NURSING THEORIES & MODELS

Professor Sue Frost

By the end of this session you should:

• Be able to explain what is meant by a model and a theory of nursing

• understand the main features of at least two models of nursing

• understand how to critically review a model • Identify how the application of models to

practice influences the activity of the nurse and the experience for the patient or client

References………………….

• Models of nursing practice. McGee P. Stanley Thornes 1998

• Conceptual bases of professional nursing. Leddy S. Pepper J. Lippincott 4th ed.. 1998

• Foundations of nursing practice. Hogston R & Simpson P. Macmillan 1999 (Ch 14)

Nature of theory:

“represent a scientist’s best effort to describe and explain phenomena”

Pollitt & Hungler 1997

Theory……

“…is a general statement that summarizes and organizes knowledge by proposing a general relationship between events - if it is a good one it will cover a large number of events and predict events that have not yet occurred or been observed”

Robson C.

“an internally consistent group of relational statements (concepts, definitions & propositions) that present a systematic view about phenomenon and that is useful for description, explanation, prediction and control. A theory ….is the primary means of meeting the goals of the nursing profession concerned with a clearly defined body of knowledge”Walker & Avant 1996 (cited by Jasper M in Hogston & Simpson))

Purpose of theory

• Support the development of knowledge through thesis and contestability

• Explains and predicts outcomes• Supports decision making• Embeds goals and outcomes for the client

and by implication for the nurse• Supports modeling of processes of nursing

Classifying theories• Meta-theory (Theory building - values etc)• Grand theory (Broad conceptual frameworks

- not testable e.g. Leininger theory of transcultural care)

• Middle range theory (Narrower and testable e.g. Peplau)

• Practice Theory(situational theory - focuses on the way in which nursing is practised e.g. Norton’s theory of nursing elderly people))

Typology:

• Descriptive theory: Explains through describing relationships and patterns within the framework (e.g. Roper et al)

• Predictive Theories: Address the consequences of interventions (e.g. Noddings theory of care)

The medical model

• Bio-reductionist• Differential diagnosis: signs & symptoms• Provision of treatment• Scientific theory - testable and not

contestable• Goals - cure and therapy• Evaluation of treatment efficacy

Nursing models

• Located in social science• Constructed • Contestable knowledge• Capable of change and development• Embed values and culture

What sort of theories would you use?

• Tony Archer (18 years) underwent surgery to have a below knee amputation of his left leg

• Peggy Mountford is 82 years old, lives alone with no family and is becoming increasingly confused and depressed

What sort of theories did you identify?

• Physiology• Psychology• Sociological theory• Nursing theories• Descriptive theory• Predictive theory

Metaparadigm: constructs in all nursing theories

• The person• the environment• health• nursing

Commonly used models

• Roper, Logan & Tierney (ADL)• Peplau (interpersonal communication)• Orem (Self-Care)• Roy (adaptation model)• Wolfensberger (social role valorisation)• Carper (personal explanations)

Roper, Logan & Tierney• Developmental model - emphasises growth &

development• Person oriented• Focus on change• Sees process over time• Sees a range of activities of daily living

changing with maturation• Supporting and enabling• Draws on Henderson’s work strongly

Callister Roy’s model• Systems model - person is made up of systems• Systems interact with the environment • Health is equilibrium and managed systems• Nursing is supporting adaptation to

environment• Is holist, purposeful and unifying• Adaptive modes: physiologic, self concept,

role function, interdependence• Health is a process of responding positively to

environmental changes

Hildegarde Peplau

• Inter-actional model• concerned with interpersonal relationships• nursing is organised through building

relationships to support communication • nurse must be able to use self

therapeutically

Dorothea Orem

• Nursing as part of a social care paradigm • supporting client to self care• caring as a part of moral consciousness • care as the core and essence of nursing• caring and community• collective responsibilities to support and

enable

Carpers model

• Four dimensions of nursing:

empirical dimensionpersonal dimensionethical dimensionaesthetic dimension

Exercise

• What does the Roper et al model suggest about the person, environment, health, nursing?

• What might Roy say about the person? - how may it be different?

Roper et al• Person: A developing maturing individual

throughout the life span moving from dependence to independence

• Health: meeting a range of needs - health changes with many separate facets

• Environment: Anything external to the person and is a framework of the activities of living

• Nursing restoring or maintaining ADL when person cannot cope independently

Roy’s modelPerson: a biopsychosocial being with a

unified systemHealth: equilibrium resulting from effective

copingEnvironment internal and external systems

that impact on equilibriumNursing: Manipulating environment to

enable coping

exercise

• How is assessment likely to be undertaken in Roper modeling?

• How might nursing be different in a model based on interpersonal relationships? (e.g. Peplau)

Criticising a model

• Models are constructions & conceptual• They enable us to explore how the nature of

nursing is defined• Models are not facts - they evolve and emerge• You do not “do” models - they inform your

thinking• Models imply different nursing processes

Questioning models & theories• What methodologies were used to develop?(?draws on other/theories/research/evidence)• How clear is it (overly complex jargon?)• What does the theory say - what is the central

assertion- is it clear and coherent - is there thesis?

• What type of theory is it? (e.g. a mid-range theory that can be tested in practice)

• Can the theory be used• Is this theory relevant to my area of practice

Can you…..

• explain what is meant by a model and a theory of nursing

• understand the main features of at least two models of nursing

• understand how to critically review a model • Identify how the application of models to

practice influences the activity of the nurse and the experience for the patient or client