Theories, Frameworks, and Concepts in Nursing

Donna Hinson BrownWinston-Salem State University

NUR 2312Spring 2012

What is nursing?

• Science?• Art?• What makes nursing different?• How do we know?• What is a theory?• “Theory helps us bear our ignorance of the

facts.” George Santayana

What theory should be…

“Enthusiastic discourse that that fits the description…a place where people work at the very edges of their abilities, constantly pushing each other’s thinking into new territory, giving names to things that have gone unnamed, dreaming of better ways, describing common ground and finding ways to realize shared dreams”

Belenky, Clinchy, Goldberg, & Tarule (1996).

CONCEPTS

FRAMEWORK

THEORY

Person

CARE

HOPE Wellness

trauma

health

Nurse-patient relationship

Health-wellness

continuum

Story of Hope

Theories

• Represent abstract ideas rather than concrete facts

• Can be broad or limited• Grand theories• Middle-range or midrange theories• Practice theories (situation-specific theories)

Grand Theories• Florence Nightingale’s Environmental Theory• Martha Rogers’ Science of Unitary Human Beings• Dorothea Orem’s Self-Care Deficit Theory• Roy’s Adaptation Model• Neuman’s Systems Model• Watson’s Science of Philosophy and Caring• Peplau’s Interpersonal Process• King’s Theory of Goal Attainment• Leininger’s Cultural Care Theory

Middle Range Theories• Uncertainty in Illness (Mishel & Clayton)• Theory of Self-Transcendence (Pam Reed)• Theory of Community Empowerment (Persily

& Hildebrandt)• Theory of Self-Efficacy (Resnick)• Theory of Unpleasant Symptoms (Lenz &

Pugh)• Story Theory (Smith & Liehr)

Practice Theories• Less abstract• Limited scope and focus (single phenomenon)• Situational (does not transcend time, place)• Answers a specific question• Sociopolitical, cultural, historical in

perspective; easily recognizable in clinical practice setting

• Examples

Where to begin???

• What are my interests?• How do I think about my nursing process and

practice?• What do I want to know? • Sources (original)• Sources (secondary/ application)

Story Theory: Theoretical Model

Connecting with Self–in-Relation

Creating Ease

NURSE PERSONIntentional Dialogue

Complicating health challenge

Developing story-plot

Movement toward resolving

Smith, M.J., & Liehr, P.R. (2008). Middle Range Theory for Nursing, 2nd ed. New York: Springer

Purpose

• Stories as a part of human experience• Stories bind people and time• Stories as expressions of who we are, where

we have been and where we are going• Story theory = context for nurse-person health

promoting process• Structure to guide nursing in practice and

research by collecting stories about health situations that are important to the person

Story Theory • The major concepts:1. Person2. Environment3. Health4. Nursing

• Clinical practice use for story theory

NURSINGPRACTICE

Questions and Comments