UNDERSTANDING THE WORK OF NURSE THEORISTS

This page was last updated on 18-01-2010

---------------------------------------------------------------Theories of Nursing

Theory is "an internally consistent group of relational statements (concepts, definitions

and propositions) that present a systematic view about a phenomenon and which is useful
for description, explanation, prediction and control".

Theories are road maps that provide a framework for selecting and organizing
information:
o What to ask
o What to observe
o What to focus on
o What to think about

Nursing theory is an organized and systematic articulation of a set of statements related to

questions in the discipline of nursing.

Uses of Theory
Theory is used to:

Describe

Explain

Predict

Prescribe

Uses of Nursing Theory

Define relationships among the variables of a given field of inquiry

Guide research, practice and communication

Allow the prediction of the consequences of care

Allow the prediction of a range of patient responses

Levels of Theory
There are four levels of theory

Metatheory

Grand Theory

Middle Range Theory

Practice Theory

Types of Theory
In Nursing there are four types of theories:

Needs

Interaction

Outcome

Humanistic

Practice value of theory

Enhances understanding and explanation for events

Influence our behavior.

Makes to think differently about a problem or a situation

Helps to try new approaches or altering behavior.

We can gain a new perspective of events

Basis for challenge of its speculative tenets or propositions

Challenges subsequent discovery of new ideas or knowledge that might explain and
predict events not yet understood

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.

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 specific field of study.

Offer a systematic approach to identify questions for study, select variables, interpret
findings, and validate nursing interventions.

An illustration
The germ theory

Explains the phenomenon of disease transmission

Means of speculative explanation and prediction of certain observable events

Allows us to effectively function to prevent transmission of communicable disease.

Viable basis upon which to make decisions about how to prevent certain illnesses.

There are phenomena we do not understand that are related to germ transmission,

Example-the communicability of cancer.

"Nursing Practice."
All experiences and events a practicing nurse encounters in the process of providing nursing

care.
Events..

Some may be experienced by the client,

Others by the nurse

Some may be observed in the environment

May be observed in the nurse-client interaction.

In situations of daily work or living,

..but as long as they are observable during the process of providing direct nursing care,
they are considered part of nursing practice.
Approaches to inter relationships between practice and theory

How nursing practice contributes to the process of theory development..

How theory contributes to nursing practice

Contribution of practice to theory development

Theory development within nursing occurs in the context of practice.

Two activities contribute significantly to the overall process of developing theory in

nursing.

Concept analysis and

Practical validation of theory.

Concept analysis

Identify and verify abstract concepts

"what events in practice can be linked with abstract concept x"

Application of theory in practice

Nursing process operation of analysis of assessment data.

Used as scientific rationale supporting judgments in nursing care plans.

Concepts

Concepts may be (a) readily observable, or concrete, ideas such as thermometer, rash, and
lesion; (b) indirectly observable, or inferential, ideas such as pain and temperature; or c)
non-observable, or abstract, ideas such as equilibrium, adaptation, stress, and
powerlessness

nursing theories address and specify relationships among four major abstract concepts
referred to as the metaparadigm of nursing.

Four concepts are considered to be central to nursing :

Person or client, the recipient of nursing care (includes individuals, families, groups, and
communities).

Environment, the internal and external surroundings that affect the client. This includes
people in the physical environment, such as families, friends, and significant others.

Health, the degree of wellness or well-being that the client experiences.

Nursing, the attributes, characteristics, and actions of the nurse providing care on behalf
of, or in conjunction with, the client

Nightingales environmental theory

"the act of utilizing the environment of the patient to assist him in his recovery"

She linked health with five environmental factors :

Pure or fresh air

Pure water

Efficient drainage

Cleanliness

Light, especially direct sunlight

Deficiencies in these five factors produced lack

Of health or illness.

Peplaus interpersonal relations model

Nurses enter into a personal relationship with an individual when a felt need is present

Hendersons definition of nursing

Henderson conceptualized the nurses role as assisting sick or well individuals to gain
independence in meeting 14 fundamental needs (Henderson)

Breathing normally

Eating and drinking adequately

Eliminating body wastes

Moving and maintaining a desirable position

Sleeping and resting

Selecting suitable clothes

Maintaining body temperature within normal range by adjusting clothing and modifying
the environment.

Keeping the body clean and well groomed to protect the integument.

Avoiding dangers in the environment and avoiding injuring others

Communicating with others in expressing emotions, needs, fears, or opinions

Worshipping according to ones faith

Working in such a way that one feels a sense of accomplishment

Playing or participating in various forms of recreation.

Learning, discovering, or satisfying the curiosity that leads to normal development and
health, and using available health facilities

Rogers science of unitary human beings

She states that humans are dynamic energy fields in continuous exchange with
environmental fields, both of which are infinite.

Nurses applying Roger's theory in practice (a) focus on the persons wholeness, (b) seek
to promote symphonic interaction between the two energy fields (human and
environment) to strengthen the coherence and integrity of the person, c) coordinate the
human field with the rhythmicities of the environmental field, and (d) direct and redirect
patterns of interaction between the two energy fields to promote maximum health
potential

Orems general theory of nursing

Orems self-care deficit theory explains not only when nursing is needed but also how
people can be assisted through five methods of helping: acting or doing for, guiding,
teaching, supporting, and providing an environment that promotes the individuals
abilities to meet current and future demands.

Kings goal attainment theory

Kings theory offers insight into nurses interactions with individuals and groups within
the environment. It highlights the importance of clients participation in decision that
influence care and focuses on both the process of nurse-client interaction and the
outcomes of care.

Neumans systems model

The model is based on the individuals relationship to stress, the reaction to it, and
reconstitution factors that are dynamic in nature.

Betty Neuman's model of nursing is applicable to a variety of nursing practice settings

involving individuals, families, groups, and communities.

Roys adaptation model

Roy focuses on the individual as a biopsychosocial adaptive system that employs a

feedback cycle of input (stimuli), throughput (control processes), and output (behaviors
or adaptive responses).

Watsons human caring theory

Jean Watson (1979) believes the practice of caring is central to nursing; it is the unifying
focus for practice.

Nursing interventions related to human care are referred to as carative factors.

Watsons theory of human caring has receiving worldwide recognition and is a major
force in redefining nursing as a caring-healing health model.

Parses human becoming theory

Parses model of human becoming emphasizes how individuals choose and bear
responsibility for patterns of personal health.

Leiningers cultural care diversity and universality theory

She emphasizes that human caring, although a universal phenomenon, varies among
cultures in its expressions, processes, and patterns; it is largely culturally derived.

Orems general theory of nursing

Assessing

Involves collecting data about the clients capacities (knowledge, skills, and motivation)
to perform universal, developmental, and health-deviation self-care requisites. Determine
self-care deficits.

Diagnosing

Stated in terms of the clients limitations for maintaining self care (a deficit in self-care
agency)

Planning

Involves considering and designing, with the clients participation, an appropriate nursing
system (wholly compensatory, partially compensatory, supportive-educative, or a mix)
that will help the client achieve an optimal level of self care

Implementing

Assisting the client

Evaluating

Determining the clients level of achievement

References
1. Phipps J Wilma, Sands K Judith. Medical Surgical Nursing: concepts & clinical
practice.6th edition. Philadelphia. Mosby publications. 1996.
2. Black M. Joice, Hawks hokanson Jane. Medical Surgical Nursing: Clinical Management
for positive outcomes. St Lois, Missouri. 2005.
3. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby,
Philadelphia, 2002
4. Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby,
Philadelphia, 2002.