Weekly Objectives:
1) Discuss categories commonly used to organize nursing theories (CO 3).
2) Distinguish between grand theories, middle-range theories, and models (CO 3).
3) Compare and contrast theories for their application to the nurse practitioner role (CO 4).
Main Topics and Concepts:
Nursing Theories
Borrowed and Interdisciplinary Theories
Required Reading:
Butts, B. J. & Rich, L. K. (2018). Philosophies and theories for advanced nursing practice (3rd ed.). Jones & Bartlett Learning. Chapters 18, 19, 25
Week 4: Borrowed Theories Used by Nursing
Table of ContentsBorrowed Theories
As a fledgling profession in the late 1800s and early 1900s, the vast majority of the knowledge base for nursing practice was borrowed from medicine. During the 1950s and later, nursing became determined to separate itself from medicine and establish itself as a unique profession. To do so, nursing needed to demonstrate the characteristics of a profession with one of these being the presence of a unique knowledge base.
Each profession needs to have a focus or object (i.e., another characteristic of a profession). The object or focus of a profession indicates the discrete aspect of reality that is the subject of the discipline (Parker & Smith, 2015).
The following table assists with understanding the object of a profession.
Discipline
Primary Knowledge Base
Focus or Object of Care
Medicine
Emphasis on biologic and pharmacologic theory
Diagnosis and treatment of health alterations
Nursing
Emphasis on biologic, psychological, and social theories
Emphasis on individuals as biopsychosocial beings to determine appropriate actions in order to foster health
Pharmacy
Emphasis placed on biologic, chemistry, and pathophysiology
Provide safe and appropriate medications while educating the consumer
Dieticians
Emphasis on biologic, nutritional, and psychological theory
Determine nutritional needs and provide appropriate interventions
There is an interesting and ongoing debate in the literature regarding the use or avoidance of theories from non-nursing disciplines. On one side, borrowed theories may not adequately describe, explain, or predict nursing phenomena (Villarruel, Bishop, Simpson, Jemmott, & Fawcett, 2001). However, advocates believe nursing's theoretical foundations depend on borrowed theories (McEwen & Wills, 2014); and are important to guiding nursing practice in a variety of settings. It is important to note the use and application of borrowed theories in nursing. McEwen and Willis (2014) cautioned that "simply adopting concepts or theories from another discipline does not convert them into nursing concepts or theories" (p.40). Borrowed theories can become shared theories as they have applied to nursing-specific situations (Bond et al., 2011). Desbiens, Gagnon, and Fillion (2012) further stated shared theory, although not derived from nursing, is used to explain or predict nursing phenomena.
Borrowed Theories Used by Nursing
Borrowed Theories Used by Nursing
Open the activity below to explore borrowed theories used by nursing.
Borrowed Theories Used by Nursing (Links to an external site.)Transcript
Theories from Social Sciences
Theories from social sciences are integral to the discipline of nursing. Nurses in virtually all settings caring for vast groups of patients routinely use concepts and principles from social theories (McEwen & Wills, 2014). Sociologic theories are rich and substantively diverse. Because of this richness and diversity, their theory perspectives are relevant to the discipline of nursing. Social forces have a strong impact on the wellness and health of individuals. Developing a sociological perspective in caring for patients is not always comfortable because it calls for confronting and questioning existing assumptions regarding social arrangements (Parker & Smith, 2015). The knowledge gained can benefit not only patients but healthcare and professional nurses, as well.
Theories from Behavioral Sciences
The behavioral science theories attempt to explain an individual's behavior in terms related to the development of the self that is formed by adulthood. There are five families of theories that try to explain human behavior. Each theory emphasizes a different concept or viewpoint, but no one theory best explains the complexity of human behavior (McEwen & Wills, 2014). The behavioral theorists believe that behavior is learned by reinforcement; whereas, cognitive theorists believe that reinforcement is related to an individual's thought patterns. Humanistic theories propose that individuals will have within themselves the capacity to change. The potential for healthy and creative growth occurs throughout an individual's life span; thus, the behavior of an individual is a dynamic process. The stress-adaption theories are associated with behaviors identified with the way a person adapts to stress through individual coping mechanisms. The social-psychology theory looks at how a person changes and ways to incorporate those changes through the promotion of health.
Theories from Behavioral Sciences
The following table provides brief comparisons of the five families of behavioral theories (Parker & Smith, 2015).
Theory
Theorist
Emphasis
Enablers
Psychodynamic
Erikson
Psychosocial factors that influence behavior
Id, ego, superego, conscious, unconscious
Freud
The study of unconscious mental processes of behavior
Analysis of human behavior observed in the current situation
Operant conditioning, positive and negative reinforcement
Humanistic
Maslow
Fulfilling human potential
Hierarchy of needs, safety needs through self- actualization
Rogers
Person-centered
Congruence and incongruence, positive regard and self-regard
Stress Adaptation
Lazarus
A cognitive model of stress
Appraisal, coping, outcome
Social Psychology
Rosenstock
Perceived threat and net benefits
Benefits, perceived barriers, cues of action, self-efficacy
Each of the five families of behavioral theories has been extensively used in the nursing profession. For example, academic preparation, gaining an understanding of the phases of development and applying those stages in the practice setting, and understanding age-specific tendencies related to patient care (McEwen & Wills, 2014).
Theories from Biomedical Science
Historically, the nursing theory has its roots in theories from the biomedical sciences. For example, Florence Nightingale's theory is built on principles of Germ theory. McEwen (2014) stated biomedical theories can be separated into two categories: theories of disease causation and theories related to physiology. Nursing clinical guidelines, principles of infection control, and levels of prevention are all attributed to biomedical theories. Biomedical theories continue to be an important part of nursing knowledge and practice, particularly for nurses in direct patient care roles.
Theories from Leadership and Management
Master's-prepared nurses are considered leaders in a variety of different healthcare roles and settings. As such, regardless of role or practice setting, leadership, and management practices should be supported by theories, models, and frameworks (Oberleitner, 2015). Leadership and management theories include focus on leadership styles, management principles, quality improvement strategies, change management, and team building - the concepts, principles, and strategies of leadership and management theories are "crucial to the viability and sustainability" of nursing leader roles (Oberleitner, 2015, p. 382).
Interprofessional Theory
Knowledge is not specific to one discipline; however, the perspective or worldview of the discipline shapes how knowledge is interpreted and used. As healthcare is evolving and Interprofessional practice is becoming the norm, nurse researchers have collaborated with other healthcare professionals to build upon borrowed theories and to develop new Interprofessional theories to improve patient care (Bond et al., 2011). Interprofessional theory is developed through collaboration and shaping the delivery of healthcare in today's and future practice settings.
Learning Theories
Learning theories describe the processes used to bring about changes in the ways individuals understand information and changes in the ways they perform a task or skill. Learning theories can help provide a focus for creating an environment and conditions in which teaching can occur more effectively. A good learning theory enables you to make choices confidentially and consistently and to explain or define why you made the choice you did (McEwen & Wills, 2014). Thus, although nursing theory provides the framework for a professional assessment of the patient's condition or needs and the specific language the nurse uses when making a diagnosis or charting, learning theory explains how this information is assimilated and suggests effective ways to present it to the patient as an intervention. Learning theory combined with nursing theory gives nurses guidance as they interact with patients (McEwen & Wills, 2014).
Specialty Tracks
Click on the link below to download theories related to specialty tracks.
NR501 Specialty Areas Nursing Theories (Links to an external site.)
Reflection
Think about your future professional nursing practice. Explore a theory identified above related to your specialty track and consider ways in which the selected theory could be used to guide your practice.
Theory Analysis
In the previous week, we discussed concept analysis as a process for examining concepts, contextually, as building blocks of theory. Not only do concepts need analysisto provide clarity, but so do the various nursing theories used. Theory analysis takes a critical look at the various components and linkages within any given nursing theory. While there are a variety of methodologies described, the key components or areas of consideration are comprehensiveness and parsimony (Melnyk & Fineout-Overholt, 2015; McEwen & Wills, 2014).
Comprehensiveness asks if the theory can be used in all areas of practice, whereas parsimony takes a close examination of the multiple parts of the theory (Parker & Smith, 2015; Walker & Avant, 2011). While there are a variety of approaches to the analysis of theory available in the literature, most strategies focus on similar criteria (McEwen & Wills, 2014). In addition to determining comprehensiveness and parsimony, theory analysis involves looking at the usefulness of theory. Is the theory being used by direct patient caregivers and nurse educators, or is it restricted to one specific area of practice? What about the fruitfulness? Are other nurses publishing on how they are using the theory?
Walker and Avant (2011) offer the following steps for theory analysis.
Theory Analysis Definitions
Click on the interactive to learn more about theory analysis definitions.
Theory Analysis Definitions (Links to an external site.)
TranscriptOrigin - Where and when did this theory come from?
Meaning - How the theory’s concepts relate to one another
Logical Adequacy - Looks at the logical structure of the components of the theory
Usefulness - How practical or helpful is the theory?
Generalizability - Can the theory be applied to other situations?
Parsimony - Can the theory be explained in a simple or brief manner while still including all the important concepts?
Testability - Can the theory be supported by empirical evidence?
Week 4: Nursing Theories
Table of Contents
Theory
Transcript
Consider the following questions: "Should the nature of nursing knowledge be abstract or concrete?"
To answer this question, the following questions need to be considered first:
How can something abstract be useful in nursing practice?
How can something concrete consider all of the diversity of possible nursing care situations with individuals, families, and communities?
How can something concrete consider different roles and practice settings of nurses?
Definition of a Theory
A theory is a frame of reference on how individuals view reality. A formal definition notes that theory is a group of interrelated concepts, assumptions, and propositions that explains or guides action. For the nursing profession, a nursing theory provides a view of or a window into the reality of nursing. It guides the thinking about and the doing of nursing. A comprehensive theory includes an explanation of both the noun and verb aspects of the profession, as well as a consideration of the concepts of the nursing metaparadigm: person, health, environment, and nursing (Melnyk & Fineout-Overholt, 2011; McEwen & Wills, 2014). Theories go beyond interventions to consider, in both speculative and practical manners; the focus of the person using the theory; and the desired nursing outcome. Practitioners, researchers, and educators of nursing have a common discussion point of what is and what is not nursing (Parker & Smith, 2015).
Level of Abstraction
Grand Theories
How can something abstract be useful in nursing practice? Let's first consider the level of abstraction and how it applies to the scope of the theory. Take a moment a look into the following picture.
Image Description (Links to an external site.)
How many objects do you see?
The first time you read a grand nursing theory with its high level of abstraction, the words may seem fuzzy and unclear. But as you peer into the words more closely, the theory along with its concepts becomes discernible and comprehensible, similar to the picture (Parker & Smith, 2015).
A grand theory uses a high level of abstraction so that its scope or picture of the nursing profession is very broad and generalized. Only by being abstract, ideal, visionary, and even transcendental is a grand nursing theory able to address all of the variables that a professional nurse may encounter while providing care to individuals, families, groups, and communities (Parker & Smith, 2015).
By definition, a grand theory must consider all of the concepts of a profession. Remember, for the profession of nursing, the metaparadigm concepts are person, health, environment, and nursing itself (Parker & Smith, 2015). So the question becomes: How can something abstract be useful in nursing practice? Without careful thought, the initial answer may be: "It can't be used, because it is abstract."
Actually, grand nursing theories are too broad to orchestrate direct patient-care activities, but they are useful in nursing practice because more specific theories (i.e., middle-range, practice) can be derived from the grand theories.
Examples of Grand Theories
Let's take a look at a few examples of grand theories. Open the activity by clicking the link below.
Examples of Grand Theories
View the following activity on Examples of Grand Theories.
Examples of Grand Theories (Links to an external site.)
Transcript
Virginia Henderson: The Principles and Practice of Nursing
In 1937, Virginia Henderson and other scholars developed a nursing curriculum for the National League of Nursing in which the education was focused on patient-centered care and nursing problems. Thus, her theory was derived from her practice and education. The major assumption of Henderson’s framework is that nurses care for patients until patients can care for themselves. For patients, the desire is to return to a state of wellness and health. The major concepts of the theory relate to the nursing metaparadigm (i.e., patient, nursing, health, and environment). Henderson believes that the unique function of the nurse was to assist the patient during illness and assist in performing those activities that restore the patient to health. She defined the patient as someone who needs nursing care but not limited to illness (McEwen & Wills, 2014).
Faye Abdellah: Patient-Centered Approaches to Nursing
Faye Abdellah was one of the first major nursing theorists. Her nursing theory was developed inductively from her practice and considered a human-needs framework. Abdellah and her colleagues developed a list of 21 nursing problems and 10 steps in identifying patient problems. They also identified 10 nursing skills to be used in developing treatment typology. Furthermore, her team distinguished between nursing diagnosis and nursing functions. Diagnoses were a determination of the nature and extent of the patient's problems. Other concepts central to her work were: healthcare team, the professionalization of nursing, patient, and nursing (McEwen & Wills, 2014).
Dorothea Orem: The Self-Care Deficit Nursing Theory
Dorothea Orem is well recognized for her conceptual framework of self-deficit nursing theory. Between 1971 and 1995, several revisions have been made to the model, but the premise underlying her theory is the individual and the idea of nursing as a system. The paradigms supporting her theory include: nursing meets the needs of patients for self-care; humans are defined as men, women, and children; the environment has a physical and chemical component; and health is defined as beings structurally and functionally whole (McEwen & Wills, 2014). Orem felt that humans engage in continuous interaction between themselves and the environment to remain well and live. Human agency is exercised and discovered by developing, engaging, and transmitting with others in a way that provides meaning to oneself. Self-care requisites are common to all humans, as is growth and development and deficits. Nurses play a major role in assisting patients with healthcare deficits. Orem’s theory has been adopted by many nursing school curriculums (McEwen & Wills, 2014).
Betty Neuman: The Neuman Systems Model
Since the 1960s, Betty Neuman has been recognized as a pioneer in nursing, particularly in the specialty area of mental health. She developed her model while lecturing in community mental health at UCLA. The model uses a systems approach that is focused on human needs and protection against stress. Neuman believed that stress can be modified and remedied through nursing interventions (McEwen & Wills, 2010). She emphasized the need for humans to maintain a dynamic balance that nurses can provide to patients by assisting them to identify problems and agreed-upon mutual goals. The environmental component of Neuman's model is both the internal and external forces surrounding the client and can be influenced or changed at any time. Neuman identified five variables of her theory: physiological, sociocultural, psychological, developmental, and spiritual (McEwen & Wills, 2014).
Middle-Range Theories
How can something concrete consider all of the diversity of possible nursing care situations with individuals, families, and communities?
The initial answer is that as theory becomes more concrete or narrow in scope, something is left out. For example, a middle-range theory regarding chronic illness leaves out acute illnesses, as well as preventive healthcare. A middle-range theory regarding home healthcare would leave out providing healthcare to individuals in other settings such as an extended-care facility. A practice theory concerning abused children from chemically addicted parents would not consider abused children from other situations, such as economically stressed families (Melnyk & Fineout-Overholt, 2011).
Middle-range theories were first suggested in the discipline of sociology in the 1960s and introduced into nursing in 1974. Middle-range theories were useful in other disciplines because they were more readily operationalized and addressed through research than grand theories (McEwen & Wills, 2014). The development of middle-range theories was supported by the critique that grand theories were difficult to understand and apply to the practice setting. Thus, the function of the middle-range theory is to describe, explain, or predict phenomena and be explicit and testable. Middle-range theories are more readily applied to research studies. In addition, middle-range theories are able to guide nursing interventions and change conditions to enhance nursing care. Furthermore, each middle-range theory addresses concrete or specific phenomena by stating what the phenomena are, why they occur, and how they occur. These theories support the connection between diagnosis and outcomes of care (McEwen & Wills, 2014).
A major disadvantage to a middle-range and/or practice theory is that something is left out, but one advantage is that the information gained is far more focused and can be verified with research. This would contribute to evidence-based practice for nursing. To see the comprehensive picture of the nursing profession, a grand theory is needed. But to work with specific actions or develop researchable topics, a middle-range or practice theory is needed (McEwen & Wills, 2014).
Examples of Middle Range Theories
Click on each tab below to explore a few examples of middle range theory.
Benner's model depicts five stages of skill acquisition: novice, advanced beginner, competent, proficient, and expert. The model emphasizes the importance of rewarding nurses for their clinical expertise and leadership in clinical practice settings because it describes the process of excellence and caring practice. Expertise develops when the nurse tests and refines clinical expertise and practical knowledge. The central essentials of Benner's model are those of skill acquisition, experience, competence, clinical knowledge, and practical knowledge (McEwen & Wills, 2014).
Examples of Middle Range Theories
Click on each tab below to explore a few examples of middle-range theory.
Pender's health promotion model was developed as the theory for integrating behavioral and nur nursing-science perspectivessing-science perspectives on factors that influence health behaviors. The model is used to explore and guide the psychosocial processes that motivate individuals to engage in behaviors directed toward wellness and health enhancement. The model has been used extensively in nursing research as a framework for predicting health-promoting lifestyles. Major components of the model include individual characteristics and experiences, self-efficacy, situational influences, and behavioral outcomes (McEwen & Wills, 2014).
Examples of Middle Range Theories
Click on each tab below to explore a few examples of middle-range theory.
The synergy model for patient care was developed in the 1990s by a panel of nurses of the American Association of Critical-Care Nurses. The purpose of the theory is to acknowledge nurses' activities, contributions, and outcomes with regard to caring for critically ill patients. The model identifies eight patient needs and eight competencies of nurses in critical-care situations. The nursing competencies depict how knowledge, skills, and experience are integrated within nursing care. The model describes three levels of outcomes - those relating to the patient, the nurse, and the system (McEwen & Wills, 2014).
Read: Neuman System Model
ANSWER.
PAPER DETAILS
Academic Level
Masters
Subject Area
Nursing
Paper Type
Discussion Post
Number of Pages
1 Page(s)/275 words
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Format
APA 6
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