Nursing Theories and Nursing Practice PDF 4th Edition

·- Fourth Edition Nursing Theories and Nursing Practice 3312_FM_i-xx 26/12/14 5:51 PM Page i Nursing Theories & Nursing Practice Fourth Edition 3312_FM_i-xx 26/12/14 5:51 PM P...

·- Fourth Edition Nursing Theories and Nursing Practice 3312_FM_i-xx 26/12/14 5:51 PM Page i Nursing Theories & Nursing Practice Fourth Edition 3312_FM_i-xx 26/12/14 5:51 PM Page ii 3312_FM_i-xx 26/12/14 5:51 PM Page iii Nursing Theories & Nursing Practice Fourth Edition Marlaine C. Smith, PhD, RN, AHN-BC, FAAN Marilyn E. Parker, PhD, RN, FAAN 3312_FM_i-xx 26/12/14 5:51 PM Page iv F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2015 by F. A. Davis Company Copyright © 2015 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher, Nursing: Joanne Patzek DaCunha, RN, MSN; Susan Rhyner Developmental Editor: Marcia Kelley Director of Content Development: Darlene D. Pedersen Content Project Manager: Echo K. Gerhart Manager of Art and Design: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Nursing theories and nursing practice. Nursing theories & nursing practice / [edited by] Marlaine C. Smith, Marilyn E. Parker. — Fourth edition. p. ; cm. Preceded by Nursing theories and nursing practice / [edited by] Marilyn E. Parker, Marlaine C. Smith. 3rd ed. c2010. Proudly sourced and uploaded by [StormRG] Includes bibliographical references and index. Kickass Torrents | TPB | ET | h33t ISBN 978-0-8036-3312-4 (alk. paper) I. Smith, Marlaine C. (Marlaine Cappelli), editor. II. Parker, Marilyn E., editor. III. Title. [DNLM: 1. Nursing Theory—Biography. 2. Nurses—Biography. WY 86] RT84.5 610.7301—dc23 2014047296 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-3312-4/15 0 + $.25. 3312_FM_i-xx 26/12/14 5:51 PM Page v Preface to the Fourth Edition This book offers the perspective that nursing is theory and Paterson & Zderad’s humanistic a professional discipline with a body of knowl- nursing have been moved to supplementary on- edge that guides its practice. Nursing theories line resources at http://davisplus.fadavis.com. are an important part of this body of knowl- This book is intended to help nursing stu- edge, and regardless of complexity or abstrac- dents in undergraduate, masters, and doctoral tion, they reflect phenomena central to the nursing programs explore and appreciate nurs- discipline, and should be used by nurses to ing theories and their use in nursing practice frame their thinking, action, and being in the and scholarship. In addition, and in response world. As guides, nursing theories are practical to calls from practicing nurses, this book is in- in nature and facilitate communication with tended for use by those who desire to enrich those we serve as well as with colleagues, stu- their practice by the study of nursing theories dents, and others practicing in health-related and related illustrations of nursing practice. services. We hope this book illuminates for the The contributing authors describe theory de- readers the interrelationship between nursing velopment processes and perspectives on the theories and nursing practice, and that this un- theories, giving us a variety of views for the derstanding will transform practice to improve twenty-first century and beyond. Each chapter the health and quality of life of people who are of the book includes descriptions of a theory, recipients of nursing care. its applications in both research and practice, This very special book is intended to honor and an example that reflects how the theory the work of nursing theorists and nurses who can guide practice. We anticipate that this use these theories in their day-to-day practice. overview of the theory and its applications will Our foremost nursing theorists have written lead to deeper exploration of the theory, lead- for this book, or their theories have been de- ing students to consult published works by the scribed by nurses who have comprehensive theorists and those working closely with the knowledge of the theorists’ ideas and who have theory in practice or research. a deep respect for the theorists as people, There are six sections in the book. The first nurses, and scholars. To the extent possible, provides an overview of nursing theory and a contributing authors have been selected by focus for thinking about evaluating and choos- theorists to write about their work. Three ing a nursing theory for use in practice. For middle-range theories have been added to this this edition, the evolution of nursing theory edition of the book, bringing the total number was added to Chapter 1. Section II introduces of middle-range theories to twelve. Obviously, the work of early nursing scholars whose ideas it was not possible to include all existing provided a foundation for more formal theory middle-range theories in this volume; how- development. The nursing conceptual models ever, the expansion of this section illustrates and grand theories are clustered into three the recent growth in middle-range theory de- parts in Sections III, IV, and V. Section III velopment in nursing. Two chapters from the contains those theories classified within the third edition, including Levine’s conservation interactive-integrative paradigm, and those in v 3312_FM_i-xx 26/12/14 5:51 PM Page vi vi Preface to the Fourth Edition the unitary-transformative paradigm are in- editors we’ve found that continuing to learn cluded in Section IV. Grand theories that are about and share what we love nurtures our focused on the phenomena of care or caring growth as scholars, reignites our passion and appear in Section V. The final section contains commitment, and offers both fun and frustra- a selection of middle-range theories. tion along the way. We continue to be grateful An outline at the beginning of each chapter for the enthusiasm for this book shared by provides a map for the contents. Major points many nursing theorists and contributing are highlighted in each chapter. Since this authors and by scholars in practice and book focuses on the relationship of nursing research who bring theories to life. For us, it theory to nursing practice, we invited the has been a joy to renew friendships with col- authors to share a practice exemplar. You will leagues who have contributed to past editions notice that some practice exemplars were writ- and to find new friends and colleagues whose ten by someone other than the chapter author. theories enriched this edition. In this edition the authors also provided Nursing Theories and Nursing Practice, now content about research based on the theory. in the fourth edition, has roots in a series of Because of page limitations you can find nursing theory conferences held in South additional chapter content online at http:// Florida, beginning in 1989 and ending when davisplus.fadavis.com. While every attempt efforts to cope with the aftermath of Hurricane was made to follow a standard format for each Andrew interrupted the energy and resources of the chapters throughout the book, some of needed for planning and offering the Fifth the chapters vary from this format; for exam- South Florida Nursing Theory Conference. ple, some authors chose not to include practice Many of the theorists in this book addressed exemplars. audiences of mostly practicing nurses at these The book’s website features materials that conferences. Two books stimulated by those will enrich the teaching and learning of these conferences and published by the National nursing theories. Materials that will be helpful League for Nursing are Nursing Theories in for teaching and learning about nursing theo- Practice (1990) and Patterns of Nursing Theories ries are included as online resources. For exam- in Practice (1993). ple, there are case studies, learning activities, For me (Marilyn), even deeper roots of this and PowerPoint presentations included on book are found early in my nursing career, both the instructor and student websites. Other when I seriously considered leaving nursing for online resources include additional content, the study of pharmacy. In my fatigue and frus- more extensive bibliographies and longer biog- tration, mixed with youthful hope and desire raphies of the theorists. Dr. Shirley Gordon for more education, I could not answer the and a group of doctoral students from Florida question “What is nursing?” and could not dis- Atlantic University developed these ancillary tinguish the work of nursing from other tasks materials for the third edition. For this edition, I did every day. Why should I continue this the ancillary materials for students and faculty work? Why should I seek degrees in a field were updated by Diane Gullett, a PhD candi- that I could not define? After reflecting on date at Florida Atlantic University. She devel- these questions and using them to examine my oped all materials for the new chapters as well nursing, I could find no one who would con- as updating ancillary materials for chapters that sider the questions with me. I remember being appeared in the third edition. We are so grate- asked, “Why would you ask that question? You ful to Diane and Shirley for their creativity and are a nurse; you must surely know what nurs- leadership and to the other doctoral students for ing is.” Such responses, along with a drive for their thoughtful contributions to this project. serious consideration of my questions, led me We hope that this book provides a useful to the library. I clearly remember reading se- overview of the latest theoretical advances of veral descriptions of nursing that, I thought, many of nursing’s finest scholars. We are could just as well have been about social work grateful for their contributions to this book. As or physical therapy. I then found nursing 3312_FM_i-xx 26/12/14 5:51 PM Page vii Preface to the Fourth Edition vii defined and explained in a book about educa- enough! It led to my decision to pursue my tion of nurses written by Dorothea Orem. PhD in Nursing at New York University During the weeks that followed, as I did my where I studied with Martha Rogers. During work of nursing in the hospital, I explored this same time I taught at Duquesne University Orem’s ideas about why people need nursing, with Rosemarie Parse and learned more about nursing’s purposes, and what nurses do. I Man-Living-Health, which is now humanbe- found a fit between her ideas, as I understood coming. I conducted several studies based on them, with my practice, and I learned that I Rogers’ conceptual system and Parse’s theory. could go even further to explain and design At theory conferences I was fortunate to nursing according to these ways of thinking dialogue with Virginia Henderson, Hildegard about nursing. I discovered that nursing shared Peplau, Imogene King, and Madeleine some knowledge and practices with other serv- Leininger. In 1988 I accepted a faculty posi- ices, such as pharmacy and medicine, and I tion at the University of Colorado when Jean began to distinguish nursing from these related Watson was Dean. The School of Nursing was fields of practice. I decided to stay in nursing guided by a caring philosophy and framework and made plans to study and work with and I embraced caring as a central focus of the Dorothea Orem. In addition to learning about discipline of nursing. As a unitary scholar, I nursing theory and its meaning in all we do, I studied Newman’s theory of health as expand- learned from Dorothea that nursing is a unique ing consciousness and was intrigued by it, so discipline of knowledge and professional prac- for my sabbatical I decided to study it further tice. In many ways, my earliest questions about as well as learn more about the unitary appre- nursing have guided my subsequent study and ciative inquiry process that Richard Cowling work. Most of what I have done in nursing has was developing. been a continuation of my initial experience of We both have been fortunate to hold faculty the interrelations of all aspects of nursing appointments in universities where nursing the- scholarship, including the scholarship that is ory has been valued, and we are fortunate today nursing practice. Over the years, I have been to hold positions at the Christine E. Lynn Col- privileged to work with many nursing scholars, lege of Nursing at Florida Atlantic University, some of whom are featured in this book. where faculty and students ground their teach- My love for nursing and my respect for our ing scholarship and practice on caring theories, discipline and practice have deepened, and including nursing as caring, developed by Dean knowing now that these values are so often Anne Boykin and a previous faculty member at shared is a singular joy. the College, Savina Schoenhofer. Many faculty Marlaine’s interest in nursing theory had colleagues and students continue to help us similar origins to Marilyn’s. As a nurse pursu- study nursing and have contributed to this book ing an interdisciplinary master’s degree in pub- in ways we would never have adequate words to lic health, I (Marlaine) recognized that while acknowledge. We are grateful to our knowl- all the other public health disciplines had some edgeable colleagues who reviewed and offered unique perspective to share, public health helpful suggestions for chapters of this book, nursing seemed to lack a clear identity. In and we sincerely thank those who contributed search of the identity of nursing I pursued a to the book as chapter authors. It is also our second master’s in nursing. At that time nurs- good fortune that many nursing theorists and ing theory was beginning to garner attention, other nursing scholars live in or visit our lovely and I learned about it from my teachers and state of Florida. Since the first edition of this mentors Sr. Rosemary Donley, Rosemarie book was published, we have lost many nursing Parse, and Mary Jane Smith. This discovery was theorists. Their work continues through those the answer I was seeking, and it both expanded refining, modifying, testing, and expanding the and focused my thinking about nursing. The theories. The discipline of nursing is expanding question of “What is nursing?” was answered as research and practice advances existing theories for me by these theories and I couldn’t get and as new theories emerge. This is especially 3312_FM_i-xx 26/12/14 5:51 PM Page viii viii Preface to the Fourth Edition important at a time when nursing theory can and her niece, Cherie Parker, who represents provide what is missing and needed most in many nurses who love nursing practice and health care today. scholarship and thus inspire the work of this All four editions of this book have been nur- book. Marlaine acknowledges her husband tured by Joanne DaCunha, an expert nurse and Brian and her children, Kirsten, Alicia, and editor for F. A. Davis Company, who has shep- Brady, and their spouses, Jonathan Vankin and herded this project and others because of her Tori Rutherford, for their love and understand- love of nursing. Near the end of this project ing. She honors her parents, Deno and Rose Joanne retired, and Susan Rhyner, our new ed- Cappelli, for instilling in her the love of learning, itor, led us to the finish line. We are both grate- the value of hard work, and the importance of ful for their wisdom, kindness, patience and caring for others, and dedicates this book to her understanding of nursing. We give special granddaughter Iyla and the new little one who thanks to Echo Gerhart, who served as our con- is scheduled to arrive as this book is released. tact and coordinator for this project. Marilyn thanks her husband, Terry Worden, for his Marilyn E. Parker, Marlaine C. Smith, abiding love and for always being willing to help, Olathe, Kansas Boca Raton, Florida 3312_FM_i-xx 26/12/14 5:51 PM Page ix Nursing Theorists Elizabeth Ann Manhart Barrett, PhD, RN, FAAN Imogene King† Professor Emerita Katharine Kolcaba, PhD, RN Hunter College Associate Professor Emeritus Adjunct City University of New York The University of Akron New York, New York Akron, Ohio Charlotte D. Barry, PhD, RN, NCSN, FAAN Madeleine M. Leininger† Professor of Nursing Christine E. Lynn College of Nursing Patricia Liehr, PhD, RN Florida Atlantic University Professor Boca Raton, Florida Christine E. Lynn College of Nursing Florida Atlantic University Anne Boykin, PhD, RN* Boca Raton, Florida Dean and Professor Emerita Christine E. Lynn College of Nursing Rozzano C. Locsin, PhD, RN Florida Atlantic University Professor Emeritus Boca Raton, Florida Christine E. Lynn College of Nursing Florida Atlantic University Barbara Montgomery Dossey, PhD, RN, AHN-BC, FAAN, Boca Raton, Florida HWNC-BC Co-Director, International Nurse Coach Afaf I. Meleis, PhD, DrPS(hon), FAAN Association Professor of Nursing and Sociology Core Faculty, Integrative Nurse Coach University of Pennsylvania Certificate Program Philadelphia, Pennsylvania Miami, Florida Betty Neuman, PhD, RN, PLC, FAAN Joanne R. Duffy, PhD, RN, FAAN Beverly, Ohio Endowed Professor of Research and Margaret Newman, RN, PhD, FAAN Evidence-based Practice and Director Professor Emerita of the PhD Program University of Minnesota College of Nursing West Virginia University Saint Paul, Minnesota Morgantown, West Virginia Dorothea E. Orem† Helen L. Erickson* Professor Emerita Ida Jean Orlando (Pelletier)† University of Texas at Austin Marilyn E. Parker, PhD, RN, FAAN Austin, Texas Professor Emerita Lydia Hall† Christine E. Lynn College of Nursing Florida Atlantic University Virginia Henderson† Boca Raton, Florida Dorothy Johnson† ix 3312_FM_i-xx 26/12/14 5:51 PM Page x x Nursing Theorists Rosemarie Rizzo Parse, PhD, FAAN Mary Jane Smith, PhD, RN Distinguished Professor Emeritus Professor Marcella Niehoff School of Nursing West Virginia University Loyola University Chicago Morgantown, West Virginia Chicago, Illinois Mary Ann Swain, PhD Hildegard Peplau† Professor and Director, Doctoral Program Decker School of Nursing Marilyn Anne Ray, PhD, RN, CTN Binghamton University Professor Emerita Binghamton, New York Christine E. Lynn College of Nursing Florida Atlantic University Kristen M. Swanson, PhD, RN, FAAN Boca Raton, Florida Dean Seattle University Pamela G. Reed, PhD, RN, FAAN Seattle, Washington Professor University of Arizona Evelyn Tomlin* Tucson, Arizona Joyce Travelbee† Martha E. Rogers† Meredith Troutman-Jordan, PhD, RN Sister Callista Roy, PhD, RN, FAAN Associate Professor Professor and Nurse Theorist University of North Carolina William F. Connell School of Nursing Chapel Hill, North Carolina Boston College Jean Watson, PhD, RN, AHN-BC, FAAN Chestnut Hill, Massachusetts Distinguished Professor Emeritus Savina O. Schoenhofer, PhD, RN University of Colorado at Denver—Anschutz Professor of Nursing Campus University of Mississippi Aurora, Colorado Oxford, Mississippi Ernestine Wiedenbach† Marlaine C. Smith, PhD, RN, AHN-BC, FAAN Dean and Helen K. Persson Eminent Scholar Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida *Retired †Deceased 3312_FM_i-xx 26/12/14 5:51 PM Page xi Contributors Patricia Deal Aylward, MSN, RN, CNS Laureen M. Fleck, PhD, FNP-BC, FAANP Assistant Professor Associate Faculty Santa Fe Community College Christine E. Lynn College of Nursing Gainesville, Florida Florida Atlantic University Boca Raton, Florida Howard Karl Butcher, PhD, RN, PMHCNS-BC Associate Professor Maureen A. Frey, PhD, RN* University of Iowa Iowa City, Iowa Shirley C. Gordon, PhD, RN Professor and Assistant Dean Graduate Practice Lynne M. Hektor Dunphy, PhD, APRN-BC Programs Associate Dean for Practice and Community Christine E. Lynn College of Nursing Engagement Florida Atlantic University Christine E. Lynn College of Nursing Boca Raton, Florida Florida Atlantic University Boca Raton, Florida *Retired. xi 3312_FM_i-xx 26/12/14 5:51 PM Page xii xii Contributors Diane Lee Gullett, RN, MSN, MPH Beth M. King, PhD, RN, PMHCNS-BC Doctoral Candidate Assistant Professor and RN-BSN Coordinator Christine E. Lynn College of NursingFlorida Christine E. Lynn College of Nursing Atlantic University Florida Atlantic University Boca Raton, Florida Boca Raton, Florida Donna L. Hartweg, PhD, RN Lois White Lowry, DNSc, RN* Professor Emerita and Former Director Professor Emerita Illinois Wesleyan University East Tennessee State University Bloomington, Illinois Johnson City, Tennessee Bonnie Holaday, PhD, RN, FAAN Violet M. Malinski, PhD, MA, RN Professor Associate Professor Clemson University College of New Rochelle Clemson, South Carolina New Rochelle, New York Mary B. Killeen, PhD, RN, NEA-BC Ann R. Peden, RN, CNS, DSN Consultant Professor and Chair Evidence Based Practice Nurse Consultants, Capital University LLC Columbus, Ohio Howell, Michigan 3312_FM_i-xx 26/12/14 5:51 PM Page xiii Contributors xiii Margaret Dexheimer Pharris, PhD, RN, CNE, FAAN Jacqueline Staal, MSN, ARNP, FNP-BC Associate Dean for Nursing PhD Candidate St. Catherine University Christine E. Lynn College of Nursing St. Paul, Minnesota Florida Atlantic University Boca Raton, Florida Maude Rittman, PhD, RN Associate Chief of Nursing Service for Research Marian C. Turkel, PhD, RN, NEA-BC, FAAN Gainesville Veteran’s Administration Director of Professional Nursing Practice Medical Center Holy Cross Medical Center Gainesville, Florida Fort Lauderdale, Florida Pamela Senesac, PhD, SM, RN Hiba Wehbe-Alamah, PhD, RN, FNP-BC, CTN-A Assistant Professor Associate Professor University of Massachusetts University of Michigan-Flint Shrewsbury, Massachusetts Flint, Michigan Christina L. Sieloff, PhD, RN Associate Professor Montana State University Billings, Montana 3312_FM_i-xx 26/12/14 5:51 PM Page xiv xiv Contributors Kelly White, RN, PhD, FNP-BC Terri Kaye Woodward, MSN, RN, CNS, AHN-BC, HTCP Assistant Professor Founder South University Cocreative Wellness West Palm Beach, Florida Denver, Colorado 3312_FM_i-xx 26/12/14 5:51 PM Page xv Reviewers Ferrona Beason, PhD, ARNP Carol L. Moore, PhD, APRN, CNS Assistant Professor in Nursing Assistant Professor of Nursing, Coordinator, Barry University – Division of Nursing Graduate Nursing Studies Miami Shores, Florida Fort Hays State University Hays, Kansas Abimbola Farinde, PharmD, MS Clinical Pharmacist Specialist Kathleen Spadaro, PhD, PMHCNS, RN Clear Lake Regional Medical Center MSN Program Co-coordinator & Assistant Webster, Texas Professor of Nursing Chatham University Lori S. Lauver, PhD, RN, CPN, CNE Pittsburgh, Pennsylvania Associate Professor Jefferson School of Nursing Thomas Jefferson University Philadelphia, Pennsylvania Elisheva Lightstone, BScN, MSc Professor Department of Nursing Seneca College King City, Ontario, Canada xv 3312_FM_i-xx 26/12/14 5:51 PM Page xvi 3312_FM_i-xx 26/12/14 5:51 PM Page xvii Contents Section I An Introduction to Nursing Theory, 1 Chapter 1 Nursing Theory and the Discipline of Nursing, 3 Marlaine C. Smith and Marilyn E. Parker Chapter 2 A Guide for the Study of Nursing Theories for Practice, 19 Marilyn E. Parker and Marlaine C. Smith Chapter 3 Choosing, Evaluating, and Implementing Nursing Theories for Practice, 23 Marilyn E. Parker and Marlaine C. Smith Section II Conceptual Influences on the Evolution of Nursing Theory, 35 Chapter 4 Florence Nightingale’s Legacy of Caring and Its Applications, 37 Lynne M. Hektor Dunphy Chapter 5 Early Conceptualizations About Nursing, 55 Shirley C. Gordon Chapter 6 Nurse-Patient Relationship Theories, 67 Ann R. Peden, Jacqueline Staal, Maude Rittman, and Diane Lee Gullett Section III Conceptual Models/Grand Theories in the Integrative- Interactive Paradigm, 87 Chapter 7 Dorothy Johnson’s Behavioral System Model and Its Applications, 89 Bonnie Holaday Chapter 8 Dorothea Orem’s Self-Care Deficit Nursing Theory, 105 Donna L. Hartweg xvii 3312_FM_i-xx 26/12/14 5:51 PM Page xviii xviii Contents Chapter 9 Imogene King’s Theory of Goal Attainment, 133 Christina L. Sieloff and Maureen A. Frey Chapter 10 Sister Callista Roy’s Adaptation Model, 153 Pamela Sensac and Sister Callista Roy Chapter 11 Betty Neuman’s Systems Model, 165 Lois White Lowry and Patricia Deal Aylward Chapter 12 Helen Erickson, Evelyn Tomlin, and Mary Ann Swain’s Theory of Modeling and Role Modeling, 185 Helen L. Erickson Chapter 13 Barbara Dossey’s Theory of Integral Nursing, 207 Barbara Montgomery Dossey Section IV Conceptual Models and Grand Theories in the Unitary–Transformative Paradigm, 235 Chapter 14 Martha E. Rogers Science of Unitary Human Beings, 237 Howard Karl Butcher and Violet M. Malinski Chapter 15 Rosemarie Rizzo Parse’s Humanbecoming Paradigm, 263 Rosemarie Rizzo Parse Chapter 16 Margaret Newman’s Theory of Health as Expanding Consciousness, 279 Margaret Dexheimer Pharris Section V Grand Theories about Care or Caring, 301 Chapter 17 Madeleine Leininger’s Theory of Culture Care Diversity and Universality, 303 Hiba Wehbe-Alamah Chapter 18 Jean Watson’s Theory of Human Caring, 321 Jean Watson Chapter 19 Theory of Nursing as Caring, 341 Anne Boykin and Savina O. Schoenhofer Section VI Middle-Range Theories, 357 Chapter 20 Transitions Theory, 361 Afaf I. Meleis 3312_FM_i-xx 26/12/14 5:51 PM Page xix Contents xix Chapter 21 Katharine Kolcaba’s Comfort Theory, 381 Katharine Kolcaba Chapter 22 Joanne Duffy’s Quality-Caring Model©, 393 Joanne R. Duffy Chapter 23 Pamela Reed’s Theory of Self-Transcendence, 411 Pamela G. Reed Chapter 24 Patricia Liehr and Mary Jane Smith’s Story Theory, 421 Patricia Liehr and Mary Jane Smith Chapter 25 The Community Nursing Practice Model, 435 Marilyn E. Parker, Charlotte D. Barry. and Beth M. King Chapter 26 Rozzano Locsin’s Technological Competency as Caring in Nursing, 449 Rozzano C. Locsin Chapter 27 Marilyn Anne Ray’s Theory of Bureaucratic Caring, 461 Marilyn Anne Ray and Marian C. Turkel Chapter 28 Troutman-Jordan’s Theory of Successful Aging, 483 Meredith Troutman-Jordan Chapter 29 Barrett’s Theory of Power as Knowing Participation in Change, 495 Elizabeth Ann Manhart Barrett Chapter 30 Marlaine Smith’s Theory of Unitary Caring, 509 Marlaine C. Smith Chapter 31 Kristen Swanson’s Theory of Caring, 521 Kristen M. Swanson Index, 533 3312_FM_i-xx 26/12/14 5:51 PM Page xx 3312_Ch01_001-018 26/12/14 9:35 AM Page 1 Section I An Introduction to Nursing Theory 1 3312_Ch01_001-018 26/12/14 9:35 AM Page 2 Section I An Introduction to Nursing Theory In this first section of the book, you will be introduced to the purpose of nursing theory and shown how to study, analyze, and evaluate it for use in nursing practice. If you are new to the idea of theory in nursing, the chapters in this section will orient you to what theory is, how it fits into the evolution and context of nursing as a professional discipline, and how to approach its study and evaluation. If you have studied nursing theory in the past, these chapters will provide you with additional knowledge and insight as you continue your study. Nursing is a professional discipline focused on the study of human health and healing through caring. Nursing practice is based on the knowledge of nursing, which consists of its philosophies, theories, concepts, principles, research findings, and practice wisdom. Nursing theories are patterns that guide the thinking about nursing. All nurses are guided by some implicit or explicit theory or pattern of thinking as they care for their patients. Too often, this pattern of thinking is implicit and is colored by the lens of diseases, diagnoses, and treatments. This does not reflect practice from the disciplinary perspective of nursing. The major reason for the development and study of nursing theory is to improve nursing practice and, therefore, the health and quality of life of those we serve. The first chapter in this section focuses on nursing theory within the context of nursing as an evolving professional discipline. We examine the relationship of nursing theory to the characteristics of a discipline. You’ll learn new words that describe parts of the knowledge structure of the discipline of nursing, and we’ll speculate about the future of nursing theory as nursing, health care, and our global society change. Chapter 2 is a guide to help you study the theories in this book. Use this guide as you read and think about how nursing theory fits in your prac- tice. Nurses embrace theories that fit with their values and ways of thinking. They choose theories to guide their practice and to create a practice that is meaningful to them. Chapter 3 focuses on the selection, evaluation, and implementation of theory for practice. Students often get the assignment of evaluating or critiquing a nursing theory. Evaluation is coming to some judgment about value or worth based on criteria. Various sets of criteria exist for you to use in theory evaluation. We introduce some that you can explore further. Finally, we offer reflections on the process of implementing theory-guided practice models. 2 3312_Ch01_001-018 26/12/14 9:35 AM Page 3 Nursing Theory and the Discipline of Nursing Chapter 1 M ARLAINE C. S MITH AND M ARILYN E. P ARKER The Discipline of Nursing What is nursing? At first glance, the question Definitions of Nursing Theory may appear to be one with an obvious an- The Purpose of Theory in a Professional swer, but when it is posed to nurses, many Discipline define nursing by providing a litany of func- The Evolution of Nursing Science tions and activities. Some answer with the The Structure of Knowledge in the elements of the nursing process: assessing, Discipline of Nursing planning, implementing, and evaluating. Oth- Nursing Theory and the Future ers might answer that nurses coordinate a Summary patient’s care. References Defining nursing in terms of the nursing process or by functions or activities nurses per- form is problematic. The phases of the nursing process are the same steps we might use to solve any problem we encounter, from a bro- ken computer to a failing vegetable garden. We assess the situation to determine what is going on and then identify the problem; we plan what to do about it, implement our plan, and then evaluate whether it works. The nurs- Marlaine C. Smith Marilyn E. Parker ing process does nothing to define nursing. Defining ourselves by tasks presents other problems. What nurses do—that is, the func- tions associated with practice—differs based on the setting. For example, a nurse might start IVs, administer medications, and per- form treatments in an acute care setting. In a community-based clinic, a nurse might teach a young mother the principles of infant feeding or place phone calls to arrange community resources for a child with special needs. Mul- tiple professionals and nonprofessionals may perform the same tasks as nurses, and persons with the ability and authority to perform cer- tain tasks change based on time and setting. For example, both physicians and nurses may listen to breath sounds and recognize the pres- ence of rales. Both nurses and social workers might do discharge planning. Both nurses 3 3312_Ch01_001-018 26/12/14 9:35 AM Page 4 4 SECTION I An Introduction to Nursing Theory and family members might change dressings, nurses in all nursing venues, who share a monitor vital signs, and administer medications, commitment to values, knowledge, and so defining nursing based solely on functions or processes to guide the thought and work of activities performed is not useful. the discipline. To answer the question “What is nursing?” The classic work of King and Brownell we must formulate nursing’s unique identity (1976) is consistent with the thinking of nurs- as a field of study or discipline. Florence ing scholars (Donaldson & Crowley, 1978; Nightingale is credited as the founder of mod- Meleis, 1977) about the discipline of nursing. ern nursing, the one who articulated its dis- These authors have elaborated attributes that tinctive focus. In her book Notes on Nursing: characterize all disciplines. As you will see in What It Is and What It Is Not (Nightingale, the discussion that follows, the attributes of 1859/1992), she differentiated nursing from King and Brownell provide a framework that medicine, stating that the two were distinct contextualizes nursing theory within the dis- practices. She defined nursing as putting the cipline of nursing. person in the best condition for nature to act, insisting that the focus of nursing was on Expression of Human Imagination health and the natural healing process, not on Members of any discipline imagine and create disease and reparation. For her, creating an structures that offer descriptions and explana- environment that provided the conditions for tions of the phenomena that are of concern to natural healing to occur was the focus of nurs- that discipline. These structures are the theories ing. Her beginning conceptualizations were of that discipline. Nursing theory is dependent the seeds for the theoretical development of on the imagination of nurses in practice, ad- nursing as a professional discipline. ministration, research, and teaching, as they In this chapter, we situate the understand- create and apply theories to improve nursing ing of nursing theory within the context of practice and ultimately the lives of those they the discipline of nursing. We define the dis- serve. To remain dynamic and useful, the dis- cipline of nursing, describe the purpose of cipline requires openness to new ideas and in- theory for the discipline of nursing, review novative approaches that grow out of members’ the evolution of nursing science, identify the reflections and insights. structure of the discipline of nursing, and speculate on the future place of nursing the- Domain ory in the discipline. A professional discipline must be clearly defined by a statement of its domain—the The Discipline of Nursing boundaries or focus of that discipline. The do- main of nursing includes the phenomena of in- Every discipline has a unique focus that directs terest, problems to be addressed, main content the inquiry within it and distinguishes it from and methods used, and roles required of the other fields of study (Smith, 2008, p. 1). Nurs- discipline’s members (Kim, 1997; Meleis, ing knowledge guides its professional practice; 2012). The processes and practices claimed by therefore, it is classified as a professional disci- members of the disciplinary community grow pline. Donaldson and Crowley (1978) stated out of these domain statements. Nightingale that a discipline “offers a unique perspective, a provided some direction for the domain of the distinct way of viewing... phenomena, which discipline of nursing. Although the discipli- ultimately defines the limits and nature of its nary focus has been debated, there is some inquiry” (p. 113). Any discipline includes net- degree of consensus. Donaldson and Crowley works of philosophies, theories, concepts, ap- (1978, p. 113) identified the following as the proaches to inquiry, research findings, and domain of the discipline of nursing: practices that both reflect and illuminate its dis- tinct perspective. The discipline of nursing is 1. Concern with principles and laws that formed by a community of scholars, including govern the life processes, well-being, and 3312_Ch01_001-018 26/12/14 9:35 AM Page 5 CHAPTER 1 Nursing Theory and the Discipline of Nursing 5 optimal functioning of human beings, sick statement of philosophical unity in the disci- or well pline was published by Roy and Jones (2007). 2. Concern with the patterning of human Statements include the following: behavior in interactions with the environ- The human being is characterized by ment in critical life situations wholeness, complexity, and consciousness. 3. Concern with the processes through The essence of nursing involves the nurse’s which positive changes in health status true presence in the process of human- are affected to-human engagement. Fawcett (1984) described the metapara- Nursing theory expresses the values and be- digm as a way to distinguish nursing from liefs of the discipline, creating a structure to other disciplines. The metaparadigm is very organize knowledge and illuminate nursing general and intended to reflect agreement practice. among members of the discipline about the The essence of nursing practice is the nurse– field of nursing. This is the most abstract level patient relationship. of nursing knowledge and closely mirrors be- In 2008, Newman, Smith, Dexheimer- liefs held about nursing. By virtue of being Pharris, and Jones revisited the disciplinary nurses, all nurses have some awareness of focus asserting that relationship was central nursing’s metaparadigm. However, because to the discipline, and the convergence of the term may not be familiar, it offers no di- seven concepts—health, consciousness, car- rect guidance for research and practice (Kim, ing, mutual process, presence, patterning, and 1997; Walker & Avant, 1995). The metapara- meaning—specified relationship in the pro- digm consists of four concepts: persons, envi- fessional discipline of nursing. Willis, Grace, ronment, health, and nursing. According to and Roy (2008) posited that the central uni- Fawcett, nursing is the study of the interrela- fying focus for the discipline is facilitating tionship among these four concepts. humanization, meaning, choice, quality of Modifications and alternative concepts for life, and healing in living and dying (p. E28). this framework have been explored throughout Finally, Litchfield and Jondorsdottir (2008) the discipline (Fawcett, 2000). For example, defined the discipline as the study of human- some nursing scholars have suggested that ness in the health circumstance. Smith (1994) “caring” replace “nursing” in the metaparadigm defined the domain of the discipline of nurs- (Stevenson & Tripp-Reimer, 1989). Kim ing as “the study of human health and healing (1987, 1997) set forth four domains: client, through caring” (p. 50). For Smith (2008), client–nurse encounters, practice, and environ- “nursing knowledge focuses on the wholeness ment. In recent years, increasing attention has of human life and experience and the been directed to the nature of nursing’s rela- processes that support relationship, integra- tionship with the environment (Kleffel, 1996; tion, and transformation” (p. 3). Nursing Schuster & Brown, 1994). conceptual models, grand theories, middle- Others have defined nursing as the study range theories, and practice theories explicate of “the health or wholeness of human beings the phenomena within the domain of nurs- as they interact with their environment” ing. In addition, the focus of the nursing dis- (Donaldson & Crowley, 1978, p. 113), the life cipline is a clear statement of social mandate process of unitary human beings (Rogers, and service used to direct the study and prac- 1970), care or caring (Leininger, 1978; Watson, tice of nursing (Newman et al., 1991). 1985), and human–universe–health interrela- tionships (Parse, 1998). A widely accepted focus statement for the discipline was published Syntactical and Conceptual Structures by Newman, Sime, and Corcoran-Perry Syntactical and conceptual structures are (1991): “Nursing is the study of caring in the essential to any discipline and are inherent human health experience” (p. 3). A consensus in nursing theories. The conceptual structure 3312_Ch01_001-018 26/12/14 9:35 AM Page 6 6 SECTION I An Introduction to Nursing Theory delineates the proper concerns of nursing, at conferences, societies, and other communi- guides what is to be studied, and clarifies ac- cation networks of the nursing discipline. cepted ways of knowing and using content of the discipline. This structuṙe is grounded in the Tradition focus of the discipline. The conceptual struc- The tradition and history of the discipline is ev- ture relates concepts within nursing theories. ident in the study of nursing over time. There The syntactical structures help nurses and is recognition that theories most useful today other professionals to understand the talents, often have threads of connection with ideas skills, and abilities that must be developed originating in the past. For example, many the- within the community. This structure directs orists have acknowledged the influence of descriptions of data needed from research, as Florence Nightingale and have acclaimed her well as evidence required to demonstrate the leadership in influencing nursing theories of effect on nursing practice. In addition, these today. In addition, nursing has a rich heritage structures guide nursing’s use of knowledge in of practice. Nursing’s practical experience and research and practice approaches developed by knowledge have been shared and transformed related disciplines. It is only by being thor- as the content of the discipline and are evident oughly grounded in the discipline’s concepts, in many nursing theories (Gray & Pratt, 1991). substance, and modes of inquiry that the bound- aries of the discipline can be understood and Values and Beliefs possibilities for creativity across disciplinary Nursing has distinctive views of persons and borders can be created and explored. strong commitments to compassionate and knowledgeable care of persons through nurs- Specialized Language and Symbols ing. Fundamental nursing values and beliefs As nursing theory has evolved, so has the need include a holistic view of person, the dignity for concepts, language, and forms of data that and uniqueness of persons, and the call to care. reflect new ways of thinking and knowing spe- There are both shared and differing values and cific to nursing. The complex concepts used in beliefs within the discipline. The metapara- nursing scholarship and practice require lan- digm reflects the shared beliefs, and the para- guage that can be specific and understood. The digms reflect the differences. language of nursing theory facilitates commu- Systems of Education nication among members of the discipline. Expert knowledge of the discipline is often A distinguishing mark of any discipline is the required for full understanding of the meaning education of future and current members of of these theoretical terms. the community. Nursing is recognized as a professional discipline within institutions of higher education because it has an identifiable Heritage of Literature and body of knowledge that is studied, advanced, Networks of Communication and used to underpin its practice. Students of This attribute calls attention to the array any professional discipline study its theories of books, periodicals, artifacts, and aesthetic and learn its methods of inquiry and practice. expressions, as well as audio, visual, and elec- Nursing theories, by setting directions for the tronic media that have developed over cen- substance and methods of inquiry for the dis- turies to communicate the nature of nursing cipline, should provide the basis for nursing knowledge and practice. Conferences and fo- education and the framework for organizing rums on every aspect of nursing held through- nursing curricula. out the world are part of this network. Nursing organizations and societies also provide critical communication links. Nursing theories are Definitions of Nursing Theory part of this heritage of literature, and those A theory is a notion or an idea that explains working with these theories present their work experience, interprets observation, describes 3312_Ch01_001-018 26/12/14 9:35 AM Page 7 CHAPTER 1 Nursing Theory and the Discipline of Nursing 7 relationships, and projects outcomes. Parsons in nursing practice, education, administration, (1949), often quoted by nursing theorists, or research: wrote that theories help us know what we Theory is a set of concepts, definitions, and know and decide what we need to know. The- propositions that project a systematic view ories are mental patterns or frameworks cre- of phenomena by designating specific inter- ated to help understand and create meaning relationships among concepts for purposes from our experience, organize and articulate of describing, explaining, predicting, and/or our knowing, and ask questions leading to new controlling phenomena (Chinn & Jacobs, insights. As such, theories are not discovered 1987, p. 71). in nature but are human inventions. Theory is a creative and rigorous structuring Theories are organizing structures of our re- of ideas that projects a tentative, purposeful, flections, observations, projections, and infer- and systematic view of phenomena (Chinn ences. Many describe theories as lenses because & Kramer, 2004, p. 268). they color and shape what is seen. The same Nursing theory is a conceptualization phenomena will be seen differently depending of some aspect of reality (invented or on the theoretical perspective assumed. For discovered) that pertains to nursing. The these reasons, “theory” and related terms have conceptualization is articulated for the been defined and described in a number of purpose of describing, explaining, predict- ways according to individual experience and ing, or prescribing nursing care (Meleis, what is useful at the time. Theories, as reflec- 1997, p. 12). tions of understanding, guide our actions, help Nursing theory is an inductively and/or de- us set forth desired outcomes, and give evi- ductively derived collage of coherent, cre- dence of what has been achieved. A theory, by ative, and focused nursing phenomena that traditional definition, is an organized, coherent frame, give meaning to, and help explain set of concepts and their relationships to each specific and selective aspects of nursing re- other that offers descriptions, explanations, search and practice (Silva, 1997, p. 55). and predictions about phenomena. A theory is an imaginative grouping of Early writers on nursing theory brought knowledge, ideas, and experience that are rep- definitions of theory from other disciplines to resented symbolically and seek to illuminate direct future work within nursing. Dickoff and a given phenomenon.” (Watson, 1985, p. 1). James (1968, p. 198) defined theory as a “con- ceptual system or framework invented for some purpose.” Ellis (1968, p. 217) defined The Purpose of Theory in theory as “a coherent set of hypothetical, con- ceptual, and pragmatic principles forming a a Professional Discipline general frame of reference for a field of in- All professional disciplines have a body of quiry.” McKay (1969, p. 394) asserted that knowledge consisting of theories, research, and theories are the capstone of scientific work and methods of inquiry and practice. They organize that the term refers to “logically interconnected knowledge, guide inquiry to advance science, sets of confirmed hypotheses.” Barnum (1998, guide practice and enhance the care of patients. p. 1) later offered a more open definition of Nursing theories address the phenomena of in- theory as a “construct that accounts for or or- terest to nursing, human beings, health, and ganizes some phenomenon” and simply stated caring in the context of the nurse–person rela- that a nursing theory describes or explains tionship1. On the basis of strongly held values nursing. and beliefs about nursing, and within con- Definitions of theory emphasize its various texts of various worldviews, theories are pat- aspects. Those developed in recent years are terns that guide the thinking about, being, more open and conform to a broader concep- and doing of nursing. tion of science. The following definitions of the- ory are consistent with general ideas of theory 1Person refers to individual, family, group, or community. 3312_Ch01_001-018 26/12/14 9:35 AM Page 8 8 SECTION I An Introduction to Nursing Theory Theories provide structures for making 2003). Engagement in practice generates the sense of the complexities of reality for both ideas that lead to the development of nursing practice and research. Research based in nurs- theories. ing theory is needed to explain and predict At the empirical level of theory, abstract nursing outcomes essential to the delivery of concepts are operationalized, or made concrete, nursing care that is both humane and cost- for practice and research (Fawcett, 2000; Smith effective (Gioiella, 1996). Some conceptual & Liehr, 2013). Empirical indicators provide structure either implicitly or explicitly directs specific examples of how the theory is experi- all avenues of nursing, including nursing edu- enced in reality; they are important for bringing cation and administration. Nursing theories theoretical knowledge to the practice level. provide concepts and designs that define the These indicators include procedures, tools, and place of nursing in health care. Through instruments to determine the effects of nursing theories, nurses are offered perspectives for practice and are essential to research and man- relating with professionals from other disci- agement of outcomes of practice (Jennings & plines, who join with nurses to provide Staggers, 1998). The resulting data form the human services. Nursing has great expecta- basis for improving the quality of nursing care tions of its theories. At the same time, the- and influencing health-care policy. Empirical ories must provide structure and substance indicators, grounded carefully in nursing con- to ground the practice and scholarship of cepts, provide clear demonstration of the utility nursing and must also be flexible and dynamic of nursing theory in practice, research, admin- to keep pace with the growth and changes in istration, and other nursing endeavors (Allison the discipline and practice of nursing. & McLaughlin-Renpenning, 1999; Hart & The major reason for structuring and Foster, 1998). advancing nursing knowledge is for the sake Meeting the challenges of systems of care of nursing practice. The primary purpose delivery and interprofessional work demands of nursing theories is to further the develop- practice from a theoretical perspective. Nurs- ment and understanding of nursing practice. ing’s disciplinary focus is important within Because nursing theory exists to improve prac- the interprofessional health-care environment tice, the test of nursing theory is a test of its (Allison & McLaughlin-Renpenning, 1999); usefulness in professional practice (Colley, otherwise, its unique contribution to the in- 2003; Fitzpatrick, 1997). The work of nursing terprofessional team is unclear. Nursing ac- theory is moving from academia into the tions reflect nursing concepts from a nursing realm of nursing practice. Chapters in the re- perspective. Careful, reflective, and critical maining sections of this book highlight the thinking are the hallmarks of expert nursing, use of nursing theories in nursing practice. and nursing theories should undergird these Nursing practice is both the source and the processes. Appreciation and use of nursing goal of nursing theory. From the viewpoint of theory offer opportunities for successful col- practice, Gray and Forsstrom (1991) suggested laboration with colleagues from other disci- that theory provides nurses with different ways plines and provide definition for nursing’s of looking at and assessing phenomena, ratio- overall contribution to health care. Nurses nales for their practice, and criteria for evalu- must know what they are doing, why they are ating outcomes. Many of the theories in this doing it, and what the range of outcomes of book have been used to guide nursing practice, nursing may be, as well as indicators for doc- stimulate creative thinking, facilitate commu- umenting nursing’s effects. These theoretical nication, and clarify purposes and processes in frameworks serve as powerful guides for ar- practice. The practicing nurse has an ethical re- ticulating, reporting, and recording nursing sponsibility to use the discipline’s theoretical thought and action. knowledge base, just as it is the nurse scholar’s One of the assertions referred to most often ethical responsibility to develop the knowledge in the nursing-theory literature is that theory is base specific to nursing practice (Cody, 1997, born of nursing practice and, after examination 3312_Ch01_001-018 26/12/14 9:35 AM Page 9 CHAPTER 1 Nursing Theory and the Discipline of Nursing 9 and refinement through research, must be re- Although there were healers from other turned to practice (Dickoff, James, & Wieden- countries who can be acknowledged for their bach, 1968). Nursing theory is stimulated by importance to the history of nursing, Florence questions and curiosities arising from nursing Nightingale holds the title of the “mother of practice. Development of nursing knowledge modern nursing” and the person responsible is a result of theory-based nursing inquiry. The for setting Western nursing on a path toward circle continues as data, conclusions, and rec- scientific advancement. She not only defined ommendations of nursing research are evalu- nursing as “putting the person in the best con- ated and developed for use in practice. Nursing dition for nature to act,” she also established a theory must be seen as practical and useful to phenomenological focus of nursing as caring practice, and the insights of practice must in for and about the human–environment rela- turn continue to enrich nursing theory. tionship to health. While nursing soldiers dur- ing the Crimean War, Nightingale began to study the distribution of disease by gathering The Evolution of data, so she was arguably the first nurse-scientist Nursing Science in that she established a rudimentary theory Disciplines can be classified as belonging to and tested that theory through her practice and the sciences or humanities. In any science, research. there is a search for an understanding about Nightingale schools were established in the specified phenomena through creating some West at the turn of the 20th century, but organizing frameworks (theories) about the Nightingale’s influence on the nursing profes- nature of those phenomena. These organizing sion waned as student nurses in hospital-based frameworks (theories) are evaluated for their training schools were taught nursing primarily empirical accuracy through research. So sci- by physicians. Nursing became strongly influ- ence is composed of theories developed and enced by the “medical model” and for some tested through research (Smith, 1994). time lost its identity as a distinct profession. The evolution of nursing as a science has Slowly, nursing education moved into in- occurred within the past 70 years; however, stitutions of higher learning where students before nursing became a discipline or field were taught by nurses with higher degrees. By of study, it was a healing art. Throughout 1936, 66 colleges and universities had bac- the world, nursing emerged as a healing min- calaureate programs (Peplau, 1987). Graduate istry to those who were ill or in need of sup- programs began in the 1940s and grew signifi- port. Knowledge about caring for the sick, cantly from the 50s through the 1970s. injured, and those birthing, dying, or expe- The publication of the journal Nursing Re- riencing normal developmental transitions search in 1952 was a milestone, signifying the was handed down, frequently in oral tradi- birth of nursing as a fledgling science (Peplau, tions, and comprised folk remedies and prac- 1987). But well into the 1940s, “many text- tices that were found to be effective through books for nurses, often written by physicians, a process of trial and error. In most societies, clergy or psychologists, reminded nurses that the responsibility for nursing fell to women, theory was too much for them, that nurses did members of religious orders, or those with not need to think but rather merely to follow spiritual authority in the community. With rules, be obedient, be compassionate, do their the ascendency of science, those who were ‘duty’ and carry out medical orders” (Peplau, engaged in the vocations of healing lost their 1987, p. 18). We’ve come a long way in a mere authority over healing to medicine. Tradi- 70 years. tional approaches to healing were marginal- The development of nursing curricula stim- ized, as the germ theory and the development ulated discussion about the nature of nursing of pharmaceuticals and surgical procedures as distinct from medicine. In the 1950s, early were legitimized because of their grounding nursing scholars such as Hildegard Peplau, in science. Virginia Henderson, Dorothy Johnson, and 3312_Ch01_001-018 26/12/14 9:35 AM Page 10 10 SECTION I An Introduction to Nursing Theory Lydia Hall established the distinct character- published theories in research and practice istics of nursing as a profession and field formalized networks into organizations and of study. Faye Abdellah, Ida Jean Orlando, held conferences. For example the Society for Joyce Travelbee, Ernestine Wiedenbach, Myra Rogerian Scholars held the first Rogerian Levine, and Imogene King followed during Conference; the Transcultural Nursing Society the 1960s, elaborating their conceptualizations was formed, and the International Association of nursing. During the early 1960s, the federally- for Human Caring was formed. Some of these funded Nurse Scientist Program was initiated organizations developed journals publishing to educate nurses in pursuit of doctoral degrees the work of scholars advancing these concep- in the basic sciences. Through this program tual models and grand theories. Metatheorists nurses received doctorates in education, soci- such as Jacqueline Fawcett, Peggy Chinn, and ology, physiology, and psychology. These grad- Joyce Fitzpatrick and Ann Whall published uates brought the scientific traditions of these books on nursing theory, making nursing disciplines into nursing as they assumed faculty theories more accessible to students. Theory positions in schools of nursing. courses were established in graduate programs By the 1970s, nursing theory development in nursing. The Fuld Foundation supported a became a priority for the profession and the series of videotaped interviews of many theo- discipline of nursing was becoming estab- rists, and the National League for Nursing dis- lished. Martha Rogers, Callista Roy, Dorothea seminated videos promoting theory within Orem, Betty Newman, and Josephine Pater- nursing. Nursing Science Quarterly, a journal son and Loraine Zderad published their theo- focused exclusively on advancing extant nurs- ries and graduate students began studying and ing theories, published its first issue in 1988. advancing these theories through research. During the 1990s, the expansion of con- During this time, the National League for ceptual models and grand theories in nursing Nursing required a theory-based curriculum as continued to deepen, and forces within nurs- a standard for accreditation, so schools of nurs- ing both promoted and inhibited this expan- ing were expected to select, develop, and im- sion. The theorists and their students began plement a conceptual framework for their conducting research and developing practice curricula. This propelled the advancement of models that made the theories more visible. theoretical thinking in nursing. (Meleis, 1992). Regulatory bodies in Canada required that A national conference on nursing theory and every hospital be guided by some nursing the- the Nursing Theory Think Tanks were formed ory. This accelerated the development of nurs- to engage nursing leaders in dialogue about the ing theory–guided practice within Canada and place of theory in the evolution of nursing sci- the United States. The accrediting bodies of ence. The linkages between theory, research, nursing programs pulled back on their require- and philosophy were debated in the literature, ment of a specified conceptual framework and Advances in Nursing Science, the premiere guiding nursing curricula. Because of this, journal for publishing theoretical articles, was there were fewer programs guided by specific launched. conceptualizations of nursing, and possibly In the 1980s additional grand theories such fewer students had a strong grounding in the as Parse’s man-living-health (later changed theoretical foundations of nursing. Fewer to human becoming); Newman’s health as grand theories emerged; only Boykin and expanding consciousness; Leininger’s tran- Schoenhofer’s nursing as caring grand theory scultural nursing; Erickson, Tomlinson, and was published during this time. Middle-range Swain’s modeling and role modeling; and theories emerged to provide more descriptive, Watson’s transpersonal caring were dissemi- explanatory, and predictive models around nated. Nursing theory conferences were con- circumscribed phenomena of interest to nurs- vened, frequently attracting large numbers of ing. For example, Meleis’s transition theory, participants. Those scholars working with the Mishel’s uncertainty theory, Barrett’s power 3312_Ch01_001-018 26/12/14 9:35 AM Page 11 CHAPTER 1 Nursing Theory and the Discipline of Nursing 11 theory, and Pender’s health promotion model distinguishing features of nursing science over were generating interest. others. From 2000 to the present, there has been If nursing is to advance as a science in its accelerated development of middle-range the- own right, future generations of nurses must re- ories with less interest in conceptual models spect and advance the theoretical legacy of our and grand theories. There seems to be a de- discipline. Scientific growth happens through valuing of nursing theory; many graduate pro- cumulative knowledge development with cur- grams have eliminated their required nursing rent research building on previous findings. To theory courses, and baccalaureate programs survive and thrive, nursing theories must be may not include the development of concep- used in nursing practice and research. tualizations of nursing into their curricula. This has the potential for creating generations of nurses who have no comprehension of the im- The Structure of Knowledge portance of theory for understanding the focus of the discipline and the diverse, rich legacy in the Discipline of Nursing of nursing knowledge from these theoretical Theories are part of the knowledge structure perspectives. of any discipline. The domain of inquiry (also On the other hand, health-care organiza- called the metaparadigm or focus of the disci- tions have been more active in promoting at- pline) is the foundation of the structure. The tention to theoretical applications in nursing knowledge of the discipline is related to its practice. For example, those hospitals on the general domain or focus. For example, knowl- magnet journey are required to select a guiding edge of biology relates to the study of living nursing framework for practice. Watson’s the- things; psychology is the study of the mind; ory of caring is guiding nursing practice in a sociology is the study of social structures and group of acute care hospitals. These hospitals behaviors. Nursing’s domain was discussed have formed a consortium so that best prac- earlier and relates to the disciplinary focus tices can be shared across settings. statement or metaparadigm. Other levels of Although nursing research is advancing and the knowledge structure include paradigms, making a difference in people’s lives, the re- conceptual models or grand theories, middle- search may not be linked explicitly to theory, range theories, practice theories, and research and probably not linked to nursing theory. This and practice traditions. These levels of nursing compromises the advancement of nursing sci- knowledge are interrelated; each level of devel- ence. All other disciplines teach their founda- opment is influenced by work at other levels. tional theories to their students, and their Theoretical work in nursing must be dynamic; scientists test or develop their theories through that is, it must be continually in process and research. useful for the purposes and work of the disci- There is a trend toward valuing theories pline. It must be open to adapting and extend- from other disciplines over nursing theories. ing to guide nursing endeavors and to reflect For example, motivational interviewing is a development within nursing. Although there practice theory out of psychology that nurse re- is diversity of opinion among nurses about the searchers and practitioners are gravitating to in terms used to describe the levels of theory, the large numbers. Arguably, there are several sim- following discussion of theoretical develop- ilar nursing theoretical approaches to engaging ment in nursing is offered as a context for others in health promotion behaviors that pre- further understanding nursing theory. ceded motivational interviewing, yet these have not been explored. Interprofessional prac- Paradigm tice and interdisciplinary research are essential Paradigm is the next level of the disciplinary for the future of health care, but we do not do structure of nursing. The notion of paradigm can justice to this concept by abandoning the rich, be useful as a basis for understanding nursing 3312_Ch01_001-018 26/12/14 9:35 AM Page 12 12 SECTION I An Introduction to Nursing Theory knowledge. A paradigm is a global, general from the historical conception of nursing as framework made up of assumptions about a part of biomedical science, developments aspects of the discipline held by members to in the nursing discipline are directed by at be essential in development of the discipline. least two paradigms, or worldviews, outside Paradigms are particular perspectives on the the medical model. These are now described. metaparadigm or disciplinary domain. The Several nursing scholars have named the ex- concept of paradigm comes from the work of isting paradigms in the discipline of nursing Kuhn (1970, 1977), who used the term to (Fawcett, 1995; Newman et al., 1991; Parse, describe models that guide scientific activity 1987). Parse (1987) described two paradigms: and knowledge development in disciplines. the totality and the simultaneity. The totality Because paradigms are broad, shared perspec- paradigm reflects a worldview that humans are tives held by members of the discipline, they integrated beings with biological, psychological, are often called “worldviews.” Kuhn set forth sociocultural, and spiritual dimensions. Humans the view that science does not always evolve as adapt to their environments, and health and ill- a smooth, regular, continuing path of knowl- ness are states on a continuum. In the simultane- edge development over time, but that period- ity paradigm, humans are unitary, irreducible, ically there are times of revolution when and in continuous mutual process with the traditional thought is challenged by new ideas, environment (Rogers, 1970, 1992). Health is and “paradigm shifts” occur. subjectively defined and reflects a process of Kuhn’s ideas provide a way for us to think becoming or evolving. In contrast to Parse, about the development of science. Before any Newman and her colleagues (1991) iden