Introduction to Nursing Theories

INTRODUCTION Nursing theory is the term given to the body of knowledge that is used to support nursing practice. Nursing theory is a framework designed to organize knowledge and explain phenomena in nursing, at a more concrete and specific level. 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. Each discipline has a unique focus for knowledge development that directs its inquiry and distinguishes it from other fields of study.(Smith & Liehr, 2008). Theory-guided, evidence-based practice is the hallmark of any professional discipline. Nursing is a professional discipline (Donaldson & Crowley, 1978). Almost 90% of all Nursing theories are generated in the last 20 years.  Nursing models are conceptual models, constructed of theories and concepts A paradigm is a model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline. METAPARADIGMS IN NURSING Person Recipient of care, including physical, spiritual, psychological, and sociocultural components. Individual, family, or community Environment All internal and external conditions, circumstances, and influences affecting the person Health Degree of wellness or illness experienced by the person Nursing Actions, characteristics and attributes of person giving care. COMPONENTS OF A THEORY DEFINITIONS Theory a set of related statements that describes or explains phenomena in a systematic way. the doctrine or the principles underlying an art as distinguished from the practice of that particular art.  a formulated hypothesis or, loosely speaking, any hypothesis or opinion not based upon actual knowledge.  a provisional statement or set of explanatory propositions that purports to account for or characterize some phenomenon. Concept a mental idea of a phenomenon Concepts are the building blocks—the primary elements—of a theory. Construct a phenomena that cannot be observed and must be inferred Constructs are concepts developed or adopted for use in a particular theory. The key concepts of a given theory are its constructs. Proposition a statement of relationship between concepts Conceptual model made up of concepts and propositions They epresent ways of thinking about a problem or ways of representing how complex things work the way that they do. Different Frameworks will emphasize different variables and outcomes and their interrelatedness.( Bordage, 2009) Models may draw on a number of theories to help understand a particular problem in a certain setting or context. They are not always as specified as theory. Variables Variables are the operational forms of constructs. They define the way a construct is to be measured in a specific situation. Match variables to constructs when identifying what needs to be assessed during evaluation of a theory-driven program. Middle range theory  a testable theory that contains a limited number of variables, and is limited in scope as well, yet is of sufficient generality to be useful with a variety of clinical research questions. NURSING PHILOSOPHIES Theory Key emphasis Florence Nightingale’s Legacy of caring Focuses on nursing and the patient environment relationship. Ernestine Wiedenbach: The helping art of clinical nursing  Helping process meets needs through the art of individualizing care. Nurses should identify patients ‘need-for –help’ by: Observation Understanding client behaviour Identifying cause of discomfort Determining if clients can resolve problems or have a need for help Virginia Henderson’s   Definition of Nursing Patients require help towards achieving independence. Derived a definition of nursing Identified 14 basic human needs on which nursing care is based.  Faye G.Abedellah’s Typology of twenty one Nursing problems  Patient’s problems determine nursing care Lydia E. Hall :Care, Cure, Core model Nursing care is person directed towards self love. Jean Watson’s Philosophy and Science of caring Caring is moral ideal: mind -body – soul engagement with one and other. Caring is a universal, social phenomenon that is only effective when practiced interpersonally considering humanistic aspects and caring. Patricia Benner’s Primacy of caring Caring is central to the essence of nursing.  It sets up what matters, enabling connection and concern.  It creates possibility for mutual helpfulness. Caring creates - possibilities of coping possibilities for connecting with and concern for others, possibilities for giving and receiving help Described systematically five stages of skill acquisition in nursing practice – novice, advanced beginner, competent, proficient and expert. CONCEPTUAL MODELS AND GRAND THEORIES Dorothea E. Orem’s Self care deficit theory in nursing Self–care maintains wholeness. Three Theories: Theory of Self-Care Theory of Self-Care Deficit Theory of Nursing Systems Nursing Care: Wholly compensatory (doing for the patient) Partly compensatory (helping the patient do for himself or herself) Supportive- educative (Helping patient to learn self care and emphasizing  on the importance of  nurses’ role Myra Estrin Levine’s: The conservation model Holism is maintained by conserving integrity Proposed that the nurses use the principles of conservation of: Client Energy Personal integrity Structural integrity Social integrity A conceptual model with three nursing theories – Conservation Redundancy Therapeutic intention Martha E.Roger’s: Science of unitary  human beings Person and environment are energy fields that evolve negentropically Nursing is a basic scientific discipline Nursing is using knowledge for human betterment.                  The unique focus of nursing is on the unitary or irreducible  human being and the environment (both are energy fields) rather than health and illness Dorothy E.Johnson’s Behavioural system model  Individuals maintain stability and balance through adjustments and adaptation to the forces that impinges them. Individual as a behavioural system is composed of seven subsystems. Attachment, or the affiliative subsystems – is the corner stone of social organisations.                                 Behavioural system also includes the subsystems of dependency, achievement, aggressive, ingestive-eliminative and sexual.                                                          Disturbances in these causes nursing problems.  Sister Callista: Roy‘s  Adaptation model Stimuli disrupt an adaptive system The individual is a biopsychosocial adaptive system within an environment. The individual and the environment provide three classes of stimuli-the focal, residual and contextual.                                    Through two adaptive mechanisms, regulator and cognator, an individual demonstrates adaptive responses or ineffective responses requiring nursing interventions  Betty Neuman’s : Health care systems model Reconstitution is a status of adaptation to stressors A conceptual model with two theories “Optimal patient stability and prevention as intervention” Neuman’s model includes intrapersonal, interpersonal and extrapersonal stressors. Nursing is concerned with the whole person.   Nursing actions (Primary, Secondary, and Tertiary levels of prevention) focuses on the variables affecting the client’s response to stressors. Imogene King’s Goal attainment theory Transactions provide a frame of reference toward goal setting. A conceptual model of nursing from which theory of goal attainment is derived. From her major concepts (interaction, perception, communication, transaction, role, stress, growth and development) derived goal attainment theory.  ·Perceptions, Judgments and actions of the patient and the nurse lead to reaction, interaction, and transaction (Process of nursing). Nancy Roper, WW.Logan and A.J.Tierney    A model for nursing based on a model of living Individuality in living. A conceptual model of nursing from which theory of goal attainment is derived. Living is an amalgam of activities of living (ALs).  Most individuals experience significant life events which can affect ALs causing actual and potential problems. This affects dependence – independence continuum which is bi-directional. Nursing helps to maintain the individuality of person by preventing potential problems, solving actual problems and helping to cope. Hildegard E. Peplau: Psychodynamic Nursing Theory Interpersonal process is maturing force for personality. Stressed the importance of nurses’ ability to understand own behaviour to help others identify perceived difficulties. The four phases of nurse-patient relationships are: 1. Orientation 2. Identification 3. Exploitations 4. Resolution The six nursing roles are: 1. Stranger 2. Resource person 3. Teacher 4. Leader 5. Surrogate 6. Counselor Ida Jean Orlando’s Nursing Process Theory Interpersonal process alleviates distress. Nurses must stay connected to patients and assure that patients get what they need, focused on patient’s verbal and non verbal expressions of need and nurse’s reactions to patient’s behaviour to alleviate distress. Elements of nursing situation:    Patient Nurse reactions Nursing actions Joyce Travelbee’s Human To Human Relationship Model Therapeutic human relationships. Nursing is accomplished through human to human relationships that began with: The original encounter and then progressed through stages of Emerging identities Developing feelings of empathy and sympathy, until the nurse and patient attained rapport in the final stage. Kathryn E. Barnard’s Parent Child Interaction Model Growth and development of children and mother–infant  relationships Individual characteristics of each member influence the parent–infant system and adaptive behaviour modifies those characteristics to meet the needs of the system. Ramona T.Mercer’s :Maternal Role Attainment Parenting and maternal role attainment in diverse populations A complex theory to explain the factors impacting the development of maternal role over time.  Katharine Kolcaba’s Theory of comfort Comfort is desirable holistic outcome of care. Health care needs are needs for comfort, arising from stressful health care situations that cannot be met by recipients’ traditional support system.  These needs include physical, psycho spiritual, social and environmental needs.                                              Comfort measures include those nursing interventions designed to address the specific comfort needs. Madeleine Leininger’s Transcultural nursing, culture-care theory Caring is universal and varies transculturally. Major concepts include care, caring, culture, cultural values and cultural variations Caring serves to ameliorate or improve human conditions and life base. Care is the essence and the dominant, distinctive and unifying feature of nursing Rosemarie Rizzo Parse’s :Theory of human becoming Indivisible beings and environment co-create health. A theory of nursing derived from Roger’s conceptual model. Clients are open, mutual and in constant interaction with environment. The nurse assists the client in interaction with the environment and co creating health Nola J.Pender’s :The Health promotion; model Promoting optimum health supersedes disease prevention. Identifies cognitive, perceptual factors in clients  which are modified by demographical and biological characteristics, interpersonal influences, situational and behavioural factors that help predict in health promoting behaviour CONCLUSION The conceptual and theoretical nursing models help to provide knowledge to improve practice, guide research and curriculum and identify the goals of nursing practice. Nursing knowledge is the inclusive total of the philosophies, theories, research, and practice wisdom of the discipline.As a professional discipline this knowledge is important for guiding practice.(Smith & Liehr, 2008). It is important the nursing knowledge is learnt, used, and applied in the theory based practice for the profession and the continued development of nursing and academic discipline. REFERENCES Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26, 113–120. Smith, M. J., & Liehr, P. R. (2008). Middle range theory for nursing. New York: Springer Publishing. George B. Julia , Nursing Theories- The base for professional Nursing Practice, 3rd ed. Norwalk, Appleton & Lange. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia,  Lippincott. Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed. Philadelphia,  Lippincott. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book.  Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.).  Mosby,  Philadelphia, 2002  Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby,  Philadelphia, 2002.