Development of Nursing Theories

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.
• Theory gives planners tools for moving beyond intuition to design and evaluate health behavior and health promotion interventions based on understanding of behavior.[Robert T. Croyle (2005)].
  
• They are derived through two principal methods; deductive reasoning and inductive reasoning. Nursing theorists use both of these methods.
•  Theory is “a creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena”.
• A theory makes it possible to “organize the relationship among the concepts to describe, explain, predict, and control practice”

Definition

• Concepts - Concepts are basically vehicles of thought that involve images. Concepts are words that describe objects, properties, or events & are basic components of theory.
• Types:
  1. Empirical concepts
  2. Inferential concepts
  3. Abstract concepts

• Models are representations of the interaction among and between the concepts showing patterns.
  • The terms ‘model’ and ‘theory’ are often wrongly used interchangeably, which further confounds matters.
    
  • In nursing, models are often designed by theory authors to depict the beliefs in their theory (Lancaster and Lancaster 1981).
    
  • They provide an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice, for example, through specific methods of assessment.
    
  • Models are useful as they allow the concepts in nursing theory to be successfully applied to nursing practice (Lancaster and Lancaster 1981). Their main limitation is that they are only as accurate or useful as the underlying theory.
    
• Propositions - are statements that explain the relationship between the concepts.
• Process - it is a series of actions, changes or functions intended to bring about a desired result. During a process one takes systemic & continuous steps to meet a goal & uses both assessments & feedback to direct actions to the goal.
• A conceptual framework - directs how these actions are carried out. The delivery of nursing care within the nursing process is directed by the way specific conceptual frameworks & theories define the person (patient), the environment, health & nursing.

Importance of nursing theories

• Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs1978).
  
• It should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964).
  
• Theory is important because it helps us to decide what we know and what we need to know (Parsons1949).
  
• 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 (Nolan 1996).
  
• 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.
  

The 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.
  

Basic processes in the development of nursing theories

Nursing theories are often based on & influenced by broadly applicable processes & theories. Following theories are basic to many nursing concepts.

General System Theory

• It describes how to break whole things into parts & then to learn how the parts work together in “systems”. These concepts may be applied to different kinds of systems, e.g. Molecules in chemistry, cultures in sociology, and organs in Anatomy & Health in Nursing.

Adaptation Theory

• It defines adaptation as the adjustment of living matter to other living things & to environmental conditions.
  
• Adaptation is a continuously occurring process that effects change & involves interaction & response.
  

Human adaptation occurs on three levels :

• 1. The internal (self)
  
• 2. The social (others) &
  
• 3. the physical (biochemical reactions)
  

Developmental Theory

• It outlines the process of growth & development of humans as orderly & predictable, beginning with conception & ending with death.
  
• The progress & behaviors of an individual within each stage are unique.
  
• The growth & development of an individual are influenced by heredity, temperament, emotional, & physical environment, life experiences & health status.
  

Common concepts in nursing theories

Four concepts common in nursing theory that influence & determine nursing practice are:

• The person (patient).
  
• The environment
  
• Health
  
• Nursing (goals, roles, functions)
  

Each of these concepts is usually defined & described by a nursing theorist, often uniquely; although these concepts are common to all nursing theories. Of the four concepts, the most important is that of the person. The focus of nursing, regardless of definition or theory, is the person.

Historical perspectives and key concepts

1. Nightingale (1860): To facilitate “the body’s reparative processes” by manipulating client’s environment
   
2. Peplau 1952: Nursing is; therapeutic interpersonal process.
   
3. Henderson 1955: The needs often called Henderson’s 14 basic needs
   
4. Abdellah 1960: The nursing theory developed by Faye Abdellah et al (1960) emphasizes delivering nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family.
   
5. Orlando 1962: To Ida Orlando (1960), the client is an individual; with a need; that, when met, diminishes distress, increases adequacy, or enhances well-being.
   
6. Johnson’s Theory 1968: Dorothy Johnson’s theory of nursing 1968 focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. The goal of nursing to reduce stress so that; the client can move more easily through recovery.
   
7. Rogers 1970: to maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through “humanistic science of nursing”
   
8. Orem1971: This is self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs.
   
9. King 1971: To use communication to help client reestablish positive adaptation to environment.
   
10. Neuman 1972: Stress reduction is goal of system model of nursing practice.
    
11. Roy 1979: This adaptation model is based on the physiological, psychological, sociological and dependence-independence adaptive modes.
    
12. Watson’s Theory 1979: Watson’s philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the; humanistic aspects of life.
    

Classification of nursing theories

A. Depending On Function (Polit et al 2001)

1. Descriptive-to identify the properties and workings of a discipline
   
2. Explanatory-to examine how properties relate and thus affect the discipline
   
3. Predictive-to calculate relationships between properties and how they occur
   
4. Prescriptive -to identify under which conditions relationships occur
   

B. Depending on the Generalisability of their principles

1. Metatheory: the theory of theory. Identifies specific phenomena through abstract concepts.
   
2. Grand theory: provides a conceptual framework under which the key concepts and
   

C. Principles of the discipline can be identified.

1. Middle range theory: is more precise and only analyses a particular situation with a limited number of variables.
   
2. Practice theory: explores one particular situation found in nursing. It identifies explicit goals and details how these goals will be achieved.
   

D. Based on the philosophical underpinnings of the theories

1. “Needs “theories.
   
2. “Interaction” theories.
   
3. “Outcome “theories.
   
4. Humanistic theories.
   

1. “Needs” theories

• These theories are based around helping individuals to fulfill their physical and mental needs. Needs theories have been criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position.

2.“Interaction” theories

• As described by Peplau (1988), these theories revolve around the relationships nurses form with patients.

• Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs.
  

3. “Outcome” theories"

• Outcome theories portray the nurse as the changing force, who enables individuals to adapt to or cope with ill health.

• Outcome theories have been criticized as too abstract and difficult to implement in practice.
  

4. “Humanistic” Theories

• Humanistic theories developed in response to the psychoanalytic thought that a person’s destiny was determined early in life.

• Humanistic theories emphasize a person’s capacity for self-actualization.
  
• Humanists believe that the person contains within himself the potential for healthy & creative growth.
  
• Carl Rogers developed a person –centered model of psychotherapy that emphasizes the uniqueness of the individual.
  
• The major contribution that Rogers added to nursing practice is the understandings that each client is a unique individual, so, person-centered approach now practice in nursing.
  

Conclusion

• Theory and practice are related.
  
• A theory presents a systematic way of understanding events or situations.
  
• It is a set of concepts, definitions, and propositions that explain or predict these events or situations by illustrating the relationships between variables.
  
• Theories must be applicable to a broad variety of situations. They are, by nature, abstract, and don’t have a specified content or topic area. Like empty coffee cups, theories have shapes and boundaries, but nothing inside. They become useful when filled with practical topics, goals, and problems. [Robert T. Croyle (2005)]
  

References

1. Robert T. Croyle (2005). 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.
2. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
3. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott.
5. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott.
6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book.
7. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
8. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):22