Introduction to Nursing Theories INTRODUCTION

Nursing theory is the term given to the body of knowledge that is used to support nursing practice. Nursing theory is a framework designed to organize knowledge and explain phenomena in nursing, at a more concrete and specific level. 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. Each discipline has a unique focus for knowledge development that directs its inquiry and distinguishes it from other fields of study.(Smith & Liehr, 2008). Theory-guided, evidence-based practice is the hallmark of any professional discipline. Nursing is a professional discipline (Donaldson & Crowley, 1978). Almost 90% of all Nursing theories are generated in the last 20 years. Nursing models are conceptual models, constructed of theories and concepts A paradigm is a model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline.

METAPARADIGMS IN NURSING Person

Recipient of care, including physical, spiritual, psychological, and sociocultural components. Individual, family, or community

Environment

All internal and external conditions, circumstances, and influences affecting the person

Health

Degree of wellness or illness experienced by the person

Nursing

Actions, characteristics and attributes of person giving care.

COMPONENTS OF A THEORY

DEFINITIONS Theory

a set of related statements that describes or explains phenomena in a systematic way. the doctrine or the principles underlying an art as distinguished from the practice of that particular art. a formulated hypothesis or, loosely speaking, any hypothesis or opinion not based upon actual knowledge. a provisional statement or set of explanatory propositions that purports to account for or characterize some phenomenon.

Concept

a mental idea of a phenomenon Concepts are the building blocks (the primary elements) of a theory.

Construct

a phenomena that cannot be observed and must be inferred Constructs are concepts developed or adopted for use in a particular theory. The key concepts of a given theory are its constructs.

Proposition

a statement of relationship between concepts

Conceptual model

made up of concepts and propositions They epresent ways of thinking about a problem or ways of representing how complex things work the way that they do. Different Frameworks will emphasize different variables and outcomes and their interrelatedness.( Bordage, 2009) Models may draw on a number of theories to help understand a particular problem in a certain setting or context. They are not always as specified as theory.

Variables

Variables are the operational forms of constructs. They define the way a construct is to be measured in a specific situation. Match variables to constructs when identifying what needs to be assessed during evaluation of a theorydriven program.

Middle range theory

a testable theory that contains a limited number of variables, and is limited in scope as well, yet is of sufficient generality to be useful with a variety of clinical research questions.

NURSING PHILOSOPHIES Theory Key Points Focuses on nursing and the patient environment relationship. Florence Nightingales Legacy of caring Helping process meets needs through the art of individualizing care. Nurses should identify patients need-for help by: o Observation Ernestine Wiedenbach: The helping o Understanding client behaviour art of clinical nursing o Identifying cause of discomfort o Determining if clients can resolve problems or have a need for help Virginia Hendersons Definition of Nursing Faye G.Abedellahs Typology of twenty one Nursing problems Lydia E. Hall :Care, Cure, Core model Jean Watsons Philosophy and Science of caring

Patients require help towards achieving independence. Derived a definition of nursing Identified 14 basic human needs on which nursing care is based. Patients problems determine nursing care Nursing care is person directed towards self love. Caring is a universal, social phenomenon that is only effective when practiced interpersonally considering humanistic aspects and caring. Caring is central to the essence of nursing. Described systematically five stages of skill acquisition in nursing practice novice, advanced beginner, competent, proficient and expert.

Patricia Benners Novice to Expert

CONCEPTUAL MODELS AND GRAND THEORIES Dorothea E. Orems Self care deficit Selfcare maintains wholeness. theory in nursing Three Theories: o Theory of Self-Care o Theory of Self-Care Deficit o Theory of Nursing Systems Nursing Care: o Wholly compensatory (doing for the patient) o Partly compensatory (helping the patient do for himself or herself) o Supportive- educative (Helping patient to learn self care

and emphasizing on the importance of nurses role Myra Estrin Levines: The conservation model

Proposed that the nurses use the principles of conservation of: o Client Energy o Personal integrity o Structural integrity o Social integrity A conceptual model with three nursing theories o Conservation o Redundancy o Therapeutic intention Person and environment are energy fields that evolve negentropically Nursing is a basic scientific discipline Nursing is using knowledge for human betterment. The unique focus of nursing is on the unitary or irreducible human being and the environment (both are energy fields) rather than health and illness Individuals maintain stability and balance through adjustments and adaptation to the forces that impinges them. Individual as a behavioural system is composed of seven subsystems: the subsystems of attachment, or the affiliative, dependency, achievement, aggressive, ingestive-eliminative and sexual. Disturbances in these causes nursing problems. Stimuli disrupt an adaptive system The individual is a biopsychosocial adaptive system within an environment. The individual and the environment provide three classes of stimuli-the focal, residual and contextual. Through two adaptive mechanisms, regulator and cognator, an individual demonstrates adaptive responses or ineffective responses requiring nursing interventions Neumans model includes intrapersonal, interpersonal and extrapersonal stressors. Nursing is concerned with the whole person. Nursing actions (Primary, Secondary, and Tertiary levels of prevention) focuses on the variables affecting the clients response to stressors. Transactions provide a frame of reference toward goal setting. Major concepts (interaction, perception, communication, transaction, role, stress, growth and development) Perceptions, Judgments and actions of the patient and the nurse lead to reaction, interaction, and transaction (process of nursing). Individuality in living. A conceptual model of nursing from which theory of goal

Martha E.Rogers: Science of unitary human beings

Dorothy E.Johnsons Behavioural system model

Sister Callista: Roys Adaptation model

Betty Neumans : Health care systems model

Imogene Kings Goal attainment theory

Nancy Roper, WW.Logan and A.J.Tierney A model for nursing

based on a model of living

attainment is derived. Living is an amalgam of activities of living (ALs). Most individuals experience significant life events which can affect ALs causing actual and potential problems. This affects dependence independence continuum which is bidirectional. Nursing helps to maintain the individuality of person by preventing potential problems, solving actual problems and helping to cope. Interpersonal process is maturing force for personality. Stressed the importance of nurses ability to understand own behaviour to help others identify perceived difficulties. The four phases of nurse-patient relationships are: o 1. Orientation o 2. Identification o 3. Exploitations o 4. Resolution The six nursing roles are: o 1. Stranger o 2. Resource person o 3. Teacher o 4. Leader o 5. Surrogate o 6. Counselor Interpersonal process alleviates distress. Nurses must stay connected to patients and assure that patients get what they need, focused on patients verbal and non verbal expressions of need and nurses reactions to patients behaviour to alleviate distress. Elements of nursing situation: 1. Patient 2. Nurse reactions 3. Nursing actions Therapeutic human relationships. Nursing is accomplished through human to human relationships that began with the original encounter and then progressed through stages of emerging identities. Growth and development of children and mother infant relationships Individual characteristics of each member influence the parent infant system and adaptive behaviour modifies those characteristics to meet the needs of the system. A complex theory to explain the factors impacting the development of maternal role over time. Comfort is desirable holistic outcome of care. Health care needs are needs (physical, psycho spiritual, social and

Hildegard E. Peplau: Psychodynamic Nursing Theory

Ida Jean Orlandos Nursing Process Theory

Joyce Travelbees Human To Human Relationship Model

Kathryn E. Barnards Parent Child Interaction Model

Ramona T.Mercers :Maternal Role Attainment Katharine Kolcabas Theory of comfort

environmental needs) for comfort, arising from stressful health care situations that cannot be met by recipients traditional support system. Comfort measures include those nursing interventions designed to address the specific comfort needs. Caring is universal and varies transculturally. Major concepts include care, caring, culture, cultural values and cultural variations Caring serves to ameliorate or improve human conditions and life base. Care is the essence and the dominant, distinctive and unifying feature of nursing Indivisible beings and environment co-create health. A theory of nursing derived from Rogers conceptual model. Clients are open, mutual and in constant interaction with environment. The nurse assists the client in interaction with the environment and co creating health Promoting optimum health supersedes disease prevention. Identifies cognitive, perceptual factors in clients which are modified by demographical and biological characteristics, interpersonal influences, situational and behavioural factors that help predict in health promoting behaviour

Madeleine Leiningers Transcultural nursing, culture-care theory

Rosemarie Rizzo Parses :Theory of human becoming

Nola J.Penders :The Health promotion; model

CONCLUSION

The conceptual and theoretical nursing models help to provide knowledge to improve practice, guide research and curriculum and identify the goals of nursing practice. Nursing knowledge is the inclusive total of the philosophies, theories, research, and practice wisdom of the discipline.As a professional discipline this knowledge is important for guiding practice.(Smith & Liehr, 2008).