Nursing Theories: An Overview

This page was last updated on February 4, 2012

INTRODUCTION

A theory is a group of related concepts that propose action that guide practice. Theory refers to a coherent group of general propositions used as principles of explanation 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.

Kerlinger - theories as a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory and predictive in nature. Theories are composed of concepts, definitions, models , propositions and are based on assumptions. They are derived through two principal methods: 1. 2. Deductive reasoning Inductive reasoning.

Nursing theorists use both of these methods. Nursing theories are "attempts to describe or explain the phenomenon (process, occurrence and event) called nursing" Barnum(1998) Theories are for professional nursing. 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"

DEFINITIONS

Concepts

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Concepts are basically vehicles of thought that involve images. Concepts are words that describe objects , properties, or events and are basic components of theory. Types of Concepts:

Models

Empirical concepts Inferential concepts Abstract concepts.

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Models are representations of the interaction among and between the concepts showing patterns. Models allow the concepts in nursing theory to be successfully applied to nursing practice. 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.

Propositions

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Process

Prepositions are statements that explain the relationship between the concepts.

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Processes are series of actions, changes or functions intended to bring about a desired result . During a process one takes systemic and continuous steps to meet a goal and uses both assessments and feedback to direct actions to the goal. A particular theory or conceptual frame work directs how these actions are carried out . The delivery of nursing care within the nursing process is directed by the way specific conceptual frameworks and theories define the person (patient), the environment, health and 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. This can be seen as an attempt by the nursing profession to maintain its professional boundaries.

CHARACTERISTICS OF THEORIES Theories:

interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. are logical in nature. are generalizable. are the bases for hypotheses that can be tested. increase the general body of knowledge within the discipline through the research implemented to validate them. are used by the practitioners to guide and improve their practice. are 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 and influenced by broadly applicable processes and theories. Following theories are basic to many nursing concepts. A. General System Theory:

It describes how to break whole things into parts and 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, organs in Anatomy and health in Nursing.

B. Adaptation Theory

It defines adaptation as the adjustment of living matter to other living things and to environmental conditions. Adaptation is a continuously occurring process that effects change and involves interaction and response. Human adaptation occurs on three levels:

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--- the internal ( self ) --- the social (others) --- and the physical ( biochemical reactions )

C. Developmental Theory

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

experiences and health status.

COMMON CONCEPTS IN NURSING THEORIES

Four concepts common in nursing theory that influence and determine nursing practice are

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

Each of these concepts is usually defined and described by a nursing theorist. Of the four concepts, the most important is that of the person. The focus of nursing is the person.

HISTORY

Nightingale (1860): To facilitate "the bodys reparative processes" by manipulating clients environment Paplau 1952: Nursing is; therapeutic interpersonal process. Henderson 1955: The needs often called Hendersons 14 basic needs Abdellah 1960: This theory focus on delivering nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family. 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. Johnsons Theory 1968: Dorothy Johnsons 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.

Rogers 1970: to maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through "humanistic science of nursing" Orem1971: This is self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs. King 1971: To use communication to help client reestablish positive adaptation to environment. Neuman 1972: Stress reduction is goal of system model of nursing practice. Roy 1979: This adaptation model is based on the physiological, psychological, sociological and dependence-independence adaptive modes. Watsons Theory 1979: Watsons philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the; humanistic aspects of life.

CLASSIFICATION OF NURSING THEORIES Depending on the generalisability of their principles

Metatheory: the theory of theory. Identifies specific phenomena through abstract concepts. Grand theory: provides a conceptual framework under which the key concepts and principles of the discipline can be identified. Middle range theory: is more precise and only analyses a particular situation with a limited number of variables. Practice theory: explores one particular situation found in nursing. It identifies explicit goals and details how these goals will be achieved.

School of thoughts in Nursing Theories-1950-1970

Need theorists

Interaction Theorists

Outcome theorists

Abdellah Henderson Orem

King Orlando Peterson and Zderad Paplau Travelbee Wiedenbach

Johnson Levine Rogers Roy

Theories can also be categorised as:

"Needs "theories. "Interaction" theories. "Outcome "theories. "Humanistic theories"

"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.

"Interaction" theories

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.

"Outcome" theories

These portray the nurse as the changing force, who enables individuals to adapt to or cope with ill health (Roy 1980). Outcome theories have been criticized as too abstract and difficult to implement in practice (Aggleton and Chalmers 1988).

"Humanistic" Theories:

Humanistic theories developed in response to the psychoanalytic thought that a persons destiny was determined early in life. Humanistic theories emphasize a persons capacity for self actualization . Humanists believes that the person contains within himself the potential for healthy and 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 understanding that each client is a unique individual, so personcentered approach now practice in Nursing.

MODELS OF NURSING

A model, as an abstraction of reality, provides a way to visualize reality to simplify thinking. A conceptual model shows how various concepts are interrelated and applies theories to predict or evaluate consequences of alternative actions. A conceptual model "gives direction to the search for relevant questions about the phenomena of central interest to a discipline and suggests solutions to practical problems"

Four concepts are generally considered central to the discipline of nursing: the person who receives nursing care (the patient or client); the environment (society); nursing (goals, roles, functions); and health.

Criticisms of nursing theories

To understand why nursing theory is generally neglected on the wards. A nrsing theory should have the characteristics of accessibility and clarity. It is important that the language used in the development of nursing theory be used consistently. Many nurses have not had the training or experience to deal with the abstract concepts presented by nursing theory. Majority of nurses fail to understand and apply theory to practice (Miller 1985).

CONCLUSION

Theory and practice are related To develop nursing as a profession the concept of theory must be addressed. If nursing theory does not drive the development of nursing, it will continue to develop in the footsteps of other disciplines such as medicine.

Nursing Theorists This page was last updated on October 17, 2011

Nursing Theorists 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Florence Nightingale - Environment theory Hildegard Peplau - Interpersonal theory Virginia Henderson - Need Theory Fay Abdella - Twenty One Nursing Problems Ida Jean Orlando - Nursing Process theory Dorothy Johnson - System model Martha Rogers -Unitary Human beings Dorothea Orem - Self-care theory Imogene King - Goal Attainment theory Betty Neuman - System model Sister Calista Roy - Adaptation theory Jean Watson - Philosophy and Caring Model Madeleine Leininger -Transcultural nursing Patricia Benner - From Novice to Expert Lydia E. Hall - The Core, Care and Cure Joyce Travelbee - Human-To-Human Relationship Model Margaret Newman - Health As Expanding Consciousness Katharine Kolcaba - Comfort Theory Rosemarie Rizzo Parse - Human Becoming Theory Ernestine Wiedenbach - The Helping Art of Clinical Nursing

1. Florence Nightingale- Environmental Theory

First nursing theorist Unsanitary conditions posed health hazard (Notes on Nursing, 1859) 5 components of environment

ventilation, light, warmth, effluvia, noise

External influences can prevent, suppress or contribute to disease or death.

Nightingales Concepts

1. Person

Patient who is acted on by nurse Affected by environment Has reparative powers

2. Environment

Foundation of theory. Included everything, physical, psychological, and social

3. Health

Maintaining well-being by using a persons powers Maintained by control of environment

4. Nursing

Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate persons reparative process

2. Hildegard Peplau -Interpersonal Relations Model

Based on psychodynamic nursing using an understanding of ones own behavior to help others identify their difficulties Applies principles of human relations Patient has a felt need

Peplaus Concepts

1. Person

An individual; a developing organism who tries to reduce anxiety caused by needs Lives in instable equilibrium

2. Environment

Not defined

3. Health

Implies forward movement of the personality and human processes toward creative, constructive, productive, personal, and community living

4. Nursing

A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible Involves problem-solving

3. Virginia Henderson -The Nature of Nursing

"The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. She must in a sense, get inside the skin of each of her patients in order to know what he needs".

4. Fay Abdella- Topology of 21 Nursing Problems

A list of 21 nursing problems Condition presented or faced by the patient or family. Problems are in 3 categories

physical, social and emotional

The nurse must be a good problem solver

Abdellas Concepts

1. Nursing

A helping profession A comprehensive service to meet patients needs Increases or restores self-help ability Uses 21 problems to guide nursing care

2. Health

Excludes illness No unmet needs and no actual or anticipated impairments

3. Person

One who has physical, emotional, or social needs

The recipient of nursing care.

4. Environment

Did not discuss much Includes room, home, and community

5. Ida Jean Orlando- Deliberative Nursing Process

The deliberative nursing process is set in motion by the patients behavior All behavior may represent a cry for help. Patients behavior can be verbal or non-verbal. The nurse reacts to patients behavior and forms basis for determining nurses acts. Perception, thought, feeling Nurses actions should be deliberative, rather than automatic Deliberative actions explore the meaning and relevance of an action.

6. Dorothy Johnson-Behavioral Systems Model

The person is a behavioral system comprised of a set of organized, interactive, interdependent, and integrated subsystems Constancy is maintained through biological, psychological, and sociological factors. A steady state is maintained through adjusting and adapting to internal and external forces.

Johnsons 7 Subsystems

Affiliative subsystem - social bonds Dependency - helping or nuturing Ingestive - food intake Eliminative - excretion Sexual - procreation and gratification Aggressive - self-protection and preservation Achievement - efforts to gain mastery and control

Johnsons Concepts

1. Person

A behavioral system comprised of subsystems constantly trying to maintain a steady state

2. Environment

Not specifically defined but does say there is an internal and external

environment

3. Health

Balance and stability.

4. Nursing

External regulatory force that is indicated only when there is instability.

7. Martha Rogers -Unitary Human Beings

Energy fields

Fundamental unity of things that are unique, dynamic, open, and infinite Unitary man and environmental field

Universe of open systems

Energy fields are open, infinite, and interactive

Pattern

Characteristic of energy field A wave that changes, becomes complex and diverse

Pandimensionality

A nonlinear domain with out time or space

Rogers Definitions

Integrality

Continuous and mutual interaction between man and environment

Resonancy

Continuous change longer to shorter wave patterns in human and environmental fields

Helicy

Continuous, probabilistic, increasing diversity of the human and envrionmental fields. Characterized by nonrepeating rhymicities Change

8. Dorothea Orem- Self-Care Model

Self-care comprises those activities performed independently by an individual to promote and maintain person well-being Self care agency is the individuals ability to perform self care acti vities Self- care deficit occurs when the person cannot carry out self -care The nurse then meets the self-care needs by acting or doing for; guiding, teaching, supporting or providing the environment to promote patients ability Wholly compensatory nursing system-Patient dependent Partially compensatory- Patient can meet some needs but needs nursing assistance Supportive educative-Patient can meet self care requisites, but needs assistance with decision making or knowledge

9. Imogene King-Goal Attainment Theory

Open systems framework Human beings are open systems in constant interaction with the environment Personal System

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individual; perception, self, growth, development, time space, body image Interpersonal Society

Personal System Individual; perception, self, growth, development, time space, body image Interpersonal

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Socialization; interaction, communication and transaction

Society Family, religious groups, schools, work, peers

The nurse and patient mutually communicate, establish goals and take action to attain goals Each individual brings a different set of values, ideas, attitudes, perceptions to exchange

10. Betty Neuman - Health Care Systems Model

The person is a complete system, with interrelated parts maintains balance and harmony between internal and external environment by adjusting to stress and defending against tension-producing stimuli Focuses on stress and stress reduction Primarily concerned with effects of stress on health Stressors are any forces that alter the systems stability Flexible lines of resistance - Surround basic core Internal factors that help defend against stressors Normal line of resistance Normal adaptation state

Flexible line of defense - Protective barrier, changing, affected by variables

Wellness is equilibrium

Nursing interventions are activates to:

strengthen flexible lines of defense strengthen resistance to stressors maintain adaptation

11. Sister Calista Roy - Adaptation Model

Five Interrelated Essential Elements 1. 2. 3. 4. 5. Patiency- The person receiving care Goal of nursing- Adapting to change Health-Being and becoming a whole person Environment Direction of nursing activities- Facilitating adaptation The person is an open adaptive system with input (stimuli), who adapts by processes or control mechanisms (throughput)

The output can be either adaptive responses or ineffective responses

12. Jean Watson - Philosophy and Science of Caring

Caring can be demonstrated and practiced Caring consists of carative factors Caring promotes growth A caring environment accepts a person as he is and looks to what the person may become A caring environment offers development of potential Caring promotes health better than curing Caring is central to nursing

Watsons 10 Carative Factors

Forming humanistic-altruistic value system Instilling faith-hope Cultivating sensitivity to self and others Developing helping-trust relationship Promoting expression of feelings Using problem-solving for decision making Promoting teaching-learning Promoting supportive environment Assisting with gratification of human needs Allowing for existential-phenomenological forces

Watsons Concepts

Person

Human being to be valued, cared for, respected, nurtured, understood and assisted

Environment

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Society

Health Complete physical, mental and social well-being and functioning

Nursing Concerned with promoting and restoring health, preventing illness

13. Rosemary Parse - Human Becoming Theory

Human Becoming Theory includes Totality Paradigm

Man is a combination of biological, psychological, sociological and spiritual factors

Simultaneity Paradigm

Man is a unitary being in continuous, mutual interaction with environment

Originally Man-Living-Health Theory

Parses Three Principles

Meaning

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Mans reality is given meaning through lived experiences Man and environment cocreate

Rhythmicity Man and environment cocreate ( imaging, valuing, languaging) in rhythmical patterns Cotranscendence

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Refers to reaching out and beyond the limits that a person sets One constantly transforms

Person Open being who is more than and different from the sum of the parts

Environment Everything in the person and his experiences Inseparable, complimentary to and evolving with

Health Open process of being and becoming. Involves synthesis of values

Nursing A human science and art that uses an abstract body of knowledge to serve people

14. Madeleine Leininger - Culture Care Diversity and Universality

According to transcultural nursing, the goal of nursing care is to provide care congruent with cultural values, beliefs, and practices Sunrise model consists of 4 levels that provide a base of knowledge for delivering cultural congruent care.

Cultural care preservation

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help maintain or preserve health, recover from illness, or face death

Cultural care accommodation help adapt to or negotiate for a beneficial health status, or face death

Cultural care re-patterning help restructure or change lifestyles that are culturally meaningful

15. Patricia Benner - From Novice to Expert

Described 5 levels of nursing experience and developed exemplars and paradigm cases to illustrate each level

1. 2. 3. 4. 5.

Novice Advanced beginner Competent Proficient Expert Levels reflect:

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movement from reliance on past abstract principles to the use of past concrete experience as paradigms change in perception of situation as a complete whole in which certain parts are relevant

16. Lydia E. Hall - The Core, Care and Cure

The theory contains of three independent but interconnected circles: 1. 2. 3. the core, the care and the cure

The core is the person or patient to whom nursing care is directed and needed. The core has goals set by himself and not by any other person. The core behaved according to his feelings, and value system.

The care circle explains the role of nurse The cure is the attention given to patients by the medical professionals.

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