Theoretical Framework in Nursing

Gilbert C. Bagsic, RN

SELECTION OF RELEVANT MODELS AND THEORIES
(Chapter 5 of, choosing a Theory for Practice pg.127, Routledge Essential for Nurses Nursing
Theories and Models by Hugh Mckenna)

What is the Main pourpose of a theory? How does theories differs from one another?
The ultimate justification for the existence of theory is to give humans a view of their
world which may help them describe, explain or predict events, or prescribe actions which will
enable events to occur or not. Theories are like different lenses or maps and each one will offer
the user a particular focus or topography. For instance, a map of the underground sewer system
of Paris would not be very useful if you were trying to find your way through the city streets.
Similarly, a pair of opera glasses would not serve your purpose if you wanted to view the night
sky.

Why should we choose a Theory for nursing carefully?
Theory is a distinct and wellarticulated system of concepts and propositions rooted
explicitly in a philosophy of nursing and intended solely to guide nursing practice and research.
If we accept this definition then we must be careful in our selection. If we choose the wrong map
we may find ourselves at a different destination from the one chosen.
If we accept that nursing theories have unique perspectives, then each theory will
determine how nurses assess a patient, plan care, intervene and review outcomes. Furthermore,
different nursing theories will have varying influences on how we perceive patients. For
instance, one theory may encourage dependence by stressing that the nurse should do everything
for the patient, while another may encourage independence by stressing that the nurse should
teach the patient about self-care.



Factors to Consider in Selection of Theories
I. Philosophies
Philosophy plays a major role in the selection of a Nursing Theory. The personal point of view or
own believes, values and decisions of the seletor (nurse) has an effect on what theory he /she will
choose. For example:
Cartesian Rationslism - for instance, would indicate that the theorist developed his or
her conceptualisations without having access to the clinical area. These so-called
armchair theorists used reason to formulate their theoretical propositions. If
practitioners were attracted to this method of theorising, then such theories may be
the focus for choice.


THEORY
NURSE
NURSING PRACTICE
Empiricism- means that the theory was developed inductively from experience within
the patient care setting and the theory would be composed of concepts and propositions
which represent what the theorist perceived through his senses. A theory developed in
this way may have credibility with practising nurses and may therefore be a more
appropriate choice for application in patient care.

Historicism- as an approach to theory development shows that the theorist has
concentrated on the history, experiences, values and beliefs of those who underwent care
and those who delivered care. Those nurses who value subjectivity and experience rather
than objectivity and measurement would find these theories an attractive option.

But as said, thte are no exact guidelines and no precise criteria. Very often the decision is
a pragmatic one, where the issue for consideration is whether the theory is a realistic alternative
to that which exists currently. For example, nurses working with terminally ill patients may
realise that the medical model, with its emphasis on cure, is no longer appropriate. In their view,
it does not deal with the very important psychosocial and spiritual concerns of the dying person,
and a goodness of fit crisis occurs. As a result, they begin examining other, more humanistic,
nursing theories.
As a philosophy of science pragmatism may entice practitioners who wish to select a
nursing theory for their practice. Essentially, pragmatism is concerned with the clarity of ideas
and the value of these ideas when judged by their practical consequences. It calls for the clear
and unambiguous use of words. If a theory does not give worthwhile outcomes then whyt use it.






II. Decision making in selecting a theory. Which is which?
The importance of theory to practice is becoming increasingly realised and a new
awareness exists as to the necessity of making an appropriate choice. However, considering that
there are approximately fifty grand nursing theories available, with little research as to which is
the most effective, choosing between them is a daunting task and must be carried out with care.
Choosing on what kind of nursing theory will be used is such a difficult task therefore the
effective decision making skills s very needed.
Vinokuv (1971) formulated models of decision making based upon the work of Lewin
(1951). Vinokuv believed that in making a decision between two or more courses of action it is
rational to seek the maximum benefit to oneself. When faced with alternatives, the rational
individual chooses the alternative with the most desirable outcomes. Therefore, it is possible that
when nurses are selecting a nursing theory they will choose one that will suit their needs rather
than those of their patients.



Pragmatism
If a theory does not give
worthwhile outcomes
then whyt use it.


III. The Type of Theory- Grand, Mid Range or Practice Theories
Examining the perspectives of different theories may be like looking through telescopes
of varying focal lengths. Selecting a grand theory would be like looking through the wide-angled
end of a telescope. Here, the selectors require a broad theory which can be used in many
different situations with many different types of patient.
While the grand theory will not specify explicit interventions, it will give them a
framework for viewing the world and an assessment template for practice. Selecting a mid-range
or practice theory would be like focusing a telescope on a particular nearby scene, where more
detail is observed but the surrounding landscape cannot be seen in its entirety. Here, a theory is
required for a particular patient-care situation and in the case of a practice theory a guideline is
presented for nursing action. Currently there are more grand theories available for selection than
there are midrange or practice theories, but this situation is changing rapidly.

IV. Relevance of a Theory
Criteria for selecting an appropriate theory
Audrey Miller (1989) states that when selecting a nursing theory the relevance to practice
is central. She suggests that the person who is choosing the theory should seek answers to the
following questions:
Does the theory have direct relevance for the way in which
Nursing is practiced?
Does the theory describe real or ideal care?
Have its assumptions and propositions been tried and tested?
Does it deal with the resources which are necessary for good
care?
Does it guide the use of the nursing process?
Does it provide practising nurses with good direction for
clinical actions?
Are the concepts within the theory too abstract to be applied in
practice?
Is the language of the theory easy to understand?
Does the theory coincide with the practising nurses know
how knowledge?

V. Subjectivity and Objectivity
Meleis (1991) realised that selecting a theory was a subjective as well as an objective
process. In her opinion, the decision could fa low subjectivity (see Figure). Therefore, a choice
made in quadrant 2 would be based on a high-subjective, low-objective decision, while a choice
in quadrant 3 would be based on a decision which was low on subjectivity and high on
objectivity. In the former case, intuition plays a major role while, in the latter, rigid criteria are
used in the selection process. This latter approach may result in the selection of an unpopular
theory, especially if it is not congruent with the practitioners perceptions of what nursing is
really like.
Subjective- The personal assessment of the applicability of a theory of a person or a
nurse.
Objective- Based on a followed well defined criteira



















The subjectivity, objectivity Selection Continua

What if I make a Wong Choice?
Mistakenly choosing an inappropriate theory may also have undesirable consequences. Aggleton
and Chalmers (1986) believe that the quality of care would be adversely affected, while
McKenna (1994) maintains that early closure on an unsuitable theory may stifle creativity and
select another, more appropriate theory. To support this, Clark(1986) maintains that, if a theory
does not fit comfortably, it should be discarded like an ill-fitting pair of shoes.

Conclusion
To conclude, theories are like maps, and you will need a different one depending on the territory
in which you are working. The days when managers and tutors chose theories for practice should
now be over. Clients should work alongside practitioners in the selection process. If this occurs,
the selected theory will be a realistic reflection of what those in practice and those in receipt of
practice see as important for patient care.

Low Subjectivity
High Subjectivity
Low Objectivity
High Objectivity
1 2
3 4