Evolution of Nursing Theories PDF

 I. Evolution of Nursing A. Introduction to Nursing Theory B. History and Philosophy of Science C. Structure of Nursing Knowledge Cristina Endozo Elauria RN., MAN CON - Faculty Member UP...

 I. Evolution of Nursing A. Introduction to Nursing Theory B. History and Philosophy of Science C. Structure of Nursing Knowledge Cristina Endozo Elauria RN., MAN CON - Faculty Member UPHSD - Calamba   Learning Outcomes: ▪ Integrate relevant concepts and metaparadigm of theories on Person, Health, Environment, and Nursing in nursing practice. ▪ Apply appropriate nursing concepts and actions holistically and comprehensively. ▪ Appreciate the value of evidence-based nursing practice in the application of nursing and related models/theories.   Nursing Theory ❑ Nursing theories are organized bodies of knowledge to define: ▪ what nursing is, ▪ what nurses do, and ▪ why they do it. ❑ Nursing theories provide a way to define nursing as a unique discipline that is separate from other disciplines (e.g., medicine). ❑ It is a framework of concepts and purposes intended to guide nursing practice at a more concrete and specific level.   Nursing Theory ❑Nursing, as a profession, is committed to recognizing its own unparalleled body of knowledge vital to nursing practice—nursing science. ✓ To distinguish this foundation of knowledge, nurses need to identify, develop, and understand concepts and theories in line with nursing. ❑As a science, nursing is based on the theory of what nursing is, what nurses do, and why. ❑Nursing is a unique discipline and is separate from medicine. It has its own body of knowledge on which delivery of care is based.   Definition of Terms: ▪ Philosophy. These are beliefs and values that define a way of thinking and are generally known and understood by a group or discipline. ▪ Theory. A belief, policy, or procedure proposed or followed as the basis of action. It refers to a logical group of general propositions used as principles of explanation. Theories are also used to describe, predict, or control phenomena. ▪ Concept. Concepts are often called the building blocks of theories. They are primarily the vehicles of thought that involve images. ▪ Models. Models are representations of the interaction among and between the concepts showing patterns. They present an overview of the theory’s thinking and may demonstrate how theory can be introduced into practice. ▪ Conceptual framework. A conceptual framework is a group of related ideas, statements, or concepts. It is often used interchangeably with the conceptual model and with grand theories.   Definition of Terms: ▪ Proposition. Propositions are statements that describe the relationship between the concepts. ▪ Domain. The domain is the perspective or territory of a profession or discipline. ▪ Process. Processes are organized steps, changes, or functions intended to bring about the desired result. ▪ Paradigm. A paradigm refers to a pattern of shared understanding and assumptions about reality and the world, worldview, or widely accepted value system. ▪ Metaparadigm. A metaparadigm is the most general statement of discipline and functions as a framework in which the more restricted structures of conceptual models develop. Much of the theoretical work in nursing focused on articulating relationships among four major concepts: person, environment, health, and nursing.   History of Nursing Theories The first nursing theories appeared in the late 1800s when a strong emphasis was placed on nursing education. ❖ In 1860, Florence Nightingale defined nursing in her “Environmental Theory” as “the act of utilizing the patient’s environment to assist him in his recovery.” ❖ In the 1950s, there is a consensus among nursing scholars that nursing needed to validate itself through the production of its own scientifically tested body of knowledge. ❖ In 1952, Hildegard Peplau introduced her Theory of Interpersonal Relations that emphasizes the nurse-client relationship as the foundation of nursing practice. ❖ In 1955, Virginia Henderson conceptualized the nurse’s role as assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs. Thus her Nursing Need Theory was developed. ❖ In 1960, Faye Abdellah published her work “Typology of 21 Nursing Problems,” which shifted the focus of nursing from a disease-centered approach to a patient-centered approach.   History of Nursing Theories ▪ In 1962, Ida Jean Orlando emphasized the reciprocal relationship between patient and nurse and viewed nursing’s professional function as finding out and meeting the patient’s immediate need for help. ▪ In 1968, Dorothy Johnson pioneered the Behavioral System Model and upheld the fostering of efficient and effective behavioral functioning in the patient to prevent illness. ▪ In 1970, Martha Rogers viewed nursing as both a science and an art as it provides a way to view the unitary human being, who is integral with the universe. ▪ In 1971, Dorothea Orem stated in her theory that nursing care is required if the client is unable to fulfill biological, psychological, developmental, or social needs.   History of Nursing Theories ▪ In 1971, Imogene King‘s Theory of Goal attainment stated that the nurse is considered part of the patient’s environment and the nurse-patient relationship is for meeting goals towards good health. ▪ In 1972, Betty Neuman, in her theory, states that many needs exist, and each may disrupt client balance or stability. Stress reduction is the goal of the system model of nursing practice. ▪ In 1979, Sr. Callista Roy viewed the individual as a set of interrelated systems that maintain the balance between these various stimuli. ▪ In 1979, Jean Watson developed the philosophy of caring, highlighted humanistic aspects of nursing as they intertwine with scientific knowledge and nursing practice. Significance  of: Discipline Profession ❖ The discipline of nursing ▪ The profession of nursing encompasses the consists of persons knowledge in the extant educated in the discipline frameworks and according to nationally theories that are regulated, defined, and embedded in the totality monitored standards. and simultaneity paradigms (Parse, 1987).  Significance  of: Discipline Profession ❖ The goal of the discipline is to ❖ The goal of the profession is to expand knowledge about human provide service to humankind experiences through creative through living the art of the science. conceptualization and research. →This knowledge is the scientific ❖ Members of the nursing profession guide to living the art of nursing. are responsible for regulation of standards of practice and education ❖ The discipline-specific knowledge is given birth and fostered in based on disciplinary knowledge academic settings where research that reflects safe health service to and education move the society in all settings. knowledge to new realms of understanding.   The Nursing Metaparadigm ▪ Four major concepts are frequently interrelated and fundamental to nursing theory: person, environment, health, and nursing. ▪ These four are collectively referred to as metaparadigm for nursing.   Person Person (also referred to as Client or Human Beings) is the recipient of nursing care and may include: ✓ individuals, ✓ patients, ✓ groups, ✓ families, and ✓ communities.   Environment Environment (or situation) is defined as the internal and external surroundings that affect the client. It includes all positive or negative conditions that affect the patient, the physical environment, such as families, friends, and significant others, and the setting for where they go for their healthcare.   Health Health is defined as the degree of wellness or well- being that the client experiences. It may have different meanings for each patient, the clinical setting, and the health care provider.   Nursing The nurse’s attributes, characteristics, and actions provide care on behalf of or in conjunction with the client. There are numerous definitions of nursing, though nursing scholars may have difficulty agreeing on its exact definition. The ultimate goal of nursing theories is to improve patient care.   Nursing You’ll find that these four concepts are used frequently and defined differently throughout different nursing theories. Each nurse theorist’s definition varies by their orientation, nursing experience, and different factors that affect the theorist’s nursing view. The person is the main focus, but how each theorist defines the nursing metaparadigm gives a unique take specific to a particular theory. To give you an example, the different definitions of various theorists on the nursing metaparadigm:    Components of Nursing Theories ▪ For a theory to be a theory, it has to contain: ✓ concepts, ✓ definitions, ✓ relational statements, and ✓ assumptions that explain a phenomenon → It should also explain how these components relate to each other.   Components of Nursing Theories Concepts Interrelated concepts define a theory. Concepts are used to help describe or label a phenomenon. They are words or phrases that identify, define, and establish structure and boundaries for ideas generated about a particular phenomenon. Concepts may be abstract or concrete. ▪ Abstract Concepts. Defined as mentally constructed independently of a specific time or place. ▪ Concrete Concepts. Are directly experienced and related to a particular time or place.   Components of Nursing Theories Definitions ❑ Definitions are used to convey the general meaning of the concepts of the theory. ❑ Definitions can be theoretical or operational. ▪ Theoretical Definitions. Define a particular concept based on the theorist’s perspective. ▪ Operational Definitions. States how concepts are measured.   Components of Nursing Theories Relational Statements Relational statements define the relationships between two or more concepts. They are the chains that link concepts to one another.  Components of Nursing Theories Phenomenon ▪ A term given to describe an idea or response about an event, a situation, a process, a group of events, or a group of situations. ▪ Phenomena may be temporary or permanent. Nursing theories focus on the phenomena of nursing.   Components of Nursing Theories Assumptions ▪ Assumptions are accepted as truths and are based on values and beliefs. ▪ These statements explain the nature of concepts, definitions, purpose, relationships, and structure of a theory.   Why are Nursing Theories Important? Let’s take a look at the importance of nursing theory and its significance to nursing practice: ▪ Nursing theories help recognize what should set the foundation of practice by explicitly describing nursing. ▪ By defining nursing, a nursing theory also helps nurses understand their purpose and role in the healthcare setting. ▪ Theories serve as a rationale or scientific reasons for nursing interventions and give nurses the knowledge base necessary for acting and responding appropriately in nursing care situations. ▪ Nursing theories provide the foundations of nursing practice, generate further knowledge, and indicate which direction nursing should develop in the future (Brown, 1964).   Why are Nursing Theories Important? Let’s take a look at the importance of nursing theory and its significance to nursing practice: ▪ By providing nurses a sense of identity, nursing theory can help patients, managers, and other healthcare professionals to acknowledge and understand the unique contribution that nurses make to the healthcare service (Draper, 1990). ▪ Nursing theories prepare the nurses to reflect on the assumptions and question the nursing values, thus further defining nursing and increasing the knowledge base. ▪ Nursing theories aim to define, predict, and demonstrate nursing phenomenon (Chinn and Jacobs, 1978). ▪ It can be regarded as an attempt by the nursing profession to maintain and preserve its professional limits and boundaries.   Why are Nursing Theories Important? Let’s take a look at the importance of nursing theory and its significance to nursing practice: ▪ Nursing theories can help guide research and informing evidence-based practice. ▪ Provide a common language and terminology for nurses to use in communication and practice. ▪ Serves as a basis for the development of nursing education and training programs. ▪ In many cases, nursing theories guide knowledge development and directs education, research, and practice, although each influences the others. (Fitzpatrick and Whall, 2005).   Purposes of Nursing Theories ❖ The primary purpose of theory in nursing is to improve practice by positively influencing the health and quality of life of patients. ❖ Nursing theories are essential for the development and advancement of the nursing profession. ❖ Nursing theories are also developed to define and describe nursing care, guide nursing practice, and provide a basis for clinical decision-making. ❖ In the past, the accomplishments of nursing led to the recognition of nursing in an academic discipline, research, and profession.   Purposes of Nursing Theories ❑In Academic Discipline ▪ Much of the earlier nursing programs identified the major concepts in one or two nursing models, organized the concepts, and build an entire nursing curriculum around the created framework. ▪ These models’ unique language was typically introduced into program objectives, course objectives, course descriptions, and clinical performance criteria. ▪ The purpose was to explain the fundamental implications of the profession and enhance the profession’s status.   Purposes of Nursing Theories ❑In Research ▪ The development of theory is fundamental to the research process, where it is necessary to use theory as a framework to provide perspective and guidance to the research study. ▪ Theory can also be used to guide the research process by creating and testing phenomena of interest. ▪ To improve the nursing profession’s ability to meet societal duties and responsibilities, there needs to be a continuous reciprocal and cyclical connection with theory, practice, and research. This will help connect the perceived “gap” between theory and practice and promote the theory- guided practice.   Purposes of Nursing Theories ❑In the Profession ▪ Clinical practice generates research questions and knowledge for theory. In a clinical setting, its primary contribution has been the facilitation of reflecting, questioning, and thinking about what nurses do. Because nurses and nursing practice are often subordinate to powerful institutional forces and traditions, introducing any framework that encourages nurses to reflect on, question, and think about what they do provide an invaluable service.  Classification of Nursing Theories  There are different ways to categorize nursing theories. They are classified depending on their function, levels of abstraction, or goal orientation. ▪ By Abstraction There are three major categories when classifying nursing theories based on their level of abstraction: ▪ grand theory, ▪ middle-range theory, and ▪ practice-level theory.  Classification of Nursing Theories  There are different ways to categorize nursing theories. They are classified depending on their function, levels of abstraction, or goal orientation. By Abstraction: Grand Nursing Theories ▪ Grand theories are abstract, broad in scope, and complex, therefore requiring further research for clarification. ▪ Grand nursing theories do not guide specific nursing interventions but rather provide a general framework and nursing ideas. ▪ Grand nursing theorists develop their works based on their own experiences and their time, explaining why there is so much variation among theories. ▪ Address the nursing metaparadigm components of person, nursing, health, and environment.  Classification of Nursing Theories  There are different ways to categorize nursing theories. They are classified depending on their function, levels of abstraction, or goal orientation. By Abstraction: Middle-Range Nursing Theories ▪ More limited in scope (compared to grand theories) and present concepts and propositions at a lower level of abstraction. They address a specific phenomenon in nursing. ▪ Due to the difficulty of testing grand theories, nursing scholars proposed using this level of theory. ▪ Most middle-range theories are based on a grand theorist’s works, but they can be conceived from research, nursing practice, or the theories of other disciplines.  Classification of Nursing Theories  There are different ways to categorize nursing theories. They are classified depending on their function, levels of abstraction, or goal orientation. By Abstraction: Practice-Level Nursing Theories ▪ Practice nursing theories are situation- specific theories that are narrow in scope and focuses on a specific patient population at a specific time. ▪ Practice-level nursing theories provide frameworks for nursing interventions and suggest outcomes or the effect of nursing practice. ▪ Theories developed at this level have a more direct effect on nursing practice than more abstract theories. ▪ These theories are interrelated with concepts from middle-range theories or grand theories.  Classification of Nursing Theories  There are different ways to categorize nursing theories. They are classified depending on their function, levels of abstraction, or goal orientation. By Goal Orientation ▪ Theories can also be classified based on their goals. ▪ They can be descriptive or prescriptive.   By Goal Orientation 1. Descriptive Theories ▪ Descriptive theories are the first level of theory development. They describe the phenomena and identify its properties and components in which it occurs. ▪ Descriptive theories are not action-oriented or attempt to produce or change a situation. ▪ There are two types of descriptive theories: factor- isolating theory and explanatory theory.  By Goal Orientation  Descriptive Theories : Factor-Isolating Theory ▪ Also known as category-formulating or labeling theory. ▪ Theories under this category describe the properties and dimensions of phenomena.  By Goal Orientation  Descriptive Theories : Explanatory Theory ▪ Explanatory theories describe and explain the nature of relationships of certain phenomena to other phenomena.   By Goal Orientation 2. Prescriptive Theories ▪ Also known as “ Situation Producing Theory’ ▪ Address the nursing interventions for a phenomenon, guide practice change, and predict consequences. ▪ Includes propositions that call for change. ▪ In nursing, prescriptive theories are used to anticipate the outcomes of nursing interventions.   By Goal Orientation 2. Prescriptive Theories ▪ Deal with nursing actions, and test the validity and certainty of a specific nursing intervention. ▪ This kind of theory is commonly used in testing new nursing interventions. ▪ EXAMPLE: Laurente’s theory validates and explains the different nursing management in the Emergency Room in relieving anxiety among its clients.  Other Ways of Classifying Nursing Theories  ▪ Classification According to Meleis ▪ Afaf Ibrahim Meleis (2011), in her book Theoretical Nursing: Development and Progress, organizes the major nurse theories and models using the following headings: ✓ needs theories, ✓ interaction theories, and ✓ outcome theories. ▪ These categories indicate the basic philosophical underpinnings of the theories.  Other Ways of Classifying Nursing Theories  ▪ Classification According to Meleis ✓ Needs-Based Theories. The needs theorists were the first group of nurses who thought of giving nursing care a conceptual order. Theories under this group are based on helping individuals to fulfill their physical and mental needs. ✓ Theories of Orem, Henderson, and Abdella are categorized under this group. ✓ Need theories are criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position.  Other Ways of Classifying Nursing Theories  ▪ Classification According to Meleis ▪ Interaction Theories. These theories emphasized nursing on the establishment and maintenance of relationships. They highlighted the impact of nursing on patients and how they interact with the environment, people, and situations. ▪ Theories of King, Orlando, and Travelbee are grouped under this category.  Other Ways of Classifying Nursing Theories  ▪ Classification According to Meleis ▪ Outcome Theories. These theories describe the nurse as controlling and directing patient care using their knowledge of the human physiological and behavioral systems. ▪ The nursing theories of Johnson, Levine, Rogers, and Roy belong to this group.  Other Ways of Classifying Nursing Theories  ▪ Classification According to Alligood ▪ In her book, Nursing Theorists and Their Work, Raile Alligood (2017) categorized nursing theories into four headings: ✓ nursing philosophy, ✓ nursing conceptual models, ✓ nursing theories and grand theories, and ✓ middle-range nursing theories.  Classification According to Alligood  ▪ Nursing Philosophy → is the most abstract type and sets forth the meaning of nursing phenomena through analysis, reasoning, and logical presentation. Works of Nightingale, Watson, Ray, and Benner are categorized under this group. ▪ Nursing Conceptual Models. These are comprehensive nursing theories that are regarded by some as pioneers in nursing. These theories address the nursing metaparadigm and explain the relationship between them. Conceptual models of Levine, Rogers, Roy, King, and Orem are under this group.  Classification According to Alligood  ▪ Grand Nursing Theories → are works derived from nursing philosophies, conceptual models, and other grand theories that are generally not as specific as middle-range theories. Works of Levine, Rogers, Orem, and King are some of the theories under this category. ▪ Middle-Range Theories → are precise and answer specific nursing practice questions. They address the specifics of nursing situations within the model’s perspective or theory from which they are derived. Examples of Middle-Range theories are that of Mercer, Reed, Mishel, and Barker. Theena