Nursing theory and theories used by nursing
Assumptions of Nightingale's Practice Approach to Care
Based on the collection and analysis of data about morbidity and mortality, Nightingale posited four theoretical assumptions about nursing and health care:
The nurse and client relationship is deemed important.
The environment has a direct effect on the client's well-being, which encompasses:
Nutrition
Sanitation
Ventilation
Environmental factors such as fresh air, pure water, cleanliness of the client and environment, and light exposure contribute to good health and recovery; conversely, the absence or diminishing of these factors can contribute to illness and poor health.
A nurse has the ability to determine necessary interventions to modify the environment and influence positive client outcomes.
It is emphasized that a nurse should document a patient's health issue and what may have led to their demise.
(Reference: Gregory et al., 2020)
Concept in Nursing
Concept: An idea or notion that represents some aspect of personal or human experience, including both physiological and non-physiological pain, as well as loss (e.g., grief).
Concepts are significant as they serve as the building blocks of theory. Nurses utilize concepts to understand and describe situations and circumstances.
Examples of nursing concepts include but are not limited to pain, loss, and wellness.
(Reference: Gregory et al., 2020)
Nursing Theories
Nursing theories are specialized to the nursing field and represent the body of knowledge utilized to describe or explain various concepts found in nursing practice.
Types of Nursing Theories:
Grand Nursing Theories: Highly abstract, examples include theories proposed by Florence Nightingale and Jean Watson, which may sometimes lack practical application.
Midrange Theories: Narrower in scope, such as Nola Pender's Health Promotion Model.
Nursing Practice Theories: Developed for use within specific nursing care situations and structures.
(Reference: Gregory et al., 2020)
Metaparadigm of Nursing
The nursing metaparadigm consists of four principal components:
Person: Refers to the patient, the nurse, and how families/community respond to illness.
Environment: Encompasses physical and social environments, including factors such as cleanliness and climate change.
Health: Covers physical health, mental health, spiritual health, and includes considerations around nutrition and exercise.
Nursing: This refers to the practice of nursing and the nature of the caring process.
(Reference: Gregory et al., 2020)
Application of the "From Novice to Expert" Model
The model can be applied in various nursing practices including direct client care, education, and administration.
In 2015, the Royal College of Nursing (RCN) presented the RCN Pain Knowledge and Skills Framework, which illustrates competencies related to pain management for nurses, emphasizing:
The progression of nursing skills from novice to expert, as framed by Benner's model.
Competencies and skills required for both unregistered nurses (novice levels) and registered nurses (competent to expert levels).
Example: Unregistered novice-level nurses might observe and report on the effectiveness of pharmacological treatments, while proficient registered nurses provide rationales for the treatment choices.
The RCN framework can guide practice in:
Direct practice: Developing clinical skills in pain management.
Education: Creating educational content for nursing training.
Administration: Measuring nursing performance based on knowledge and skills.
(Reference: Gregory et al., 2020)
Paterson & Zderad's Humanistic Nursing Theory
This theory builds on Hildegard Peplau's work on interpersonal experiences between nurses and patients.
It describes nursing as "an experience lived between human beings", emphasizing:
The importance of moving beyond mere performing tasks to embodying presence and connection with patients.
The idea of humanistic nursing occurring between individuals highlights elements such as presence, awareness, and interpersonal connectedness.
Patients are regarded as the experts of their own experiences.
Characteristics of humanistic nursing include:
Being with and doing with.
Engaging in dialogue.
Focusing on the present moment (here and now).
Recognizing the situation as a context for interaction.
A complementary synthesis of actions and understanding.
(Reference: Doane & Varcoe, 2020)
Theorizing Your Own Nursing Practice
It is crucial to consider what a specific concept or theory leads a nurse to focus on or do within their practice:
How would I approach nursing situations differently with an awareness of theory?
How would I perceive and relate to people in a different manner?
Acknowledging what matters most in care.
Reflecting on one's self and the contextual environment of practice.
Evaluating the experiential value of a theory in nursing practice.
(Reference: Doane & Varcoe, 2020)
Drawing on Other Theories
Incorporation of critical social theory aids in understanding political and social aspects of lives, significantly impacting:
Healthcare access and inequities.
Social Determinants of Health: These include factors that are personal, social, and economic, which directly affect an individual's health.
Lecture Objectives
Define and differentiate between the terms concept and theory.
Define the nursing metaparadigm concepts of:
Person
Health
Environment
Nursing
Describe selected nursing theories and their role in knowledge development.
Theory in Nursing
Theory: A systematic set of concepts used to describe, explain, or make predictions about phenomena.
Theories help organize knowledge and facilitate new discoveries, which advance nursing practice.
Model: A visual representation of a theory, including graphics or symbols to demonstrate relationships among concepts.
Theories must be testable, answering the following critical questions:
Is the theory accurate?
Does it reflect reality?
Does it effectively describe, explain, or predict concerning important issues?
The research process is vital for testing and refining theories, leading to knowledge enhancement within the discipline.
(Reference: Gregory et al., 2020)
Use of Theory in Knowledge Development
The intertwining of theory within nursing practice transcends mere memorization and is pivotal in practice.
Nurses apply theories in:
Direct client care
Education
Administration
Research
These practice areas, in turn, contribute to theoretical development, exemplified by a wound assessment and treatment as per germ theory, ensuring sterile techniques are maintained.
Nursing Theorists
Hildegard Peplau (1909-1999): Developed the Theory of Interpersonal Relations focusing on therapeutic relationships in mental health contexts; identified four phases of nurse-patient relationships: orientation, identification, exploitation, termination.
Virginia Henderson (1897–1996): Provided a definition of nursing that distinguishes its role from medicine; proposed nursing care based on 14 fundamental needs of patients and how nurses can address them.
Jean Watson (1940–): Known for the Theory of Human Caring, which emphasizes establishing caring relationships to cater to the body, mind, and spirit. Introduced the concept of a "caring moment" in transformations during interactions.
Laurie Gottlieb: Advocated for strengths-based care principles.
Barbara Carper: Developed the concept of ways of knowing within nursing care.
(Reference: Gregory et al., 2020)
Theoretical Considerations
When engaging with nursing theories, reflect on:
The values embedded within a theory.
The conceptualization of people and health within within it.
How environments are defined and integrated.
The purpose and focus of nursing as defined by the theory.
Any assumptions or points the theory overlooks.
Potential implications for practice derived from this understanding.
(Reference: Doane & Varcoe, 2020)
Characteristics of Humanistic Nursing
Essential characteristics include:
Nursing as being with and doing with.
Nursing as dialogue.
Nursing emphasizing the here-and-now.
Situational nursing practices.
Concurrent nursing activities within interactions (all-at-once).
Acknowledgment that patients carry strength, despite their vulnerabilities, stressing the importance of relational dynamics within care.
(Reference: Gregory et al., 2020)
How Nursing Theory Supports a Nursing Standpoint
Nursing knowledge plays a crucial role in positively influencing the well-being of patients, families, and communities.
Nursing theory facilitates the development of a nursing orientation that enhances focus, inquiry, interpretation, and actions throughout nursing duties.
Reflection on instances where practice may not align with theoretical foundations serves to underline the importance of theory in delivering quality care.
(Reference: Doane & Varcoe, 2020)