After completing this chapter, you should be able to:
• Identify the purposes of nursing theory.
• Distinguish between grand theory, middle-range theory, and practice theory.
• Describe the origins of nursing theory.
• Describe key concepts associated with nursing theory.
• Identify some of the more well-known and well-developed nursing theories.
• Discuss some of the main points of each of these theories.
Just mentioning the word theory, let alone nursing theory, can make many nurses’ yawn reflexes start to work overtime. What is theory? Who are nursing theorists? What are the different nursing theories? Nursing theories are a way to organize and think about nursing, and the people who wrote theories are part of our nursing history. Theory provides an overall “theme” to what nurses do. In this chapter, the key words related to theory are defined, and the main elements of eight nursing theories are summarized. Buckle your seatbelts—we might be in for a bumpy ride. And no yawning!
What Is Theory?
Quite simply, theories are words or phrases (concepts) joined together in sentences, with an overall theme, to explain, describe, or predict something. A more complex definition of a theory is “a set of interrelated concepts, definitions, and propositions that present a systematic way of viewing facts/events by specifying relations among the variables, with the purpose of explaining and predicting the fact event” (Kerlinger, cited in Hickman, 2003).
Theories help us understand and find meaning in our nursing experience and also provide a foundation to direct questions that provide insights into best practices and safe patient care. You might see theory referred to as a conceptual model or a conceptual framework in nursing textbooks and journals. Meleis offered a definition of nursing theory with the following: “an articulated and communicated conceptualization of invented or discovered reality in or pertaining to nursing for the purpose of describing, explaining, predicting or prescribing nursing care” (cited in Hickman, 2003, p.16).
The bottom line is that words and phrases (concepts) are put together into sentences (propositions that show the relationships among the words/concepts), with an overall theme, to create theories. Theories also have some basic assumptions (jumping-off points; what is assumed to be true), such as the idea that nurses contribute to the patient’s wellness and recovery from illness. Nursing theories also define four metaparadigms (metaparadigms refer to big, comprehensive concepts) and address the nursing process. Finally, nursing theories can be categorized as grand theory, middle-range theory, or practice theory. Each theory level is based on the abstractness of the concept or phenomena presented. For example, grand theories offer broad and abstract concepts about nursing practice, research, and education, which provide a more global view of nursing. Middle-range theories are not as abstract as grand theories; their focus is concentrated on the relationship between concepts with a narrower scope. Last, practice theories guide nursing practice by examining specific issues in nursing practice (Research for Best Practice Box 8.1).
What Nursing Theory Is Not
Nursing theory is not managed care, primary nursing, team nursing, or any other more business-related method of delivering care. Nursing theory is not obstetric nursing, surgical nursing, home health nursing, or any other nursing specialty; however, nursing theory can be applied to all areas of nursing, including administration, education, patient care, and research. Nursing theory is by nurses and for nurses, providing quality care to their patients, either directly or indirectly.
Consider all that you do as a nurse. What you do is based on principles from many different professions, such as biology, sociology, medicine, ethics, business, theology, psychology, and philosophy. What is specifically based on nursing? Also, if nursing is a science (and it is), there must be some scientific basis for it. Furthermore, theory helps define nursing as a profession (Fig. 8.1).
Theory is a means to gather information, to identify ideas more clearly and specifically, to guide research, to show how ideas are connected to each other, to make sense of what we observe or experience, to predict what might happen, and to provide answers. A nurse is not a “junior physician,” although for years nursing care has been based on the medical model. Because nursing is a science (as well as an art) and a unique profession in its own right, nurses need nursing theory on which to base their principles of patient care (Critical Thinking Box 8.1; Research for Best Practice Box 8.2).
What Is the History of Nursing Theory?
In studying nursing theories and the people who created them, it is important to look at the background of the theorist, as well as how life experiences, beliefs, and education influenced the resulting theory. What are the overall theme and main ideas of the theory, and how does the theorist define the four nursing metaparadigms (Box 8.1)?
Florence Nightingale is considered to be the first nursing theorist. She saw nursing as “A profession, a trade, a necessary occupation, something to fill and employ all my faculties, I have always felt essential to me, I have always longed for; consciously or not. … The first thought I can remember, and the last was nursing work…” (Florence Nightingale as cited in Dunphy, 2015, p.38). Now, you might not feel as dedicated as she, but Nightingale also stated, “Nursing is an art. … It is one of the Fine Arts; I had almost said, the finest of the Fine Arts” (Florence Nightingale, as cited in Una and the Lion, 1871, p.6).
Nightingale had various influences, including her education (which was fairly comprehensive for a 19th-century English woman), her religion (Unitarianism), the history of the time (the Crimean War and invention of the telegraph), and her social status. The Unitarian belief involved salvation through health and wholeness, or our modern-day “holism.” Nightingale believed that there was no conflict between science and spirituality. Science was necessary for the development of a mature concept of God (Dunphy, 2015). She also studied many other religions throughout her life, including Anglicanism, and considered starting a Protestant religious order of nuns.
Nightingale came from a very wealthy, prominent family and enjoyed traveling throughout Europe, one of the destinations being Kaiserwerth in Germany, where she observed and was moved by nuns caring for the ill. Nightingale felt a “calling” to care for others and began training with various groups, usually nuns who cared for the sick. When the Crimean War broke out, Nightingale was asked and volunteered to go to care for the wounded English soldiers. The Crimean War was the first war after the invention of the telegraph, so news of the war was more immediately circulated than had been previously experienced (Dunphy, 2015).
The overall theme of Nightingale’s theory was that the environment influences the person. When she went to help soldiers during the Crimean War, her initial intent was to feed the soldiers healthy food, maintain cleanliness in the barrack hospital, and ensure proper sanitary and hygiene care (Dunphy, 2015) (Fig. 8.2). When soldier mortality rates fell, a legend was born!