Areas for Further Development of Theory-Based Nursing Practice

Martha Raile Alligood

Nursing’s potential for meaningful human service rests on the union of theory and practice for its fulfillment.

(Rogers, 1970, p. viii)

Systematic theory testing through application of nursing theories in practice with the participation of clinicians is essential for the enhancement of theory-based practice.

(Silva & Sorrell, 1992, p. 19)

This is a very exciting time in the history of nursing as theory utilization grows exponentially. Practice based on nursing models and theories has expanded as has development of creative applications of middle-range theories (see Chapter 2). This growth is due in part to the rapid development of doctor of nursing practice (DNP) programs. The American Association of Colleges of Nursing (AACN) DNP Fact Sheet (online, October 2012) reported the count was up to 184 DNP programs in the United States. The practice doctorate calls for nurses to deliver a professional style of practice from a nursing perspective for quality care in concert with other professional health care doctorates (Ahmed, Andrist, Davis, et al., 2012). This progress is supported by this text in its 5th edition and numerous other books focused on middle-range theory in their second and third editions (Peterson & Bredow, 2012; Sieloff & Frey, 2007; Smith & Liehr, 2008). Also theories from quantitative research derived from nursing models as well as qualitative approaches (Reed & Shearer, 2011; Renpenning & Taylor, 2011) and some from other countries such as those of McCormack, Brendan, and McCance (2011) flood the nursing literature. Expansion of theory utilization and application continues as noted in Chapter 2.

This text builds on a premise of the vital nature of the relationship between nursing theory and quality nursing practice. In Chapters 1 and 3, nursing philosophies,models, and theories have been presented as critical thinking structures that guide clinical decision making. This chapter extends that premise by (1) illustrating the growth of middle-range theory applications derived from the seven nursing models, (2) identifying possible areas of nursing practice yet to be addressed with middle-range theories derived from the seven nursing models, and (3) illustrating the design of middle-range theories with examples that might be developed to address new areas with theoretical approaches.

New middle-range theories that are relevant to specific areas of nursing practice may be derived with linkages to the nursing models, grand theories, or theories. A characteristic of middle-range theories is their specificity to the details of actual clinical practice situations. Therefore, this chapter presents examples (ideas) using areas where middle-range theories were not found in Chapter 2 to illustrate areas where middle-range theories might be developed and how they might appear. As discussed in Chapter 3, the level of abstraction of middle-range theory is more concrete and includes specific details.

• The specifics are information such as the following:

• The situation or health condition

• The client population or age group

• The location or area of nursing practice (e.g., home, hospital, community)

• The action of the nurse or nursing intervention

It is these specifics that are characteristics of middle-range theory and make it applicable in nursing practice. Furthermore, variation in the characteristics among these specific aspects of practice multiplies the middle-range theories possible from any one model or grand theory.

The areas of nursing practice in which theory-based practice has been reported were illustrated with a solid circle in Tables 2-1, 2-2, and 2-3 (see Chapter 2). In this chapter the tables are reversed, focusing on the areas where theory-based practice has not been reported in order to highlight opportunities for possible middle-range theory expansion. Table 21-1 indicates areas for expansion where practice with nursing models is described in terms of a situation or health condition with a medical focus. Table 21-2 indicates areas for expansion where practice with nursing models focuses on human development, type of practice, type of care, or health. Table 21-3 indicates areas for expansion where practice with nursing models focuses on a nursing intervention or nursing role. Counting the types of theories with the dots in Chapter 2 illustrates published theories that have been developed and stimulates thought and action for the development of new middle-range theories in areas where they have not been developed or found in the nursing literature. Although the nursing models are holistic, the focus of the model (e.g., conservation or adaptation) is considered to determine the model that has the best fit in specific nursing situations.

TABLE 21-1

Areas of Practice for Expansion with Nursing Models Described in Terms of Medical Condition Focus

Practice Area	Johnson	King	Levine	Neuman	Orem	Rogers	Roy
Acute care	•	•	•	•	•		•
Adolescent cancer	•	•	•	•	•	•
Adult diabetes	•		•	•		•	•
AIDS management		•	•		•
Alzheimer’s disease	•	•	•	•	•	•
Ambulatory care	•	•	•	•			•
Anxiety	•		•				•
Breast cancer	•	•	•		•	•
Burns	•	•		•	•	•	•
Cancer		•		•
Cancer pain management		•	•	•	•	•	•
Cancer-related fatigue	•	•	•	•		•	•
Cardiac disease			•	•
Cardiomyopathy	•	•	•	•	•	•
Chronic inflammatory bowel disease	•		•	•	•	•	•
Chronic pain	•	•		•	•
Chronic sorrow	•	•	•	•	•	•
Cognitive impairment	•	•	•		•	•	•
Congestive heart failure	•	•		•	•	•	•
Critical care	•	•
Cystitis	•	•	•		•	•	•
Diabetes	•		•			•	•
Guillain-Barré syndrome	•	•	•	•		•	•
Heart variations	•	•	•	•			•
Hemodialysis		•	•	•		•	•
Hypernatremia	•	•	•	•	•	•
Intensive care	•	•	•
Kawasaki disease	•	•	•	•	•	•
Leukemia	•	•	•	•	•	•
Long-term care	•	•		•		•	•
Medical illness	•		•		•		•
Menopause	•		•	•	•		•
Neurofibromatosis	•		•	•	•	•	•
Obesity			•	•	•	•	•
Oncology			•	•			•
Orthopedics	•		•		•	•	•
Osteoporosis	•	•	•	•	•	•
Ostomy care	•	•		•		•	•
Pediatric					•
Perioperative	•			•		•
Polio survivors	•	•	•	•	•		•
Postanesthesia	•	•	•	•	•	•
Postoperative	•	•	•			•
Postpartum	•	•	•	•	•	•
Posttrauma	•	•	•	•	•	•
Preoperative adults	•	•		•	•	•	•
Preoperative anxiety	•		•	•		•	•
Pressure ulcers	•	•		•	•	•	•
Renal disease	•		•			•	•
Rheumatoid arthritis	•	•	•	•		•	•
Schizophrenia	•	•	•	•	•	•
Stroke			•	•	•	•	•
Substance abuse	•		•	•			•
Terminal illness	•	•	•	•	•
Ventilator patient	•	•	•	•	•	•
Ventricular tachycardia		•	•	•	•	•	•
Wound healing	•	•		•	•	•	•