Application of Theory in Nursing Process

Introduction

• Theories are a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory & predictive in nature.
  
• Theories are composed of concepts, definitions, models, propositions & are based on assumptions.
  
• They are derived through two principal methods; deductive reasoning and inductive reasoning.
  

Objectives

• to assess the patient condition by the various methods explained by the nursing theory
  
• to identify the needs of the patient
  
• to demonstrate an effective communication and interaction with the patient.
  
• to select a theory for the application according to the need of the patient
  
• to apply the theory to solve the identified problems of the patient
  
• to evaluate the extent to which the process was fruitful.
  

Definition

• Nursing theory is an organized and systematic articulation of a set of statements related to questions in the discipline of nursing.
  
• "A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing."
  

Characteristics of a Useful Theory [Robert T. Croyle (2005)]

A useful theory makes assumptions about a behavior, health problem, target population, or environment that are:

• Logical
  
• Consistent with everyday observations
  
• Similar to those used in previous successful programs and
  
• Supported by past research in the same area or related ideas.
  

Importance of nursing theories

• Nursing theory aims to describe, predict and explain the phenomenon of nursing
• It should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future. Theory is important because it helps us to decide what we know and what we need to know
• It helps to distinguish what should form the basis of practice by explicitly describing nursing. The benefits of having a defined body of theory in nursing include better patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education
• The main exponent of nursing – caring – cannot be measured, it is vital to have the theory to analyze and explain what nurses do
• As medicine tries to make a move towards adopting a more multidisciplinary approach to health care, nursing continues to strive to establish a unique body of knowledge
  
• This can be seen as an attempt by the nursing profession to maintain its professional boundaries

Evolution of Nursing Theories & Application

• The history of professional nursing begins with Florence nightingale.
• Later in last century nursing began with a strong emphasis on practice.
• Following that came the curriculum era which addressed the questions about what the nursing students should study in order to achieve the required standard of nursing.
• As more and more nurses began to pursue higher degrees in nursing, there emerged the research era.
• Later graduate education and masters education was given much importance.
• The development of the theory era was a natural outgrowth of the research era.
• With an increased number of researches it became obvious that the research without theory produced isolated information; however research and theory produced the nursing sciences.
• Within the contemporary phase there is an emphasis on theory use and theory based nursing practice and lead to the continued development of the theories.

Characteristics of theories

Theories are

• Interrelating concepts in such a way as to create a different way of looking at a particular phenomenon.
  
• Logical in nature.
  
• Generalizable.
  
• Bases for hypotheses that can be tested.
  
• Increasing the general body of knowledge within the discipline through the research implemented to validate them.
  
• Used by the practitioners to guide and improve their practice.
  
• Consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated.
  

Purposes of theory in practice

• Assist nurses to describe, explain, and predict everyday experiences.
  
• Serve to guide assessment, intervention, and evaluation of nursing care.
  
• Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation.
  
• Help to establish criteria to measure the quality of nursing care
  
• Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed and words defined.
  
• Enhance autonomy (independence and self-governance) of nursing by defining its own independent functions.
  

PURPOSES OF NURSING THEORIES
In Practice:

• Assist nurses to describe, explain, and predict everyday experiences.
• Serve to guide assessment, interventions, and evaluation of nursing care.
• Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation.
• Help to describe criteria to measure the quality of nursing care.
• Help build a common nursing terminology to use in communicating with other health professionals. 
• Ideas are developed and words are defined.
• Enhance autonomy (independence and self-governance) of nursing through defining its own independent functions. 

In Education:

• Provide a general focus for curriculum design
• Guide curricular decision making.

In Research:

• Offer a framework for generating knowledge and new ideas.
• Assist in discovering knowledge gaps in the specific field of study.
• Offer a systematic approach to identify questions for study; select variables, interpret findings, and validate nursing interventions.
• Approaches to developing nursing theory
• Borrowing conceptual frameworks from other disciplines.
• Inductively looking at nursing practice to discover theories/concepts to explain phenomena.
• Deductively looking for the compatibility of a general nursing theory with nursing practice.
• Questions from practicing Nurse about using Nursing theory

Practice

• Does this theory reflect nursing practice as I know it?
• Will it support what I believe to be excellent nursing practice?
• Can this theory be considered in relation to a wide range of nursing situation?
• Personal Interests, Abilities and Experiences
• What will it be like to think about nursing theory in nursing practice?
• Will my work with nursing theory be worth the effort?

Conclusion

• If theory is expected to benefit practice, it must be developed co- operatively with people who practice nursing.
• People who do research and develop theories think differently about theory when they perceive the reality of practice.
• Theories do not provide the same type of procedural guidelines for practice as do situation- specific principles and procedures or rules.
• Procedural rules or principles help to standardize nursing practice and can also be useful in achieving minimum goals of quality of care.
• Theory is ought to improve the nursing practice.
• One of the most common ways theory has been organized in practice is in the nursing process of analyzing assessment data.

References

1. Alligood M R, Tomey A M. Nursing Theory: Utilization &Application .3rd ed. Missouri: Elsevier Mosby Publications; 2002.
   
2. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002
   
3.  George JB .Nursing Theories: The Base for Professional Nursing Practice .5th ed. New Jersey :Prentice Hall;2002.
   
4. Croyle RT. Theory at a Glance: Application to Health Promotion and Health Behavior (Second Edition). U.S. Department of Health and Human Services, National Institutes of Health, 2005. Available at www.thecommunityguide.org.