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Chapter 5 Theories of

Nursing Practice

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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

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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

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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

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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

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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.

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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

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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

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Levels of Theory

Range from a broad scope to a smaller, more specific scope

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Theory of Unpleasant Symptoms

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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

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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

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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

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Nursing Theorists

Rogers (1970) Science of unitary man: energy fields, openness, pattern, and

organization Nurse promotes synchronicity between human beings and their

universe/environment.

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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.

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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.

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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.

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Roy’s Adaptation Model

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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.

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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.

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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

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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