Nursing Theories: Grand, Middle-Range, and Descriptive

Nursing Theories

• Grand theories are systematic, broad in scope, complex, and require further specification through research.
• Examples of grand theories include Neuman's system model.
• Middle-range theories are limited in scope, more abstract, and address specific phenomena, reflecting practice in administration, clinical, or teaching.
• Examples of middle-range theories include Mishel's uncertainty theory.
• Descriptive theories are the first level of theory development and do not direct specific nursing activities but help explain nursing assessment.
• Prescriptive theories address nursing interventions for a phenomenon, describe the conditions under which the prescription occurs, and predict the consequences.
• Examples of prescriptive theories include Watkins' effective decision-making theory.

Selected Nursing Theories

• Nightingale's Theory focuses on the environment.
• Virginia Henderson's Theory focuses on the activity of daily living.
• Orem's Theory focuses on self-care.
• Leininger's Theory focuses on transcultural nursing.
• Watson's Theory focuses on caring.
• Roy's Theory focuses on adaptation.

A Brief History of Nursing Theories

• The first nursing theories appeared in the late 1800s with a strong emphasis on nursing education.
• Florence Nightingale was one of the first nursing theorists, publishing her thoughts on nursing during the Crimean War in 1859.
• Nurses' roles focus on providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition, in addition to administering treatments and medication.

Orem's Self-Care Model

• The client is a biologic, psychological, and social being with the capacity for self-care.
• Self-care refers to the practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being.
• Health is the person's ability to live fully within a particular physical, biologic, and social environment, achieving a higher level of facing 'healthy'.

Environment and Nursing

• The environment is the medium through which clients move as they conduct their daily activities.
• The environment is generally viewed as a negative factor on a person's health status because they may detract from the ability to provide self-care.
• Nursing aims to help clients conduct self-care activities to reach an optimum level of functioning.

Islamic Perspectives

• In Islam, cleanliness is an important aspect of one's life.
• The concept of ablution is significant in Islam.

Nursing Process

• Nursing is a science of human relationships and caring.
• The nursing process parallels scientific research and involves assessment, creation of a care plan, data collection, intervention, and evaluation.

Watson's Hierarchy of Needs

• Watson's hierarchy of needs aims to assist with the gratification of human needs.
• Lower-order biophysical needs include food and fluid, elimination, and ventilation.
• Lower-order psychophysical needs include activity-inactivity and sexuality.
• Higher-order psychosocial needs include achievement, affiliation, intrapersonal-interpersonal need, and self-actualization.

Roy's Adaptation Theory

• Roy's adaptation theory states that the environment and the individual are sources of stimuli that require modification to promote adaptation in the patient.
• Adaptation is defined as a process and outcome whereby thinking and feeling persons, as individuals or groups, use conscious awareness and choice to create human and environmental integration.
• Adaptation is manifested by four interrelated modes of behavior, including physiological, self-concept, role function, and interdependence modes.

Interpersonal Relations in Nursing

• Interpersonal relations in nursing stress the importance of nurses' ability to understand their own behaviors to help others identify perceived difficulties.
• The theory emphasizes the focus on interpersonal processes and therapeutic relationships between the nurse and client.
• The four phases of the nurse-patient relationship are orientation, identification, exploitation, and resolution.
• The six primary roles of the nurse are stranger, teacher, resource person, counselor, surrogate, and leader.
• The six secondary roles of the nurse are technical expert, mediator, safety agent, researcher, tutor, and leader.

Other Relevant Theories

• Health Belief Model
• Protection Motivation Theory
• Self-efficacy Theory
• Theory of Reasoned Action
• Theory of Planned Behavior
• Theories of Grief and Mourning

Conclusion

• Theoretical foundation is vital to govern the practice in Nursing.
• Each theory is unique and only explains certain elements of interest.