theory.

Middle Range Theory - A middle-range theory is less abstract than a grand theory. It is more concrete, more usable and closer to practice. Often a middle range theory is developed from a grand theory. The concepts and relationship in a middle-range theory are directed more at a specific nursing situation than in the preceding types of theory. Middle-range theories are more amenable to testing through research.

Practice Theory - A practice theory describes a theory that is very concrete. It has a low level of abstraction. An example of a very simple practice theory would be something like "turning every 2 hours decreases the risk of pressure sores". You can see how this could be easily tested to see if it is supported.

DEVELOPMENT OF NURSING THEORY

Describe the process of nursing theory development

A theory is generated from observations made regarding a given phenomena. In everyday life, people often create theories about how and why things happen. To develop formal theory requires structured observations and subsequent testing.

Knowledge that is gained through observing multiple instances of the same phenomena is from an inductive approach. Inductive reasoning takes information gathered from specific events and derives a general statement or theory to describe the underlying principle. For example, multiple observations could be made of clients who are experiencing a similar situation; some general statements could be developed that might be expected to apply to other people who also experience that situation. Qualitative research is an inductive process that is valuable to generate theoretical ideas.

Once a theory is proposed, it must be tested to see whether the proposed generalities seem to hold true, and under what circumstances. In research, this proposed relationship is called a hypothesis. A hypothesis is an educated hunch about what is thought to be true. Hypothesis testing is a deductive approach that examines how well a general statement applies to a specific case. Deductive reasoning is the type of thought process used in the scientific method. Although traditional experiments are done in a lab, that type of environment does not usually work for the things about which nurses are concerned. When testing a theory, other contextual aspects of the situation must be considered, making nursing research quite complex. It is impossible to actually "prove" something beyond a shadow of a doubt, so nurse researchers attempt to find "support" for a theory.