Theories of Nursing Practice



Theories of Nursing Practice


Susan R. Jacob, PhD, MSN, RN






We thank Margaret Soderstrom, PhD, RN, CS-P, APRN, and Linda C. Pugh, PhD, RNC, FAAN, for their contributions to this chapter in the fourth edition.




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Additional resources are available online at:


http://evolve.elsevier.com/Cherry/


VIGNETTE


When I was a nursing student, it was hard for me to understand why I needed to know anything about nursing theory, but now that I am in practice I see that theories provide a way for me to organize, deliver, and evaluate the care I provide. On our labor and delivery unit, we use Roy’s adaptation model to guide our practice as we provide care to laboring moms. The use of this theory allows us to assess how well they are coping and provides guidance as we plan nursing interventions that promote their successful coping.





Chapter Overview


Explicit, detailed knowledge is the keystone, the foundation, and the carefully laid support that are critical to the classification of a discipline. In a seminal paper entitled “The Discipline of Nursing” (1978), Donaldson and Crowley note, a discipline “is characterized by a unique perspective, a distinct way of viewing all phenomena, which ultimately defines the limits and nature of its inquiry” (p. 113). Nursing, long ranked an art and a science, is actually quite young in its continuing struggle for professional and public recognition as a matchless, expert, and commanding profession. This notion is readily supported as one marks nursing’s ongoing effort to define itself as a distinct discipline that is exclusive from other disciplines, particularly the medical practice model. Only when a substantial body of nursing knowledge is collected, organized, and developed will the profession be defined and its scope of practice differentiated. Key in this accomplishment is the development and practice of nursing theory.


It is important for nurses to study the development of nursing theory because without an idea of where you have been, how can you know how, why, when, or where to go? Nursing theory provides nurses with a focus for research and practice. You may consider using a theory as similar to using a map that provides direction while making available a variety of ways to get where you are going. As logical as this seems, the worth of studying nursing theorists and their theories and the role of responsibility these theories contribute toward the evolution of nursing science has been curiously underappreciated. Even more surprising, many of the naysayers are nursing students. Nursing theory is not usually the favorite subject of undergraduates, who would much rather learn technical hands-on skills. Whether this is a maturation issue or an issue of knowledge and experience remains undetermined by nursing faculty and the profession itself.


This chapter in no way reflects the breadth and depth of nursing theorists and their theories. There are many scholarly works devoted to this topic. Instead it is a survey, a general overview, a smattering of nursing theories, with chosen segments intended to assist in providing the idea, the notion, and indeed, the semblance of what a theory is and how it is critical to the profession of nursing. Readers interested in examining the theoretic basis for nursing practice will find resources for further exploration at the end of the chapter.



Science and Theory


Science is a method of bringing together facts and giving them coherence and integrity. Science assists us in understanding how the unique yet related parts of a structure fit and become more than the sum of individual parts. In the opening metaphor, the stones represent the facts, the process of laying the stones represents the science, and the future ideas and new directions represent the theory.


Science is dynamic and static—dynamic in figuring out how a phenomenon happens, static in describing what happens. Scientific inquiry involves five steps: (1) hypothesis, (2) method, (3) data collection, (4) results, and (5) evaluation. These five steps are described in Box 5-1.



“Nursing theory is defined as a conceptualization of some aspect of nursing reality communicated for the purpose of describing phenomena, explaining relationships between phenomena, predicting consequences, or prescribing nursing care” (Meleis, 2012). Theory development functions in a parallel manner to scientific process, although theory generally applies to a more specific area of the larger scientific process. Even though Freud and Jung each had their individual theories about the psychology of man, their theories were focused on specific ideas taken from the entire knowledge base surrounding psychology and psychotherapy and its scientific premise. Similarly, Albert Einstein’s theory of relativity was but a fraction of the existing scientific knowledge base of mathematics at the time. Nevertheless, it is an undisputed fact that these theorists changed the thinking of their time and were responsible for the evolution of their philosophic and scientific interests (Anastasi, 1958). For a proposed theory to be accepted as a theory, it must meet the following six criteria: inclusiveness, consistency, accuracy, relevance, fruitfulness, and simplicity. These six criteria are further explained in Box 5-2.



The importance of theories in the evolution of science is unquestioned. Nursing has evolved as a profession and as a science in a similar manner. Nursing theories have explained, explored, defined, and delineated specific areas. Beginning with the work of Florence Nightingale in 1860, nursing theorists have taken the vast pool of scientific information available and focused on precise target areas of interest. In so doing, theoretic models have been conceptualized to guide nursing actions, interventions, and implementation. Specific nursing theories are discussed later in the chapter.



Nursing Science


As might be expected, there are several definitions of nursing science (Abdellah, 1969; Jacox, 1974). Although these definitions differ, they generally support the premise that nursing science is a collection of data related to nursing that may be applied to the practice of nursing. These data encompass a vast array of knowledge that spans all of nursing and its diversity. This knowledge guides the practice of nursing to better serve patients through healing, prevention, education, and health maintenance.



Theories, Models, and Frameworks


Researchers use theories and conceptual models as their primary method to organize findings into a broader conceptual context (Meleis, 2012; Polit and Beck, 2011). Different terms are used in relation to conceptual contexts for research. These terms include theories, models, frameworks, schemes, and maps. Terms are often used differently by different writers, thus resulting in a blurring of distinct terms (Meleis, 2012).




Conceptual Model


A conceptual model deals with concepts that are assembled because of their relevance to a common theme. The term conceptual framework is used interchangeably with conceptual model. Conceptual models, or frameworks, also provide a conceptual perspective regarding interrelated phenomena, but they are more loosely structured than theories. There are many conceptual models of nursing that offer broad explanations of the nursing process. Four concepts basic to nursing that are included in these models are: (1) nursing, (2) person, (3) health, and (4) environment. The various nursing models define these concepts differently, link the concepts in various ways, and emphasize differently the relationships among the concepts. For example, Roy’s adaptation model emphasizes the patient’s adaptation as a central phenomenon, whereas Martha Rogers emphasizes centrality of the individual as a unified whole. These models are used by nurse researchers to formulate research questions and hypotheses.


The terms conceptual model (or framework) and nursing theory are often used interchangeably. In this chapter, the nursing theories described may also be referred to as conceptual models. The term model is also used in reference to a diagram depicting the theory. In this chapter, model will refer to a schematic model, which is a diagram or visual representation of the conceptual model or theory.



Nursing Theory


Theory and theoretic thinking guide research and practice. The basic ingredients of theory are concepts. Examples of nursing concepts include health, stress, and adaptation. Propositions are statements that propose the relationship between and among concepts (Meleis, 2012). Theories provide us with a frame of reference, the ability to choose concepts to study, or ideas that are within one’s practice. A theory helps guide research, and research helps validate theory.


In the research model, the researcher decides what to study and how and why the area of interest is important to the practice of nursing. In the practice model, the clinician decides what areas to directly assess, when to assess, and which intervention to implement. These decisions may or may not be knowingly based on a model or theory. Regardless, often the outcome supports the notion that behavior replicates a theoretic model, even though the nurse may be unaware that he or she is using a theoretic model in the practice process.


Just as in any other discipline, nursing theory has its own unique language. The words of this language identify linkages between the database of scientific nursing knowledge and the extracted information taken from this source for nursing theory. The interpretation of these words translates uniquely to the theory investigated. This application, or language of nursing theory, is the structure, or framework, from which one understands the theory. Table 5-1 presents the language of nursing theory, along with definitions and examples.




Schematic Models


A schematic model is something that demonstrates concepts, usually with a picture. It is a visual representation of ideas. The model depicts concepts and shows how the concepts are related with the use of images, such as arrows and dotted lines (Polit and Beck, 2011). For example, a blueprint is a pictorial demonstration of a particular type of house someone might build. A model airplane is a detailed miniature replication of the original full-sized version. Diagramming a sentence outlines the specific parts (adverb, adjective, verb, subject, object, phrases) that make that particular sentence complete. Similarly, a nursing model gives a visual diagram or picture of concepts. Whether that is a critical pathway, decision tree, medication protocol, or other nursing-related practice, the model allows one to view the interrelated parts of the whole in picture form. A model of a nursing theory does the same thing. From the earliest model, offered by Florence Nightingale, nursing theory has been described and explained using this medium. Schematic models are used for clarifying complex concepts. The language of theory is translated into picture form, offering a comprehensive view, or model, of the theory. The schematic model shows how the concepts are related. A model, like a blueprint of a building, allows one to see the layout, including outlines of all features specific to the theory. Although it is not the same as understanding every minute detail about the structure, its intent is to provide an overview, which at a glance is informative and descriptive.

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Nov 6, 2016 | Posted by in NURSING | Comments Off on Theories of Nursing Practice

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