Fundamentals of Nursing Chapter 4

Theoretical Foundations of Nursing Practice

• Theory serves as the foundation for nursing care, and it is bound together with research and practice in a continuous interactive relationship.
• Theory helps explain an event by defining ideas or concepts, explaining relationships among the concepts, and predicting outcomes.

Components of a Theory

• Phenomenon
• Concepts
• Definitions
  • Theoretical/conceptual
  • Operational
• Assumptions

Domain of Nursing

• Domain
• Paradigm
• Conceptual framework
• Nursing metaparadigm
  • Person
  • Health
  • Environment/Situation

Evolution of Nursing Theory

• First nursing theorist: Florence Nightingale
• Stages of evolution:
  • Curriculum era: 1900s-1940s
  • Research era: 1950s-1970s
  • Graduate education era: 1950s-1970s
  • Theory era: 1980s-1990s
  • Theory utilization era: 2000s-today

Types of Theory

• Grand: Abstract, broad in scope, complex
• Middle-range: Limited in scope and less abstract
• Practice: Narrow in scope and focus
• Descriptive: Describe phenomena and identify circumstances in which phenomena occur
• Prescriptive: Address nursing interventions for a phenomenon, guide practice change, and predict the consequences

Theory-Based Nursing Practice

• Nursing knowledge is derived from basic and nursing sciences, experience, aesthetics, nurses' attitudes, and standards of practice
• Goal of nursing knowledge: To explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines
• Theory generates nursing knowledge for use in practice, thus supporting EBP

Shared Theories

• Explain a phenomenon specific to the discipline that developed the theory
• Several nursing theories are based on systems theory, which includes the nursing process as a system
• Nursing process components:
  • Input
  • Output
  • Feedback
  • Content

Select Nursing Theories

• Nightingale's Environmental Theory
  • Focus on environment as the focus of nursing care
  • Grand theory
• Peplau's Interpersonal Theory
  • Focus on interpersonal relations between nurse, patient, and patient's family
  • Phases: preorientation, orientation, working, resolution
  • Middle-range theory
• Orem's Self-Care Deficit Nursing Theory
  • Focus on patient's self-care needs
  • Continually assess how much self-care a patient is able to perform
  • Grand theory
• Leininger's Culture Care Theory
  • Theory of cultural care diversity and universality
  • Integrates patients' cultural traditions, values, and beliefs into care plans
  • Middle-range theory
• National Council of State Boards of Nursing Clinical Judgment Model
  • Developed to help guide nursing educators in evaluating nursing students' abilities to make clinical judgments
  • Model with multiple layers that help explain the cognitive process nurses use to make clinical judgments
  • Students can use this model to learn how to think like a nurse and make safe clinical decisions

Links Among Theory and Knowledge Development and Research in Nursing

• Nursing knowledge is theoretical and experiential
• Theoretical knowledge: goals are to stimulate thinking and create a broad understanding of nursing science and practice
• Experiential knowledge: based on nurses' experiences in providing care to patients
• Nurses consider findings from theory-based research to determine whether the theory can be used in practice
• Research is used to develop new theories and refine the knowledge base of nursing
• Theory-generating research: uses logic to explore relationships among phenomena
• Theory-testing research: determines how accurately a theory describes a nursing phenomenon