Introduction to nursing theories
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Nursing theory provides a framework to organize nursing knowledge and explain phenomena in nursing practice. Theories are composed of concepts and propositions, and can be classified based on their scope, purpose, and philosophical underpinnings. Historically, nursing relied on theories from other disciplines but has increasingly developed its own theories over the past century. Key developments include Nightingale's Environmental Theory in 1860, Henderson's Definition of Nursing in 1955, and theories by Rogers, Orem, Roy, and Watson from the 1970s onward. Nursing theory continues to evolve as the profession seeks consensus on its conceptual foundations.
Introduction to nursing theories
- 1. INTRODUCTION TO NURSING THEORY L.ANAND, Lecturer, College of Nursing, NEIGRIHMS, SHILLONG “The systematic accumulation of knowledge is essential to progress in any profession . . . however theory and practice must be constantly interactive. Theory without practice is empty and practice without theory is blind.” ( Cross, 1981 , p. 110). I. INTRODUCTION A. The foundation of any profession is the development of a specialized body of knowledge 1. In the past, the nursing profession relied on theories from other disciplines, such as medicine, psychology, and sociology, as a basis for practice. 2. For nursing to define its activities and develop its research, it must have its own body of knowledge. 3. This knowledge can be expressed as conceptual MODELS and THEORIES. B. Nursing theories and models provide information about: 1. Definitions of nursing and nursing practice 2. Principles that form the basis for practice. 3. Goals and functions of nursing 4. Clarifies the scope of nursing practice. C. Nursing theories and models are derived from concepts (i) Concept is an idea of an object, property, or event. (ii) Concepts are basically vehicles of thought involving mental images. (iii) In Nursing, concepts have been borrowed from other discipline (adaption, culture, homeostasis) as well as developed directly from nursing practice and research (maternal-infant boding, health-promoting behaviours). (iv)Concepts are building blocks of theory.
- 2. Types of concepts: 1. Empirical or concrete concepts: These are directly observable objects, events, or properties, which can be seen, felt or heard e.g color of the skin, communication skill, presence of lesion, wound status etc., These are limited by time and space (it can be viewed/measured only specific period & specific setting and variable). 2. Inferential concepts: These are indirectly observable concepts, e.g pain, Dyspnea and temperature. 3. Abstract Concepts: These concepts are not clearly observable directly or indirectly (known as “Non -observable concepts directly”).E.g. social support, Personal Role, Self-esteem etc. Most of the theories use abstract concepts and it should be defined as observable (concrete) concepts when applied in research, education and practice. In simple terms, we transform the abstract concepts to concrete concepts based on local need. Abstract concepts not affected by time and space. It can be applied and used wider settings and populations. D. Propositions: Propositions are statements that explain the relationship between the concepts. II. THEORIES A. General information 1. Are a set of logically interrelated concepts that provide a systematic explanatory and predictive view of phenomena 2. Can begin as an untested premise (hypothesis) that becomes a theory when tested and supported or can progress in a more inductive manner 3. Are tested and validated through research and provide direction for this research 4. Nursing theory is a framework designed to organize knowledge and explain phenomena in nursing.
- 3. B. Characteristics 1. Must be logical, relatively simple, and generalizable. 2. Are composed of concepts and prepositions. 3. Interrelate concepts to create a specific way of looking at a particular phenomenon. 4. Provide the bases for testable hypotheses. 5. Must be consistent with other validated theories, laws, and principles but have open unanswered questions for investigation. 6. Can consist of separate theories about the same phenomenon that interrelate the same concepts but describe and explain them differently. 7. Can describe a particular phenomenon (descriptive or factor-isolating theories)’ explain relationships among phenomena (explanatory or factor-relating theories); predict the effects of one phenomenon on another (predictive or situation-relating theories); or be used to produce or control a desired phenomenon (prescriptive or situation- producing theories) 8. Contribute to and assist in increasing the general body of knowledge within a profession through research implemented to validate them. 9. Can be used by nurses to guide and improve their practice. 10. Differ from conceptual models; both can describe, explain, or predict a phenomenon. But only theories provide specific direction to guide practice; conceptual models are more abstract and less specific than theories but can provide direction for practice. 11. Facilitate communication and systematic thinking among nurses regarding professional convictions, moral/ethical structure to guide nurses actions, 12. It facilitates coordinated and less fragment care. 13. The main exponent of nursing – caring – cannot be measured, it is vital to have the theory to analyze and explain what nurses do.
- 4. II. MODELS Conceptual Model is a set of interrelated concepts that symbolically represents of mental image or phenomenon. Model deals with highly abstract concepts than theory. A. General information 1. Describe a set of ideas that are connected to illustrate a larger, more general concept 2. Are a symbolic depiction of reality 3. Provide a schematic representation of some relationships among PHENOMENA 4. Use symbols or diagrams to represent an idea B. Characteristics 1. Attempt to describe, explain, and sometimes predict the relationships among phenomena. 2. Are composed of empirical, inferential, and abstract concepts. 3. Provide an organized framework for nursing assessment, planning, intervention, and evaluation. 4. Facilitate communication among nurses and encourage a unified approach to practice, teaching, administration, and research. Conceptual models and theories in nursing are based on the nursing metaparadigm III METAPARADIGM Conceptual models and theories in nursing are based on the nursing metaparadigm. Metaparadigm is the most global conceptual or philosophical framework of a discipline or profession 1. It defines and describes relationships among major ideas and values. 2. It guides the organization of theories and models for a profession.
- 5. A. The nursing metaparadigm comprises four concepts : person, environment, health, and nursing. 1. Person refers to the recipient of nursing care, including physical. mental and social. 2. Environment refers to all the internal and external conditions, circumstances, and influences affecting the person 3. Health refers to the degree of wellness or illness experienced by the person 4. Nursing refers to the actions, characteristics, and attributes of the individual providing the nursing care. IV. CLASSIFICATION OF NURSING THEORIES Nursing theories can be classified based on range/scope or abstractness, purpose of the theory, and philosophical underpinnings. A. Based on range/scope/generalization and level of abstractness: 1. Metatheory : It refers to “theory of theories”. Characteristics of Metatheory: (i) Focus on generating Knowledge and theory development. (ii) Focus on philosophical issues and methodological issues of nursing theory. (iii) Focus on developing criteria for analysis and evaluating nursing theory. Example of Metatheory- J.Dickoff’s and P.James’s Theory of Theories 2. Grand Theories: Grand theories are the most complex and broadest in scope. Characteristics of Grand theories: (i) Focus on broad and general areas and concepts. (ii) It deals with nonspecific and relatively abstract concepts. (iii) Concepts mentioned in grand theories lack operational definitions. (iv)Grand theories are not directly amenable to testing. (v) These can be used in variety of setting and populations. Example of Grand theories- Orem, Roy, Rogers
- 6. 3. Middle RangeTheories: Middle-range theories target specific phenomena or concepts, such as pain and stress; they are limited in scope yet general enough to encourage research. It deals with concrete and relatively operational concepts and amenable to empirical testing. These theories are highly specific to nursing. These theories are relatively simple to understand and apply. Characteristics of Middle Range theories: These are characteristics of good mid-range theory as described by Whall(1996): (i) Its concepts and propositions are specific to nursing; (ii) it is readily operationalized; (iii) it can be applied to many situations; (iv) propositions can range from causal to associative, depending on their application; and (v) Assumptions fit the theory. (vi) It should be relevant for potential users of the theory, i.e. nurses; and (vii) It should be oriented to outcomes that are important for patients, not merely describe what nurses do. (viii) It should describe nursing-sensitive phenomena that are readily associated with the deliberate actions of nurses. Example: Benner Model of skill acquisition in Nursing.Corbin and strauss ”Chronic illness trajectory framework” 4. Practice Theories/Micro theories/prescriptive theories: Practice theories are narrowly defined; they address a desired goal and the specific actions needed to achieve it. Characteristics of Practice theories: (i) Least complex in nature. (ii) More specific than middle range. (iii) Provides specific directions. (iv) Limited to specific populations.
- 7. (v) Often use of knowledge of other discipline. (vi) Specific to population and setting (oncology,obg). (vii) Cannot be applied in all setting. Comparison of Grand, Middle Range And Practice Theories Characteristic Grand Theories Middle-Range Theories Practice Theories Complexity/ abstractness, scope Comprehensive, global view point (all aspects of human experience) Less comprehensive than grand theories, middle view of reality Focused on a narrow view of reality, simple and straightforward Generalizibility/ specificity Nonspecific, general application to the discipline irrespective of setting or specialty area Some generalizablity across settings and specialities, but more specific than grand theories Linked to special populations or an identified field of practice Characteristics of concepts Concepts abstract and not operationally defined Limited number of concepts that are fairly concrete and may be operationally defined Single, concrete concept that is operationalized Characteristics of propositions Propositions not always explicit Propositions are clearly stated Propositions defined Testability Not generally testable May generate testable hypotheses Goals or outcomes defined and testable Source of development Developed through thoughtful appraisal and careful consideration over many years Evolve from grand theories, clinical practice, literature review, practice guidelines Derived from practice or deduced from middle-range or grand theory B. Based on Philosophical Underpinnings: I. Developmental theories and models emphasize growth, development, and maturation 1. The primary focus is change in a particular direction. 2. This change is orderly and predictable, occurring in specific stages, levels, or phases. 3. The goal is to maximize growth.
- 8. II. Systems theories and models view persons as open systems 1. Each open system can receive input from the environment, process it, provide output to the environment, and receive feedback while maintaining a dynamic tension of forces 2. Each system strives for a steady state (balance between internal and external forces) 3. The goal is to view the whole rather than the sum of the parts. III. Interaction theories and models are based on the relationships among persons 1. The primary focus is on the person as an active participant. 2. Emphasis is on the person’s self-concept, and ability to communicate and perform roles. 3. The goal is achievement through reciprocal interaction. C. Based on Purposes of theory: I. Descriptive Theories II. Explanatory Theories III. Predictive Theories IV. Prescriptive Theories V. HISTORICAL PERSPECTIVE A. 1860 to 1959 1. In 1860, Florence Nightingale developed her Environmental Theory. 2. In 1952, the journal Nursing Research was established, encouraging nurses to become involved in scientific inquiry. 3. In the same year, Hildegard Peplau published Interpersonal Relations in Nursing; her ideas have influenced later nursing theorists. 4. In 1955, Virgina Henderson published Definition of Nursing. 5. In the mid-1950s, Teachers College, Columbia University, New York City, began offering master’s and doctoral programs in nursing education and administration, resulting in student participation in theory development and testing.
- 9. B. 1960 to 1969 1. During the 1960s, Yale University School of Nursing, New Haven, Conn., defined nursing as a process, interaction, and relationship. 2. Also during the 1960s, the U.S. government began funding master’s doctoral education in nursing. 3. In 1960, Faye Abdellah published Twenty-One Nursing Problems. 4. In 1961, Ida Orlando published her theory in The Dynamic Nurse-Patient Relationship: Function, Process, and Principles of Professional Nursing. 5. In 1962, Lydia Hall published Core, Care, and Cure model. 6. In 1964, Ernestine Wiedenbach published her theory in Clinical Nursing: A Helping Art 7. In 1965, the American Nurses Association published a position paper stating that theory development was an important goal for nursing. 8. In 1966, Myra Levine published Four Conservation Principles. 9. In 1969, Dorothy Johnson published Behavioral Systems Model. C. 1970 to 1979 1. During the 1970s, Case Western Reserve University, Cleveland, sponsored symposia to stimulate theory development. 2. During the mid 1970s, the National League for Nursing established an accreditation requirement that nursing schools base their curricula on a nursing conceptual framework. 3. In 1970, Martha Rogers published her model in An Introduction to the Theoretical Basis of Nursing. 4. In 1971, Dorothea Orem published Self-Care Deficit Therory of Nursing, Imogene King published Theory of Goal Attainment, and Joyce Travelbee published Interpersonal Aspects of Nursing. 5. In 1972, Betty Neuman published Health Care Systems Model. 6. In 1976, Sister Callista Roy published Adaptation Model. 7. In 1976, J.G.Paterson and L.T.Zderad published Humanistic Nursing.
- 10. 8. In 1978, Madeleine Leininger published Humanistic Nursing. 9. In 1979, Jean Watson published Nursing: Human Services and Human Care - A Theory of Nursing. D. 1980 to the present 1. In 1980, Evelyn Adam published To be a Nurse and Joan Riehl-Sisca published Symbolic Interactionism 2. In 1982, Joyce Fitzpatrick published Life Perspective Model. 3. In 1983, Kathryn Barnard published Parent-Child Interaction Model and Helen Erickson, Evelyn Tomlin, and Mary Ann Swain published Modeling and Role Modeling. 4. In 1984, Patricia Benner published from Novice to Expert: Excellence and Power in Clinical Nursing Practice. 5. In 1985, Ramona Mercer published Maternal Role Attainment. 6. In 1986, Margaret Newman published Model of Health. 7. In 1994, Parish Nursing Model:proposed by Bergquist and King. 8. In 1994,Rogers proposed “Occupational Health Nursing Model” 9. In 1997, Barbara Artinian and Margarnet Conger published “The intersystem Model: Integrating Theory and Practice” Conclusion: The development of nursing theories and models is a relatively recent occurrence. The nursing profession has not reached a consensus on the meaning and interpretation of concepts, theories, and models. A lack of consensus also exists whether a single model or theory should be selected or whether multiple models and theories are more useful to nursing practice. Areas of agreement among theorists include the importance of the four concepts of person, environment, health, and nursing; the goal of enhancing client comfort; a holistic approach of nursing; and a set of distinct values of nursing. Nursing should have knowledge base like other discipline.