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Theory and Practice in Nursing: Past to Present

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anastasia scime

on 10 February 2014

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Transcript of Theory and Practice in Nursing: Past to Present

Theory and Practice in Nursing: Past to Present
Kant's Philosophy

Does nursing practice shape theory or does theory shape practice?
...the most recognizable name in nursing history.
Her groundbreaking approach gained tremendous support for the need for organized and educated nurses.
She supported the development of training programs for nurses.

Nightingale believed that the nurse’s role was in manipulation of the patient environment to act in a caring, healing environment & promoting health.
Foundation based on observations and research during the Crimean War.
Observed that poor sanitation, nutrition, and water led to increased mortality and morbidity in soldiers.
Have there been obstacles along the way? Lets talk about them...
There are differences in nursing educational approaches from Diploma, Associate and BSN programs. Each approaches nursing differently. (Hospital driven program focus on performing procedures, task oriented vs reflective)

Socially there was a patriarchal hierarchy that didn't encourage debate or experiment from the female dominated nursing profession.

Sex role stereotyping (women were conditioned and expected to consider a "career"-secondary to family and home, so developing theory and testing was not at the forefront)

Can you think of any others?
Moving from a vocation to a profession
We needed to and had developed nursing knowledge apart from medical knowledge to guide our nursing practice.

This step led to awareness of the need to develop specific nursing theory.

How did nursing move forward to develop theory?
We had to develop and capture our distinct knowledge thru theory development, research and reflective practice. It is the foundation to move nursing from an occupation subservient to medicine to partnership among health professions.
The Transition Years
Playing politics: The triggers to make change
Education which emphasized research-the path to new knowledge.
Scholarly nursing publications evolved and identified that conceptual and theoretical frameworks for development of specialized nursing knowledge was lacking.
Realization that research and theory must work together to create nursing science.

ANA created Commission on Research and Council of Nurse Researchers
President Nixon impounded nurse training, research and fellowship funds, a decision that was overturned 1 year later in 1974.
Different levels of theory
Walker and Avant outline different theories and how they interact with one another...
Metatheory-clarifies the methodological roles of each level of theory development in practice.

Grand theory serves as a guide for phenomena at the middle range level.

Middle range theories are tested in reality are reference points for grand theories and also direct practice for concrete goal attainment.

Practice theory tests the empirical validity of propositions as practice in patient care
Anastasia Stacey Scime
NUS 700

Florence Nightingale
Reality is not only a thing in and of itself, but is constructed by those who experience it
Despite these linkages between the levels of theory development, none of them directly represent the methods or strategies for theory construction.

The question left unanswered for us is:
How do we get there?
in its application to nursing...that would lead to the philosophical question...
What is already known?
Development of theory is an active process.
The roots of nursing theory are based on thinking, reflecting questioning & perceiving as being able to develop knowledge.
What do you know about theory development in nursing?
late 1960's
early '70s
Helps nurses understand practice in a complete and significant manner.
Describes criteria to measure quality care
Drives curriculum design
Provides a framework for generating new knowledge
Theoretical knowledge is basis for power
Organizes knowledge
Enables one to defend ideas
Theory development=autonomy
A common knowledge base to further innovative advancement of knowledge
Late 1960' early '70's
So what does theory do?
Grand Theory
Middle Range
Practice Theory

Provides material for
Tests in Practice
We've discussed nursing's theoretical evolution.
Next week we will learn about the methods used to study nursing theoretical works. We will review analysis, critique, and evaluation.
Analysis of theory is an important process and the first step in applying nursing theoretical works to education, research, administration, or practice.
Gortner, S. (2000). Knowledge development in nursing: Our historical roots and future opportunities. Nursing Outlook, 48, 60-67.

Meleis, A. (2012). Theoretical Nursing: Development and Progress (5th ed). Philadelphia, PA: Lippincott Williams & Wilkins.

Walker, L. & Avant, K. (2011). Strategies for Theory Construction in Nursing (5th ed). Upper Saddle River, NJ: Pearson, Prentice Hall.

How have you seen theory integrated into nursing practice today?
How do you envision your integration of theory
into your dissertation?
Do any theories resonate with your interest area?
Nursing increases professional power when using theoretical research as systematic evidence for critical thinking and decision making.
When nurses use theory and theory-based evidence to structure their practice, it improves the quality of care for patients.
Considering nursing practice in a theory context helps students to develop analytical skills and critical thinking ability and to clarify their values and assumptions.
Theory guides practice, education, and research
The development of theory came out of research.
Research without theory produces isolated information.
Research and theory create nursing science.

Characteristics of theory
Logical and generalizable
Increase body of knowledge when validated by research
Used by practitioners to guide and improve practice

Dr. Madeleine Leininger, drew from anthropology to build her theory of transcultural nursing.
Virginia Henderson identified 14 components of care, and considered a number of disciplines influencing individuals including: biology, psychology, sociology, spirituality,
How do you think Henderson's approach worked or didn't work?
Rosemary Parse
Medical model limited nursing practice
Looked for framework to practice nursing that connects value of relationships (borrowed from social sciences, psychology and anthropology)
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