Theories of NursingPractice

Ramesh Kumar

Theories of NursingPractice

Ramesh Kumar

What is a theory?

A set of concepts,definitions, relationships,and assumptions thatproject a systematic viewof a phenomena

It may consist of one ormore relatively specificand concrete conceptsand propositions thatpurport to account for, ororganize somephenomenon (Barnum,1988)

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A set of concepts,definitions, relationships,and assumptions thatproject a systematic viewof a phenomena

It may consist of one ormore relatively specificand concrete conceptsand propositions thatpurport to account for, ororganize somephenomenon (Barnum,1988)

What are the components of atheory?

Concepts – ideas and mentalimages that help to describephenomena (Alligood andMarriner-Tomey, 2002)

Definitions – convey thegeneral meaning of theconcepts

Assumptions – statementsthat describe concepts

Phenomenon – aspect ofreality that can be consciouslysensed or experienced(Meleis, 1997).

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Concepts – ideas and mentalimages that help to describephenomena (Alligood andMarriner-Tomey, 2002)

Definitions – convey thegeneral meaning of theconcepts

Assumptions – statementsthat describe concepts

Phenomenon – aspect ofreality that can be consciouslysensed or experienced(Meleis, 1997).

What is a paradigm?

A model thatexplains the linkagesof science,philosophy, andtheory accepted andapplied by thediscipline (Alligoodand Marriner –Tomey, 2002)

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A model thatexplains the linkagesof science,philosophy, andtheory accepted andapplied by thediscipline (Alligoodand Marriner –Tomey, 2002)

What is a domain?

The view orperspective of thediscipline It contains the

subject, centralconcepts, values andbeliefs, phenomenaof interest, and thecentral problems ofthe discipline

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The view orperspective of thediscipline It contains the

subject, centralconcepts, values andbeliefs, phenomenaof interest, and thecentral problems ofthe discipline

How does domain relate tonursing theory?

Nursing hasidentified its domainin a paradigm thatincludes fourlinkages:1) person/client2) health3) environment4) nursing

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Nursing hasidentified its domainin a paradigm thatincludes fourlinkages:1) person/client2) health3) environment4) nursing

Purposes of nursing theory

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What are the purposes of nursingtheory?

It guides nursingpractice andgenerates knowledge It helps to describe

or explain nursing Enables nurses to

know WHY they aredoing WHAT theyare doing

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It guides nursingpractice andgenerates knowledge It helps to describe

or explain nursing Enables nurses to

know WHY they aredoing WHAT theyare doing

Types of nursing theories

Grand theories – broadand complex

Middle-range theories-address specificphenomena and reflectpractice

Descriptive theories –first level of theorydevelopment

Prescriptive theories –address nursinginterventions and predicttheir consequences

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Grand theories – broadand complex

Middle-range theories-address specificphenomena and reflectpractice

Descriptive theories –first level of theorydevelopment

Prescriptive theories –address nursinginterventions and predicttheir consequences

Why on earth do we studynursing theory?

Everyday practice enrichestheory

Both practice and theory areguided by values and beliefs

Theory helps to reframe ourthinking about nursing

Theory guides use of ideasand techniques

Theory can close the gapbetween theory and research

To envision potentialities(Gordon, Parker, & Jester,2001)

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Everyday practice enrichestheory

Both practice and theory areguided by values and beliefs

Theory helps to reframe ourthinking about nursing

Theory guides use of ideasand techniques

Theory can close the gapbetween theory and research

To envision potentialities(Gordon, Parker, & Jester,2001)

“The study and use ofnursing theory in nursing

practice must have roots inthe everyday practice of

nurses (Gordon, Parker, andJester, 2001).

“The study and use ofnursing theory in nursing

practice must have roots inthe everyday practice of

nurses (Gordon, Parker, andJester, 2001).

So how do nurses use theory ineveryday practice?

Organize patient data Understand patient data Analyze patient data Make decisions about

nursing interventions Plan patient care Predict outcomes of care Evaluate patient

outcomes(Alligood, 2001)

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Organize patient data Understand patient data Analyze patient data Make decisions about

nursing interventions Plan patient care Predict outcomes of care Evaluate patient

outcomes(Alligood, 2001)

How do student nurses begin touse nursing theory?

By asking yourselftwo very importantquestions…..

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By asking yourselftwo very importantquestions…..

Student nurse questions

What is the nature ofknowledge needed forthe practice of nursing?

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What does it mean to meto practice nursing?

Nursing also utilizes non-nursingtheories

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Commonly used non-nursingtheories

Systems theory Basic Human Needs

theory Health and Wellness

Models Stress and

Adaptation Developmental

Theories Psychosocial

Theories3-16Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Systems theory Basic Human Needs

theory Health and Wellness

Models Stress and

Adaptation Developmental

Theories Psychosocial

Theories

What is the link between nursingtheory and the research process?

Theory provides directionfor nursing research

Relationships ofcomponents in a theoryhelp to drive the researchquestions forunderstanding nursing

Chinn and Kramer(2004), indicate a spiralrelationship between thetwo

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Theory provides directionfor nursing research

Relationships ofcomponents in a theoryhelp to drive the researchquestions forunderstanding nursing

Chinn and Kramer(2004), indicate a spiralrelationship between thetwo

Current trends that influencenursing theory

Medical science Nursing education Professional nursing

organizations Evolving research

approaches Global concerns Consumer demands Technologies

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Medical science Nursing education Professional nursing

organizations Evolving research

approaches Global concerns Consumer demands Technologies

“ Practicing nurses who despisetheory are condemned to

performing a series of tasks -either at the command of aphysician or in response to

routines and policies.”

“ Practicing nurses who despisetheory are condemned to

performing a series of tasks -either at the command of aphysician or in response to

routines and policies.”

Leah Curtin, RN, MS, FAAN(1989)Former Editor, NursingManagement

Objectives

Define theoryand list

characteristicsof a theory

Trace thedevelopmentof a nursing

theory

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Define theoryand list

characteristicsof a theory

Describe thecomponentsof a theoryand its use

Trace thedevelopmentof a nursing

theory

Describe thedifferent types

of theoriesand examples

of each.

Some commonalities

PurposeConceptsDefinitionsPropositionsStructured ideasTentativeDescribe a phenomenon or occurrence

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PurposeConceptsDefinitionsPropositionsStructured ideasTentativeDescribe a phenomenon or occurrence

Components/Elements oftheory

1.Purpose “Why is the theoryformulated”

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2.Concepts are building blocks oftheory – ideas, mental images of a

phenomenon, an event or object thatis derived from an individual’s

experience and perception

Components/Elements oftheory

3.Has a major concept like nursing,person, health or environment.

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4. Definitions give meaning toconcepts which can either be

descriptive or procedural (stipulate-use of term within the theory)

Components/Elements oftheory

Propositions areexpressions of

relational statementsbetween and amongthe concepts. It can

be expressed asstatements,

paradigms or figures. AKA as theoretical

assertions

Assumptions-accepted “truths”that are basic andfundamental to the

theory. Or valueassumptions wherewhat is good or right

or ought to be.

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Propositions areexpressions of

relational statementsbetween and amongthe concepts. It can

be expressed asstatements,

paradigms or figures. AKA as theoretical

assertions

Assumptions-accepted “truths”that are basic andfundamental to the

theory. Or valueassumptions wherewhat is good or right

or ought to be.

Characteristics of a Theory

1. Systematic, logical and coherent(orderly reasoning,no contradictions)

2. Creative structuring of ideasmental images of one’s experiences andcreate different ways of looking at a particularevent or object.

3. Tentative in nature ( change over time orevolving but some remain valid despitepassage of time)

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1. Systematic, logical and coherent(orderly reasoning,no contradictions)

2. Creative structuring of ideasmental images of one’s experiences andcreate different ways of looking at a particularevent or object.

3. Tentative in nature ( change over time orevolving but some remain valid despitepassage of time)

How does a theory develop?

Fourstrategies of

theorydevelopment

• Theorypractice theory( theorydeveloped inother disciplineand used innursingsituations)

• Practice – theoryevolved fromclinical practice

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Fourstrategies of

theorydevelopment

• Theorypractice theory( theorydeveloped inother disciplineand used innursingsituations)

• Practice – theoryevolved fromclinical practice

How does a theory develop?

3. Research theory or inductive methodMust evolve from research findings or

empirical evidence.

4. Theory research theorytheories developed by other disciplines

are utilized but given unique nursingperspective. Original theory examinedand given a new research findings.

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3. Research theory or inductive methodMust evolve from research findings or

empirical evidence.

4. Theory research theorytheories developed by other disciplines

are utilized but given unique nursingperspective. Original theory examinedand given a new research findings.

TERMINOLOGY

METAPARADIGM- Most abstract level of knowledge. In

nursing this is main concepts thatencompasses the subject matter and thescope of the discipline

- Central concepts of person, environment,health and nursing

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METAPARADIGM- Most abstract level of knowledge. In

nursing this is main concepts thatencompasses the subject matter and thescope of the discipline

- Central concepts of person, environment,health and nursing

TERMINOLOGY

Philosophy- Knowledge level which specifies the

definitions of the metaparadigm conceptsin each of the conceptual models ofnursing.

- Nightingale is considered philosophicalapproach

- Out of these philosophies theory maybeformalized

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Philosophy- Knowledge level which specifies the

definitions of the metaparadigm conceptsin each of the conceptual models ofnursing.

- Nightingale is considered philosophicalapproach

- Out of these philosophies theory maybeformalized

Conceptual models

Frameworks or paradigms that provide abroad frame of reference for thesystematic approaches to thephenomena with which the discipline isconcerned. -different views nursing like Roy focuses

on adaptation, King on interaction andAbdellah on interventions

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Frameworks or paradigms that provide abroad frame of reference for thesystematic approaches to thephenomena with which the discipline isconcerned. -different views nursing like Roy focuses

on adaptation, King on interaction andAbdellah on interventions

theory

Group of related conceptsthat propose actions thatguide practice

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Group of related conceptsthat propose actions thatguide practice

Nursing theory

Group of related concepts that derivedfrom the nursing models. Some derivefrom other nursing discipline likeLEininger which comes fromanthropology

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Group of related concepts that derivedfrom the nursing models. Some derivefrom other nursing discipline likeLEininger which comes fromanthropology

Uses of theory

1. Theory guides and improve nursingpractice

Theory provides goal for nursing careand with goals, nursing practice isrendered more effective and efficient.theories help to focus the goals, makingnurses more confident about thepractice.

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1. Theory guides and improve nursingpractice

Theory provides goal for nursing careand with goals, nursing practice isrendered more effective and efficient.theories help to focus the goals, makingnurses more confident about thepractice.

Uses of theory

2. Theory guides researchaccording to Meleis, primary use oftheory is to guide research. It validatesand modifies the theory.

3. Theory contributes to the developmentof the disciplines body of knowledge

4. Theory enhances communication

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2. Theory guides researchaccording to Meleis, primary use oftheory is to guide research. It validatesand modifies the theory.

3. Theory contributes to the developmentof the disciplines body of knowledge

4. Theory enhances communication

Historical Development

Role of nurses wherequestioned; whatthey do, for whomwhere and whenwere determined. purpose of nursing,

process of theorydevelopment wasdiscussed

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Role of nurses wherequestioned; whatthey do, for whomwhere and whenwere determined. purpose of nursing,

process of theorydevelopment wasdiscussed

First Conference in Nursing theory

Brought leading scholars and theorists to discussand debate on issues regarding nursingscience ad theory development.

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Historical Development

Writings of Dickoff,James and Wiedenbach“Theory in a PracticeDiscipline” influencedthe theoretical thinking innursing . They presenteda definition of nursingtheory and goals fortheory development innursing, approacheswhere discussed

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Writings of Dickoff,James and Wiedenbach“Theory in a PracticeDiscipline” influencedthe theoretical thinking innursing . They presenteda definition of nursingtheory and goals fortheory development innursing, approacheswhere discussed

Categories of nursing theories

client nurse

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`environment

Process of KnowledgeDevelopment

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Scope of Theories

Grand Theories Middle-Range Theories

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Grand Theories Middle-Range Theories

Maslow’s Hierarchy of Needs

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