The use of nursing models and their theories in nursing practice is presented in this chapter, documenting various areas of application and utilization of the models as reported in the nursing literature. As the premise in the third edition (2006) set forth, the shift from theory development to theory utilization restores a proper relationship between theory and practice for a professional discipline such as nursing. The importance of this shift was supported by Levine’s (1995) comment, when she stated in regard to Fawcett’s clarification of models from theories, “It may be that the first prerequisite for effective use of theory in practice… rest[s] on just such a clarification” (p. 12). The literature continues to verify that nursing models and their theories have practical utility for nursing with specific details in areas of practice (Bond, Eshah, Bani-Khaled, et al., 2011; Donohue-Porter, Forbes, & White, 2011; Im & Chang, 2012; McCrae, 2011).

Based on a review of the nursing literature, this chapter begins with examples of practice areas where nursing models and their theories guide nursing. Although all three tables present the use of the nursing models and their theories in nursing practice, these applications are described by their authors in various ways: (1) in terms of the medical conditions; (2) in terms of nursing based on human development, areas of practice, type of care, and type of health; and (3) in terms of nursing interventions or the nursing role. (See the Bibliography for references to applications of each model cited in Tables 2-1, 2-2, and 2-3.) This chapter concludes with a review of thenursing models using the criteria for normal science set forth by Kuhn (1970) in The Structure of Scientific Revolutions and a discussion of how the discipline of nursing has reached a period of normal science using the nursing models.

The literature review makes it apparent that nurses describe their practice in several ways. Some describe nursing practice in terms of the medical conditions. This view focuses on the patient or area of care, as noted in Table 2-1. Examples ofthis focus are the nursing of cardiovascular patients or of intensive care patients. Several observations have been made about this focus (see Table 2-1). First, it represents the largest body of literature. Second, each model is represented within this focus. This large group of studies is surprising in light of the efforts of the past 40 years to move nursing beyond the medical view to a nursing perspective. However, this focus reflects the practice area, of the largest single group (54%) of practicing nurses, who, according to the Department of Labor Statistics (2010) provide acute care or illness care in hospitals.

Table 2-2 presents model and theory use in publications in which nurses describe their practice in terms of a developmental or life-span focus, a particulargroup in society, a type of care, or a type of health. Examples of this focus are nursing of children, homeless, holistic care, and child health. Table 2-2 reflects the second largest group of articles. Like Table 2-1, Table 2-2 represents articles based on all seven of the nursing models. Although Table 2-2 is large, it represents a grouping of several perspectives nurses use to describe their practice: nursing groups according to a developmental category, areas of practice, types of care, and types of health or health promotion.

Table 2-3 presents model and theory use in publications that focus on nursing intervention or nursing role. Examples of this focus are life review and counseling. This table is smaller than Tables 2-1 and 2-2 and differs in that not all of the nursing models are represented in Table 2-3. Certain nurses practicing from the perspective of nursing models seem to describe their practice in terms of nursing intervention or nursing role. It is noted that the specificity of the language in Rogerian science has created several unique categories in this focus. This is not surprising, considering the following:

The nursing categories in Tables 2-1, 2-2, and 2-3 can be considered in the context of Kuhn’s (1970) discussion of normal science. Paradigms (or nursing models) not only are frameworks to guide thinking about nursing and research but also the thought and action of practice. As such, their use by members of the profession produces knowledge that is evidence for practice as well as further research and theory development. Normal science verifies the growing maturity of a discipline as it moves beyond a knowledge development focus and focuses on knowledge use. Model-based nursing literature now reflects the characteristics of normal science. Middle-range theories and societies have been developed from nursing philosophies and theories in recent years that are beyond the scope of this chapter. The reader is referred to Part III of this text on expansion and Chapter 21 for a brief discussion of those developments.

In his book The Structure of Scientific Revolutions, Kuhn (1970) examines the nature of scientific discovery. He defines normal science as “research firmly based upon one or more past scientific achievements that some particular scientific community acknowledges for a time as supplying the foundation for its further practice” (p. 10). From this definition, Kuhn describes criteria that might be used for evaluation of a given paradigm (nursing model). The following are some of the characteristics of a model as it approaches normal science:

Kuhn (1970) describes a paradigm that results in normal science as “an achievement sufficiently unprecedented to attract an enduring group of adherents away from competing modes of scientific activity” and as “leaving all sorts of problems for the redefined group of practitioners to resolve” (p. 10). In the attempt to develop nursing science, theory from numerous modes of scientific activity including medicine, social and physical science, education, and even industrial management had been utilized (Wald & Leonard, 1964). However, it was not until the development of formal conceptual nursing models that nurses had “a systematic approach to nursing research, education, administration, and practice” (Fawcett, 1995, p. 5) that ultimately resulted in normal science for the discipline of nursing. Nursing theory continues to supply the foundation for knowledge development and generate evidence for practice (Bond, et al., 2011; Canavan, 2002; Colley, 2003; Im & Chang, 2012; Kikuchi, 2003; McCrae, 2011). Each of the models is reviewed with regard to Kuhn’s definition and criteria of normal science.

The concept of normal science introduced by Kuhn describes the acceptance of a new paradigm for use by a discipline. According to Kuhn (1970), normal science “means research firmly based upon one or more past scientific achievements, achievements that some particular scientific community acknowledges for a time as supplying the foundation for its further practice” (p. 10). The discipline of nursing moved toward normal science with widespread acceptance of the paradigm consisting of four concepts: person, health, environment, and nursing. However, these four concepts by themselves were not adequate for achievement of normal science. In a practice discipline such as nursing, the body of knowledge that is contained in the science must be at a level of abstraction that is suitable for application in practice.

The works of Johnson, King, Levine, Neuman, Orem, Rogers, and Roy, serving as frameworks for practice, education, and research, have provided this level of abstraction and, in doing so have resulted in a body of normal science for the discipline of nursing. Kuhn (1970) points out that “paradigms gain their status because they are more successful than their competitors in solving a few problems that the group as practitioners has come to recognize as acute” (p. 23). Affirmation of the seven models and the theories has developed through the use of them and is evidenced repeatedly in the current nursing literature. Research studies are conducted and reported and results are evidence for nursing education and client care (Barrett, 2002; Bond, et al., 2011; Donohue-Porter, et al., 2011; Im & Chang, 2012; McCrae, 2011). Im and Chang (2012) studied current trends in nursing theories from 2001 to 2010 and found that most of the theory-use-articles were based on four of the seven nursing models: Roy, Orem, Neuman, and Rogers. The theory utilization era is reflected in specific areas such as population-focused public health nursing (Bigbee & Issel, 2012), “people-centered” nursing with the elderly (Dewing, 2004), preadolescent empowerment (Frame, 2003), and curricula content to organize thinking (DeSimone, 2006; Donohue-Porter, et al., 2011).

There are several ways that Kuhn’s conception of normal science can be applied. First, it could be proposed that the discipline of nursing has one body of normal science with seven branches—the seven models. Although they are different in language, implementation, and research questions posed, each of the models is based on the four-concept metaparadigm and therefore has some commonalities. The models have their differences and all have contributed to what wecollectively call the body of nursing knowledge and, could be considered nursing normal science.

A second possibility for interpretation of Kuhn’s definition of normal science with regard to the discipline of nursing is to say that nursing has seven different bodies of normal science. Each of the seven nursing models has attracted a significant group of followers who utilize the models for practice, education, research, and development of nursing knowledge according to the specific views of nursing as evidenced by implementation of the models in health care institutions, schools of nursing, and textbooks. It is also evidenced by the fact that five of the seven models have professional organizations that have as their purpose to support and further the work in the models. In Kuhn’s (1970) words, those “whose research is based on shared paradigms are committed to the same rules and standards for scientific practice. That commitment and the apparent consensus it produces are prerequisites for normal science” (p. 11). Thus according to the criteria described by Kuhn for normal science, it is possible to accept the view that nursing does in fact have at least seven bodies of normal science.

The third and last viewpoint regarding the state of normal science within the discipline of nursing is that nursing has two bodies of normal science: one consisting of the knowledge produced from the work of Rogers Science of Unitary Human Beings and the other consisting of knowledge developed from the works of Johnson, King, Levine, Neuman, Orem, and Roy. Evidence for this viewpoint arises from the underlying worldview of the models, with Rogers’ model being based on the simultaneous action worldview and the remaining six models based on the reciprocal interaction worldview (Fawcett, 1995, 2005). A comparison of metaparadigm concept definitions from Rogers’ model with the other models demonstrates the differences, such as a human being viewed as a unitary irreducible, indivisible whole rather than as parts of a whole. A comparison of the implementation in practice, education, and research yields a similar conclusion. Although each of the six reciprocal interaction models is able to make unique contributions to the body of nursing knowledge, these contributions are similar in nature and thus can be viewed together as a body of normal science, separate and different from the knowledge developed from a simultaneous action view.

To summarize, a comparison of the body of nursing knowledge to the criteria that Kuhn proposes for normal science indicates that the discipline of nursing has, through use of the seven nursing models just examined, achieved the level of normal science. All of the models are accepted by groups of knowledge-building nurse scientists. The models all can and do provide bases for the practice of the discipline of nursing. Finally, all the models are open-ended; that is, they provide a framework for “further articulation and specification under new or more stringent conditions” (Kuhn, 1970, p. 23). Three interpretations of the structure of normal science in nursing have been used to answer the following basic question: “Has nursing achieved the level of normal science?” Each interpretation has led to the following answer: Yes; nursing conceptual models have led to the achievement of normal science in the discipline of nursing.