Nursing Theory: Concepts and Characteristics

Theory

• Theory comes from “Theoria”, Greek for looking at, viewing, and beholding
• Theories structure ideas project a tentative, purposeful, and systematic view of phenomena
• Scientific method ensures proposed phenomenon explanations are consistent

Characteristics of Theory

• Creative emphasizes human imagination and vision in theory development
• Tentative means theories remain open to revision as new evidence emerges
• Purposeful suggests how to view facts/events
• Systematic means a theory involves step-by-step processes

Phenomena

• Phenomena strike as strange, unusual, or unaccountable
• Phenomena can be extraordinary or very remarkable person, thing, or occurrence
• Phenomena are aspects of reality people consciously sense or experience, e.g., thunder

Nursing Theory

• Nursing theory is a body of knowledge supporting the field's practices
• Theories are developed from experimental learnings, formal, and non-nursing sources
• Nursing theories stem from nursing philosophies, conceptual models, and disciplines outside nursing
• Nursing theories conceptualise aspects of nursing to describe, explain, predict, and provide nursing care

Purpose of Nursing Theory

• Theories guide and give direction to practice
• Theories aim to improve patient care quality

Classification of Nursing Theory

• Descriptive theories develop properties and components of phenomena but do not produce change
• Descriptive theories are the first level of theory development
• Descriptive theories don't give action and don't produce any change

Types of Descriptive Theory

• Factor isolating theory identifies and describes main concepts or factors
• Factor relating theory explains relationships among concepts or factors

Predictive Theory

• Predictive theory relates situation to theory, and produces/creates change
• Predictive theories describe a condition under which relationships can produce future outcomes

Prescriptive Theory

• Prescriptive theory is situation-producing theory
• Prescriptive theory directs nursing action and specific interventions, and tests for validity
• Prescriptive theory Commonly guides nursing interventions to change/predict consequences, and anticipate outcomes

Nursing Metaparadigms

• Metaparadigms, from Greek for "meta (a width) “paradigm” (with pattern)", are patterns showing relationships among theoretical works
• Nursing metaparadigms are core content
• They define boundaries for the discipline, including the focus of nursing theory

Four Nursing Metaparadigms

• Four fundamental and interrelated concepts: person, health, environment, and nursing

Person

• The term is used for human beings
• A person is seen as a recipient of nursing car, whether individual, family, or community
• A person is the focus of nursing practice

Health

• Health implies complete physical, mental and social well-being, not just absence of disease or infirmity (WHO definition)
• Health can have different meanings for patients, clinicians, and healthcare professionals
• Health is dynamic and continuously changing
• Providing the best care based on a patient's health level and needs

Environment

• Environment represents a person's immediate surroundings
• It includes the community, the universe, and all its contents
• The internal aspect of a person including positive and negative condition, and the external aspects of physical environment including friends and family of the client
• Environment references surrounding objects

Nursing

• Nursing focuses on providing essential service to restore and maintain health
• Nursing characteristics are attributes and action of nurse providing care to the client

Nursing Metaparadigms in Practice

• Essential to understand the basic concepts of person, health, environment, and nursing
• Understanding these relationships is needed for professional to address the patient holistically in terms of health and well being, the patient's current environment and the nursing responsibilities
• The nursing metaparadigm points to holistic patient care

Philosophy

• Philosophy, is derived from Greek word philosophia, meaning love of wisdom
• Philosophy is understanding reality and answering fundamental questions about knowledge, life, morality, and human nature
• These specifies definitions of paradigm concepts in each conceptual model
• Philosophy gives broad direction and understanding

Philosophy in Nursing

• Philosophy is the next-level knowledge after metaparadigm
• It specifies definitions of nursing’s metaparadigm concepts

Conceptual Model/Framework

• Conceptual Models and Frameworks represent an idea
• They are based on personal understanding of concepts showing patterns and interactions
• These allow successful application of nursing theory to practice
• These concepts specify relationships to form an organized perspective for viewing phenomena
• They are vital to King's goal attainment

Differentiation

• Conceptual frameworks have a very specific structure and a narrower scope
• Theoretical frameworks have general concepts and a broader scope with less structure
• Conceptual frameworks are derived from specific concepts and variables in a study
• Theoretical frameworks derive from existing theories

Science

• Science is derived from the Latin word "scientia," meaning "knowledge"
• It is system of acquiring knowledge using the scientific method
• It is organized knowledge based on research

Basic Types of Science

• Natural sciences (geology, meteorology)
• Basic/pure sciences Mathematics, English)
• Human/social sciences (political science, economics, sociology, psychology)
• Practice/applied science (nursing, engineering, architecture)

Knowledge

• Knowledge is skills/expertise acquired through education and experience

Types of Cognitive Processes

• Perception allows perceiving things based on senses and intuition
• Association provides the ability to relate concepts
• Learning is a very important cognitive process
• It leads to acquiring information and developing new skills/capacities

Cognitive Reasoning and Communication

• Reasoning includes mental processing for conclusions and logical beliefs
• Communication is sharing acquired knowledge with others

Other Cognitive Processes

• Problem solving, critical thinking, and memory (ability to sore information)
• Comprehension is included (allows understanding of a certain concept)

Sources of Knowledge

• Traditional knowledge: Gained traditionally
• Authoritative knowledge comes from trusted people/parents
• Experimentation

Concepts

• Concepts are the building blocks of theory
• Concepts are ideas expressed in words or phrases to identify structures and boundaries for generating phenomena
• These include basic words used to describe objects, properties, or events
• Concepts bring forth mental pictures and give meanings

Categorization of Concepts

• Empirical/Concrete: Observed through the senses
  • Eg. Stethoscope, nurse
• Abstract: Not directly observable such as caring, hope, and infinity

Defining and Types of Concepts

• Defining
  • theoretical: Meaning based on theory/literature
  • operational: Meaning based on measuring the work
• Types
  • Discrete; identifies categories
  • Continuous: Classifies gradations/dimensions

Chapter 2: Importance of Nursing Theory

• Provides structure and organization
• Creates reasoning, critical thinking, and decision making abilities and enhances autonomy and create an independent job

Clinical Practice

• Assists in describing, explaining, and predicting every day experiences
• Guides assessments, interventions, and evaluations
• Helps measure quality
• Provides rational for reliable collection of data and enhances decision making
• Builds common terminology across healthcare providers/team

Education

• Provides general focus on curriculum design and guides curricular decisions creating a specialization
• Establishes profession place in the university

Research

• Provides an essential service by identifying approach gaps in specific fields of study and improve health care
• Offers a framework for generating new knowledge and ideas/concepts and assists in discovering knowledge gaps
• It offers a systematic approach to identify questions for a study, select variables, interpret findings, and validate nursing interventions

Chapter 3: Four Ways of Knowing

• Barbara Carper identifies 4 methods of establishing knowledge
  • Empirical, esthetic / ethical, and personal way of knowing

Empirical Knowing

• Knowledge gained from observation, experience, or experiment based on scientific process
• Data needs to be verifiable and tested overtime
• Formulate scientific generalization laws and theories to explain and predict

Ethical Knowing

• Ethical knowing is the acceptance of right and wrong in terms of principles that govern the conduct of one in a profession
• In nursing, ethical knowing refers to a moral code based on respecting people and on obligation to serve
• Includes Code of Ethics

Basic Ethical Principles In Nursing

 - Autonomy: Freedom and respect of their choice/decision
 - Beneficence: To always do good (e.g. rendering of care)
 - Non maleficence: To do no harm to your patients

Ethical Principles

 - Veracity: Communicate truthfully
 - Confidentiality: Safeguarding and protecting client's health and stats
 - Justice or Equity: No favoritism
 - Fidelity or word: To be faithful to your words

Aesthetic/ Esthetic Knowing

• This is the branch of philosophy dealing with nature of beauty
• Relies on perception or your own intuition
• It is emphatic and expressive, which enables the nurse to try and put herself on the situation of the client
• Skills or action evident through attitude and interactions/ To respond with skilled action

Personal Knowing

• Encompasses self-experience, and knowing
• It is expressed through personality and can integrated with personal responsibility with the help of therapeutic use of yourself

Levels of Prevention

CHAPTER 4: Development of Theory in Nursing

• Scientists are passive observers with theories structuring what scientists observe
• Pre-supposed theories and observable data interact
• When new problems/observations emerge, it causes one to think

Empiricism

• Knowledge comes from sensory experience
• Scientific data is gathered generalizing observed facts naturally
• This starts with observation

Rationalism

• Makes use of reasoning to advance knowledge
• The rationale is based on deductive logics which are from the theory to observation
• It proceeds to use deductive logics

Philosophers’ View

• Structures of theory are focused on analysis
• For science, empirical research with knowledge should not be just based on the existing understanding but what is observed

CHAPTER 5 :Categories of Theories

• Micro-range theory (practice theory) is linking of concrete concepts into statement for practice/research
• Concepts used and narrowly defined, and list specific goals and action
• Limited and provides specific population

Middle-Range Theory

• Deals with nursing's total concerns but is not discipline
• Moderately abstract, inclusive, but is composed of cones that are measurable and abstract
• Focus is on theoretical frameworks, answering to nursing questions

Grand Theory

• These are the theories that explain overall experience of the human being
• Abstract and don't lend easil