Chapter 5 Theories of Nursing Practice

Science and Theory Science A method of bringing together facts and giving them coherence and integrity Scientific inquiry involves five aspects: Hypothesis Method Data collection Results Evaluation

Science and Theory Theory A group of related concepts that explain existing phenomena and predict future events Criteria for theory acceptance involve six factors: Inclusiveness Consistency Accuracy Relevance Fruitfulness Simplicity

Nursing Science Collection of data related to nursing that may be applied to the practice of nursing Guides the practice of nursing to better serve clients

Theories, Models, and Frameworks Theory An abstract generalization that presents a systematic explanation about how phenomena are interrelated Must include at least two concepts that are related in a way that the theory explains

Theories, Models, and Frameworks Conceptual model or framework Deals with concepts that are assembled because of their relevance to a common theme Conceptual framework is used interchangeably with conceptual model. More loosely structured than theories Four concepts basic to nursing that are included in models are nursing, person, health, and environment.

Nursing Theory Guides research and practice Basic ingredients are concepts. Examples of nursing concepts include health, stress, and adaptation. Language of nursing theory: Concept Construct Conceptual model Philosophy Theory

Schematic Models Demonstrate concepts, usually through a picture or visual representation of ideas Clarify and show relationships between complex concepts Illustrate the layout and features specific to a theory—similar to the blueprint of a building

Levels of Theory Range from a broad scope to a smaller, more specific scope

Theory of Unpleasant Symptoms

Florence Nightingale: The First Nursing Theorist Influences that directed her toward nursing theory: Classic education Upper class life Religion and spirituality Era of reform throughout England

Canons of Nursing Theory of practice “Canons of Nursing”—foundation for the promotion of health and guidance for the practice of professional nursing Ventilation and warming Noise Variety Diet Light Chattering hopes and advice Cleanliness

Nursing Theorists Peplau (1952) Explored interpersonal relationship of the nurse and the client Identified the client’s feelings as a predictor of positive outcomes related to health and wellness

Nursing Theorists Rogers (1970) Science of unitary man: energy fields, openness, pattern, and organization Nurse promotes synchronicity between human beings and their universe/environment.

Nursing Theorists Newman (1979, revised 1986) Defines health as "expanding consciousness," or increasing complexity Theory stimulated by concern for those whom health as the absence of disease or disability is not possible Nurse’s role is to recognize the person’s unique pattern of life and to work within that pattern to achieve the person’s goals. Every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness.

Nursing Theorists Orem (1971) Facilitates client self-care by measuring the client’s deficit relative to self-care needs Nurse implements appropriate measures to assist the client in meeting needs by matching with an appropriate supportive intervention.

Nursing Theorists Roy (1974) Nurse will be the change agent in assisting the individual with adaptation when an insult renders him or her in need of environmental modification. Adaptation will occur by assisting the “biopsychosocial” client in modifying external stimuli.

Roy’s Adaptation Model

Nursing Theorists Watson (1978) Caring among nurse, environment, and client is essential to healing. Holistic outlook addresses the impact and importance of altruism, sensitivity, trust, and interpersonal skills.

Nursing Theorists Mishel (1981, revised 1997) Uncertainty in illness is a stress-producing incident that is capable of contributing to negative physical and/or psychologic outcomes. Uncertainty exists when the client is unsure about a diagnosed illness. Four-step framework assists nurses in working with clients: stimuli frame, appraisal stage, initiation of coping mechanisms, and adaptation.

Future of Nursing Theories and Theorists Health care concerns in the 21st century Primary focus of federal and state legislative agendas Major concerns: uninsured population, patient safety, nursing shortage, rising health care costs, technology, confidentiality issues, advanced practice nursing

Future of Nursing Theories and Theorists Nursing theories in the 21st century Established nursing theories will be reevaluated and modified to answer important health care questions. Will embrace complex issues such as genetics, computers, noninvasive surgery, robotics, decreasing energy sources, increasing pollutants under a thinning ozone layer, environmental hazards, new diseases, and antibiotic-resistant illness