Nursing Theory: The Basics of Professional Nursing

Nursing Theory: The Basics of Professional Nursing

The Theoretical Challenges for Nursing Education, Practice, and Research

Theory-Based Education

a. Curriculum for nursing students is set in a particular way due to theories based on a philosophy or conceptual model that shapes the way nursing is taught

b. graduate level nurses focus on nursing practice and testing of interventions with specific patient groups

c. the BSN nurse is introduced to research process and the use of theory to guide it

a. focus for BSN is utilization and application of nursing theory as a guide for nursing practice.

Theory-Based Practice

a. occurs when nurses intentionally structure their practice around a particular theory and use it to guide them as they assess, plan, diagnose, intervene, and evaluate nursing care

b. nursing theory provides language for you to explain what you do, how you do it, and why you do it

c. develops analytic skills, challenges thinking, and clarifies vales and assumptions

Theory-Based Research

a. nursing research tests and refines the knowledge base of nursing enabling them to improve quality of care and understand how evidence-based practice influences patient outcomes

Definitions

Theory: a group of related concepts, definitions, and statements that describe a certain view of nursing occurrences to describe, explain, or predict outcomes.

* Abstract ideas and not concrete facts

Metapardigm: Basic concepts of nursing that are most important to the profession

* patient, environment, health, nursing, and caring

Philosophy: group of beliefs about the nature of how the world works (in nursing) - linking of concepts from a paradigm

Conceptual Model: provide an organizational structure that makes clear and distinct associations between concepts

* more specific than a metaparadigm

Propositions: statement that describes the connections between concepts and propose an outcome that is able to be tasted in both research and practice

Conceptual Models of Nursing

Three Philosophies of Nursing

Roy's Adaptation Model

a. focuses on the individual as a biopsychosocial adaptive system and describes nursing as a humanistic discipline emphasizing the person's coping and adapting abilities; views person as adaptive system with four modes

i. physiological

ii. self-concept

iii. role function

iv. interdependent

b. based on adaptation; Roy believes that the individual and environment are stimuli that require modification to promote adaptation in the patient

Orem's Self Care Model:

a. In her work she formalizes three theories than develop within each other

i. Theory of self-care

ii. theory of self-care deficit

iii. theory of nursing system

b. this model focuses on self-care abilities of patient and designing nursing actions to meet the patient's needs

i. emphasis is placed on self-care deficit (extent to which a patient is incapable of providing effective self-care)

c. In order to assess self-care deficits the nurse must follow three operations:

i. diagnostic

1. establish nurse-patient relationship

2. assess factors affecting self care like developmental level and sociocultural and environmental to determine extent to which patient is limited

ii. perspective

1. planning stage

2. nurse reviews patient needs with patient and establishes care plan

iii. regulatory

1. designs, plans, and produces a system for care

King's Interacting Systems Framework and Theory of Goal Attainment

a. this theory focuses on people, their interpersonal relationships, and social contexts with three interacting systems:

i. personal

ii. interpersonal

iii. social

b. nurses must focus on goal attainment for and by the patient

i. The personal system leads nurse to pay close attention to the patients perceptions

ii. interpersonal guides nurse to explore patients roles and stresses in each role

iii. social cues nurse to consider influences on the patients decision making

ex. a mother's decision may be influenced by children's wellbeing

c. interaction with patient is an important component of king's goal attainment model

i. increase involvement between nurse and patient

ii. relationship involves mutuality

iii. goal is attaining or regaining health

Henderson

Watson

Florence Nightingale

a. Returned to earlier values of nursing and stressed caring aspects of nursing

b. Proposed 10 factors which she labeled “carative” factors (“caritas processes”)

i. Watson’s 10 Caritas Processes:

1. Practice loving kindness

2. Decision making

3. Instill faith and hope

4. Teaching and learning

5. Spiritual beliefs and practices

6. Holistic care

7. Helping and trusting relationships

8. Healing environment

9. Promote expression of feelings

10. Miracles

c. Addressed philosophical question of nature of nursing as seen as a human-to-human relationship (nurse and patient)

d. Nurses who follow Watson’s philosophy use transpersonal caring in assisting patients; has responsibility for creating and maintaining an environment that encourages human caring but also provides for patient’s primary human needs

a. “the Florence Nightingale of the 20th century”

b. Work defined nursing and specified role of nurse in relation to patient

c. Definition of nursing focused on helping patient perform activities he/she would do for himself/herself if he/she could

d. Nurses who carry-out Henderson’s philosophy focus on caring from the perspective of the 14 basic needs

i. Henderson’s 14 Basic Needs of the Patient:

1. Breathe normally

2. Eat and drink adequately

3. Eliminate body wastes

4. Move and maintain desirable position

5. Sleep and rest

6. Select suitable clothes—dress and undress

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

8. Keep the body clean and well groomed and protect the integument (skin)

9. Avoid dangers in environment and avoid injuring others

10. Communicate with others in expressing emotions, needs, fears, or opinions

11. Worship according to one’s faith

12. Work in such a way that there is a sense of accomplishment

13. Play or participate in various forms of recreation

14. Learn, discover, or satisfy the curiosity that leads to normal development and health and use available health facilities

- "Founder of professional nursing"

- Made a distinction between the work of nurses and the work of physicians

* health is the main focus of nurses

-Focus on the relationships of patients and surroundings

- Focused on the metaparadigm of nursing

- Recognized the nurses role in protecting the patient

- Nurse who follows Nightingale's philosophy: focus on the effect of the environment on the patient's health/

recovery from illness

Thank You!

Theories of Nursing

Theories are classified by breadth and depth. For example a grand theory is a broad conceptualization of nursing phenomena. There are three main theories, which are shaped by Hildegard Peplau, Ida Orlando, and Madeleine Leininger.

a. Peplau's Theory of Interpersonal Relationships in Nursing - Within the nurse-patient relationship, how can I best help him or her understand his or her health problems and develop new, healthier behaviors?

i. nursing is based on the interpersonal process and nurse-patient relationships

ii. relationship between the nurse and patient is the focus rather than the patient alone

iii. twofold goal of therapeutic interpersonal relationship

i. patient survival

ii. patient's understanding of his/her health condition and learning as he/she develops new behavioral patterns

b. Orlando's Nursing Process Theory - How can I figure out what my patient needs through my interaction with him/her?

i. specific to nurse-patient interactions

ii. goal of the nurse is to determine patient needs and relieve discomfort and/or distress

iii. emphasizes deliberate action, based on patient behavior and leads to inferences

c. Leininger's Theory of Culture Care Diversity and Universality - What can I do to provide culturally congruent care for my patient?

i. based on knowledge that is culturally defined, classified, and tested and then used to provide care that it culturally congruent

Middle-Range Theories of Nursing: neither overly broad nor too narrow; incorporates a limited number of concepts and focuses on a specific aspect of nursing.

Examples of middle-range theories:

a. Swanson's Caring Theory - developed from work with couples experiencing miscarriage

b. Mishel's Uncertainty in Illness Theory - developed from studying men with prostate cancer waiting for progression rather than seeking immediate treatment

c. Jezewski's Cultural Bockering Theory - developed from research on politically and economically powerless or those who were vulnerable because of advanced disease