Nursing Theories Lecture 1 PDF

# NURSING THEORIES Prepared by: Dr. Ali H. Al-Khatib Assis. Professor of CHN “Practicing nurses who despise theory are condemned to performing a series of tasks - either at the command of a physician or in response to routines and policies.” ### Ask… - WHY STUDY NURSING THEORY? - WHAT DOES TH...

# NURSING THEORIES Prepared by: Dr. Ali H. Al-Khatib Assis. Professor of CHN “Practicing nurses who despise theory are condemned to performing a series of tasks - either at the command of a physician or in response to routines and policies.” ### Ask… - WHY STUDY NURSING THEORY? - WHAT DOES THE PRACTICING NURSE WANT FROM NURSING THEORY? ## OUTLINE OF TOPICS - Definitions of theory, concept, model, proposition - Basic concepts related to nursing theories (person, health, environment, and nursing) - Characteristics of theories. - Needs of theories - History and evolution of nursing theory. - Types of theory - Relationship of theory to practice and research. - Relationship of theory to nursing process. ## LEARNING OBJECTIVES At the end of this chapter, the student should be able to: 1. Define of theory, concept, model, proposition. 2. Explain the relationships of concepts and propositions to theory. 3. Discuss the purpose of theory. 4. Explain the interdependent roles of nursing practice, nursing theory, and nursing research. 5. Identify the three categories relating to the scope of theories. 6. Describe the meta-paradigm concepts in nursing. 7. Identify common concept in nursing theories. ## THEORY - ORIGIN: "THOERIA" - speculate ## Introduction Nursing theory provides a perspective from which to define the what of nursing, to describe the who of nursing (who is the client) and when nursing is needed, and to identify the boundaries and goals of nursing's therapeutic activities. Theory is fundamental to effective nursing practice and research. The professionalization of nursing has been and is being brought about through the development and use of nursing theory. ## Definitions Theory is a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory & predictive in nature. Theory is "a creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena". - Theories are composed of concepts, definitions, models, propositions & are based on assumptions. - They are derived through two principal methods; deductive reasoning and inductive reasoning. - A theory makes it possible to “organize the relationship among the concepts to describe, explain, predict, and control practice". ## What are the components of a theory? - Concepts - ideas and mental images that help to describe phenomena. - Definitions - convey the general meaning of the concepts. - Assumptions - statements that describe concepts ## WHAT IS A CONCEPT? A concept is communicated using language with the intention that words, terms, and expressions represent the developed idea. Words, terms, or expressions are not the concept itself but rather represent it. ## Concept A concept is the basic building block of a theory. ## Concept Are complex mental formulations of one's perceptions of the world. A concept assists us in formulating a mental image about an object or situation. ## Types of concepts: 1. Empirical or concrete concepts: These are directly observable objects, events, or properties, which can be seen, felt or heard e.g color of the skin, communication skill, presence of lesion, wound status etc. 2. Inferential/relatively concrete concepts: These are indirectly observable concepts, e.g pain, Dyspnea. 3. Abstract Concepts: These concepts are not clearly observable directly or indirectly. E.g. social support, Personal Role, Self-esteem etc. - Most of the theories use abstract concepts and it should be defined as observable (concrete) concepts when applied in research, education and practice. In simple terms, we transform the abstract concepts to concrete concepts based on local need. - Abstract concepts not affected by time and space. It can be applied and used in wider settings and populations. ## Why concepts should be studied? 1) Concepts are used to develop theories: The theories are constructed from concepts, and thus the elaboration of concept meaning is vital for construction of theories. 2) Concepts can be operationalized: Concepts can be analyzed for their application in practice (e.g., respect, collaboration, and die with dignity. 3) Concepts can be used to enhance practice: By analyzing, concepts a professional can better understand the meaning of commonly used terms. For example, research that aims to explore the concept of dignity can help increase nurses' awareness of the importance of this concept and encourage them to appreciate the vulnerable position of patients who are receiving care. ## Nursing Concepts The clarity of a particular concept could contribute to the construction of a body of knowledge in a given area, and lack of clarity results in less consistent science than is desired. ## EMPIRICAL INDICATORS - An actual instrument, experimental condition or clinical procedure that is used to observe or measure abstract concepts ## What is a proposition? - Propositions are statements that explain the relationship between the concepts. - A nursing propositional statement linking the concept of helplessness and the concept of loss might be stated as “multiple and rapid losses predispose one to feelings of helplessness.” Propositional statements in a theory represent the theorist's particular view of which concepts fit together and, in most theories, establish how concepts affect one another. ## What is a paradigm? - A model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline ## METAPARADIGM - Most abstract level of knowledge. - The metaparadigm is very general and is intended to reflect agreement among members of the discipline about the field of nursing. - Central concepts of person, environment, health and nursing. - It offers a context for developing conceptual models and theories. ## METAPARADIGM CONCEPTS - THE PERSON - THE ENVIRONMENT - HEALTH - NURSING (GOALS, ROLES & FUNCTIONS) ## Philosophy Philosophies provide us with broad general views of nursing that clarify nursing values to answer broad disciplinary questions - A philosophy comprises statements of enduring values and beliefs held by members of the discipline. - Knowledge level which specifies the definitions of the metaparadigm concepts in each of the conceptual models of nursing. - Nightingale model is considered a philosophical approach. ## MODELS - Representations of the interaction among and between the concepts showing patterns. - In nursing, models are often designed by theory authors to depict the beliefs in their theory (Lancaster and Lancaster 1981). ## What is a domain? - The view or perspective of the discipline - It contains the subject, central concepts, values and beliefs, phenomena of interest, and the central problems of the discipline ## Nursing Domain Nightingale may have led the call for domain and focus by distinguishing nursing from medicine and other services. ## CHARACTERISTICS OF THEORIES 1. Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. 2. Theories must be logical in nature. 3. Theories should be relatively simple yet generalizable. 4. Theories can be the bases for hypotheses that can be tested. 5. Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them. 6. Theories can be used by the practitioners to guide and improve their practice. 7. Theories must be consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated. ## SIGNIFICANCE OF THEORY FOR NURSING As a Discipline and Profession ## DISCIPLINE - Specific to the academia and refers to a branch of education, a department of learning or a domain of knowledge. ## PROFESSION - A specialized field of practice, which is founded upon the theoretical structure of the science or knowledge of the discipline and the accompanying practice abilities. ## FUNCTION OF THEORIES Primary Purpose: To Generate Knowledge ## What are the purposes of nursing theory? - It guides nursing practice and generates knowledge. - It helps to describe or explain nursing. - Enables nurses to know WHY they are doing WHAT they are doing. - Explains and predicts outcomes. - Supports decision making. ## TYPES ACCORDING TO SCOPE - **GRAND THEORY** - It is the broadest in scope, represents the most abstract level of development, and addresses the broad phenomena of concern within the discipline. - **MIDDLE-RANGE THEORY** - theory that addresses more concrete and more narrowly defined phenomena. It is intended to answer questions about nursing phenomena, yet they do not cover the full range of phenomena of concern to the discipline - **MICRO-RANGE THEORY** - concrete and narrow in scope. It explains a specific phenomenon of concern to the discipline ## TYPES ACCORDING TO FUNCTION - Descriptive-to identify the properties and workings of a discipline - Explanatory-to examine how properties relate and thus affect the discipline - Predictive-to calculate relationships between properties and how they occur - Prescriptive -to identify under which conditions relationships occur ## Based on the philosophical underpinnings of the theories: 1. **"Needs" theories** - Are based around helping individuals to fulfill their physical and mental needs. 2. **"Interaction" theories** - As described by Peplau (1988), these theories revolve around the relationships nurses form with patients. 3. **"Outcome" theories"** - Outcome theories portray the nurse as the changing force, who enables individuals to adapt to or cope with ill health. 4. **"Humanistic" Theories** - Humanistic theories developed in response to the psychoanalytic thought that a person's destiny was determined early in life. - Humanistic theories emphasize a person's capacity for self-actualization. ## Commonly used non-nursing theories - Systems theory - Basic Human Needs theory - Health and Wellness Models - Stress and Adaptation - Developmental Theories - Psychosocial Theories ## What is the link between nursing theory and the research process? - Theory provides direction for nursing research - Relationships of components in a theory help to drive the research questions for understanding nursing ## Process of Knowledge Development - Nursing Practice - Nursing Theory - Nursing Research ## Historical View MID 1800'S AND 1960'S - Mid 1800's – Nursing Knowledge is distinct from medical knowledge (Nightingale) - Nursing practices was based on principles and traditions passed on through apprenticeship education and common sense wisdom. - Nursing as a Vocational heritage more than professional vision. - 1960's – debates and discussion regarding the proper direction and appropriate disciple for nursing knowledge development. ## HISTORICAL ERAS - **CURRICULM ERA** - Moving nursing education from hospital-based diploma programs into college and universities. - **RESEARCH ERA** - Research is the path to new knowledge. Part of the curricula of developing graduate programs. - **GRAD. EDU. ERA** - Masters program in nursing emerged to meet the need for nurses with specialized education in nursing. Nursing Theory and Nursing Conceptual models were included as courses in the study of nursing. - **THEORY ERA** - Outgrowth of research era. Research without theory produced isolated information; however research and theory produced nursing science. ## KEY CONCEPTS - **Nightingale 1860:** To facilitate “the body's reparative processes" by manipulating client's environment - **Peplau 1952:** Nursing is therapeutic interpersonal process. - **Henderson 1955:** The needs often called Henderson's 14 basic needs - **Abdellah 1960:** The whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family. - **Orbando 1962:** The client is an individual; with a need: that, when met, diminishes distress, increases adequacy, or enhances well-being. - **Johnson's Theory 1968:** Focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. The goal of nursing to reduce stress so that; the client can move more easily through recovery. - **Rogers 1970:** Maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through “humanistic science of nursing” - **Orem 1971:** Self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs. - **King 1971:** Use communication to help client reestablish positive adaptation to environment. - **Neuman 1972:** Stress reduction is goal of system model of nursing practice - **Roy 1979:** This adaptation model is based on the physiological, adaptive psychological, sociological and dependence-independence adaptive modes, activity in regard to the; humanistic aspects of life - **Watson's Theory 1979:** Defines the outcome of nursing activity in regard to the; humanistic aspects of life. ## Current trends that influence nursing theory - Medical science - Nursing education - Professional nursing organizations - Evolving research approaches - Global concerns - Consumer demands - Technologies ## SUMMARY - Thank you! - Learning, a division of Thomson Learning, Inc.