I.
INTRODUCTION
A. The
foundation of any profession is the development of a specialized body of
knowledge
1. In the
past, the nursing profession relied on theories from other disciplines, such as
medicine, psychology, and sociology, as a basis for practice.
2. For nursing
to define its activities and develop its research, it must have its own body of
knowledge.
3. This
knowledge can be expressed as conceptual MODELS and THEORIES.
B. Nursing theories and models provide
information about:
1. Definitions
of nursing and nursing practice
2. Principles
that form the basis for practice.
3. Goals and
functions of nursing
4. Clarifies
the scope of nursing practice.
C.
Nursing theories and models are derived from concepts
(i)
Concept
is an idea of an object, property, or event.
(ii)
Concepts
are basically vehicles of thought involving mental images.
(iii) In Nursing, concepts have been
borrowed from other discipline (adaption, culture, homeostasis) as well as
developed directly from nursing practice and research (maternal-infant boding,
health-promoting behaviours).
(iv) Concepts are building blocks of theory.
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., These are limited by time and space (it can be viewed/measured
only specific period & specific setting and variable).
2. Inferential concepts:
These are
indirectly observable concepts, e.g pain, Dyspnea and temperature.
3. Abstract Concepts: These concepts
are not clearly observable directly or indirectly (known as “Non -observable concepts directly”).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 wider settings and populations.
D. Propositions:
Propositions
are statements that explain the relationship between the concepts.
II. THEORIES
A.
General information
1. Are a set
of logically interrelated concepts that provide a systematic explanatory and
predictive view of phenomena
2. Can begin
as an untested premise (hypothesis) that becomes a theory when tested and
supported or can progress in a more inductive manner
3. Are tested
and validated through research and provide direction for this research
4. Nursing
theory is a framework designed to organize knowledge and
explain phenomena in nursing.
B.
Characteristics
1. Must be
logical, relatively simple, and generalizable.
2. Are
composed of concepts and prepositions.
3. Interrelate
concepts to create a specific way of looking at a particular phenomenon.
4. Provide the
bases for testable hypotheses.
5. Must be
consistent with other validated theories, laws, and principles but have open
unanswered questions for investigation.
6. Can consist
of separate theories about the same phenomenon that interrelate the same
concepts but describe and explain them differently.
7. Can
describe a particular phenomenon (descriptive or factor-isolating theories)’
explain relationships among phenomena (explanatory or factor-relating theories);
predict the effects of one phenomenon on another (predictive or situation-relating
theories); or be used to produce or control a desired phenomenon (prescriptive
or situation-producing theories)
8. Contribute
to and assist in increasing the general body of knowledge within a profession
through research implemented to validate them.
9. Can be used
by nurses to guide and improve their practice.
10. Differ
from conceptual models; both can describe, explain, or predict a
phenomenon. But only theories provide
specific direction to guide practice; conceptual models are more abstract and
less specific than theories but can provide direction for practice.
11. Facilitate
communication and systematic thinking among nurses regarding professional
convictions, moral/ethical structure to guide nurses actions,
12. It
facilitates coordinated and less fragment care.
13. The main exponent of nursing – caring – cannot be measured,
it is vital to have the theory to analyze and explain what nurses do.
II. MODELS
Conceptual Model is a set
of interrelated concepts that symbolically represents of mental image or
phenomenon. Model deals with highly abstract concepts than theory.
A. General
information
1. Describe a
set of ideas that are connected to illustrate a larger, more general concept
2. Are a
symbolic depiction of reality
3. Provide a
schematic representation of some relationships among PHENOMENA
4. Use symbols
or diagrams to represent an idea
B.
Characteristics
1. Attempt to
describe, explain, and sometimes predict the relationships among phenomena.
2. Are
composed of empirical, inferential, and abstract concepts.
3. Provide an
organized framework for nursing assessment, planning, intervention, and
evaluation.
4. Facilitate
communication among nurses and encourage a unified approach to practice,
teaching, administration, and research.
Conceptual models and theories in
nursing are based on the nursing metaparadigm
III METAPARADIGM
Conceptual models and
theories in nursing are based on the nursing metaparadigm. Metaparadigm is the
most global conceptual or philosophical framework of a discipline or profession
1. It defines and describes relationships
among major ideas and values.
2. It guides the organization of theories and
models for a profession.
A. The
nursing metaparadigm comprises four concepts : person, environment, health, and
nursing.
1. Person refers to the recipient of
nursing care, including physical. mental and social.
2. Environment
refers to all the internal and external conditions, circumstances, and
influences affecting the person
3. Health
refers to the degree of wellness or illness experienced by the person
4. Nursing
refers to the actions, characteristics, and attributes of the individual
providing the nursing care.
IV.
CLASSIFICATION OF NURSING THEORIES
Nursing theories can be
classified based on range/scope or abstractness, purpose of the theory, and
philosophical underpinnings.
A. Based on range/scope/generalization
and level of abstractness:
1. Metatheory :
It refers to
“theory of theories”.
Characteristics of
Metatheory:
(i)
Focus
on generating Knowledge and theory development.
(ii)
Focus
on philosophical issues and methodological issues of nursing theory.
(iii) Focus on developing criteria for
analysis and evaluating nursing theory.
Example of Metatheory- J.Dickoff’s and P.James’s Theory
of Theories
2. Grand Theories:
Grand theories are the most complex
and broadest in scope.
Characteristics of
Grand theories:
(i)
Focus
on broad and general areas and concepts.
(ii)
It
deals with nonspecific and relatively abstract concepts.
(iii) Concepts mentioned in grand theories
lack operational definitions.
(iv) Grand theories are not directly
amenable to testing.
(v) These can be used in variety of
setting and populations.
Example
of Grand theories- Orem , Roy, Rogers
3. Middle RangeTheories:
Middle-range theories target specific
phenomena or concepts, such as pain and stress; they are limited in scope yet
general enough to encourage research. It deals with concrete and relatively
operational concepts and amenable to empirical testing. These theories are
highly specific to nursing. These theories are relatively simple to understand
and apply.
Characteristics
of Middle Range
These are characteristics of good
mid-range theory as described by Whall(1996):
(i)
Its
concepts and propositions are specific to nursing;
(ii)
it
is readily operationalized;
(iii) it can be applied to many situations;
(iv) propositions can range from causal to
associative, depending on their application; and
(v) Assumptions fit the theory.
(vi) It should be relevant for potential
users of the theory, i.e. nurses; and
(vii) It should be oriented to outcomes that
are important for patients, not merely describe what nurses do.
(viii) It should describe nursing-sensitive
phenomena that are readily associated with the deliberate actions of nurses.
Example:
Benner Model of skill acquisition in Nursing.Corbin and strauss ”Chronic
illness trajectory framework”
4. Practice Theories/Micro
theories/prescriptive theories:
Practice theories are narrowly defined; they address a
desired goal and the specific actions needed to achieve it.
Characteristics
of Practice theories:
(i)
Least
complex in nature.
(ii)
More
specific than middle range.
(iii)
Provides
specific directions.
(iv)
Limited
to specific populations.
(v)
Often
use of knowledge of other discipline.
(vi)
Specific
to population and setting (oncology,obg).
(vii)
Cannot
be applied in all setting.
Comparison of Grand, Middle Range
|
Characteristic
|
Grand Theories
|
Middle-Range Theories
|
Practice Theories
|
|
Complexity/
abstractness, scope
|
Comprehensive,
global view point (all aspects of human experience)
|
Less
comprehensive than grand theories, middle view of reality
|
Focused
on a narrow view of reality, simple and straightforward
|
|
Generalizibility/
specificity
|
Nonspecific,
general application to the discipline irrespective of setting or specialty
area
|
Some
generalizablity across settings and specialities, but more specific than
grand theories
|
Linked
to special populations or an identified field of practice
|
|
Characteristics of
concepts
|
Concepts
abstract and not operationally defined
|
Limited
number of concepts that are fairly concrete and may be operationally defined
|
Single,
concrete concept that is operationalized
|
|
Characteristics of
propositions
|
Propositions
not always explicit
|
Propositions
are clearly stated
|
Propositions
defined
|
|
Testability
|
Not
generally testable
|
May
generate testable hypotheses
|
Goals
or outcomes defined and testable
|
|
Source of
development
|
Developed
through thoughtful appraisal and careful consideration over many years
|
Evolve
from grand theories, clinical practice, literature review, practice
guidelines
|
Derived
from practice or deduced from middle-range or grand theory
|
B. Based on Philosophical Underpinnings:
I. Developmental
theories and models emphasize growth, development, and maturation
1. The primary focus is change in a
particular direction.
2. This change is orderly and predictable,
occurring in specific stages, levels, or phases.
3. The goal is to maximize
growth.
II. Systems
theories and models view persons as open systems
1. Each open
system can receive input from the environment, process it, provide output to the environment,
and receive feedback while maintaining a dynamic tension of forces
2. Each system
strives for a steady state (balance between internal and external forces)
3. The goal is
to view the whole rather than the sum of the parts.
III. Interaction
theories and models are based on the relationships among persons
1. The primary
focus is on the person as an active participant.
2. Emphasis is
on the person’s self-concept, and ability to communicate and perform roles.
3. The goal is
achievement through reciprocal interaction.
C. Based on Purposes of theory:
I. Descriptive Theories
II. Explanatory Theories
III. Predictive Theories
IV. Prescriptive Theories
V. HISTORICAL PERSPECTIVE
A. 1860
to 1959
1. In 1860,
Florence Nightingale developed her Environmental Theory.
2. In 1952,
the journal Nursing Research was established, encouraging nurses to become
involved in scientific inquiry.
3. In the same
year, Hildegard Peplau published Interpersonal Relations in Nursing;
her ideas have influenced later nursing theorists.
4. In 1955,
Virgina Henderson published Definition of Nursing.
5. In the
mid-1950s, Teachers College, Columbia
University , New York
B. 1960
to 1969
1. During the
1960s, Yale University
School of Nursing, New Haven , Conn.
2. Also during
the 1960s, the U.S.
3. In 1960,
Faye Abdellah published Twenty-One Nursing Problems.
4. In 1961,
Ida Orlando published her theory in The Dynamic Nurse-Patient Relationship:
Function, Process, and Principles of Professional Nursing.
5. In 1962,
Lydia Hall published Core, Care, and Cure model.
6. In 1964,
Ernestine Wiedenbach published her theory in Clinical Nursing: A Helping Art
7. In 1965,
the American Nurses Association published a position paper stating that theory
development was an important goal for nursing.
8. In 1966,
Myra Levine published Four Conservation Principles.
9. In 1969,
Dorothy Johnson published Behavioral Systems Model.
C. 1970
to 1979
1. During the
1970s, Case Western
Reserve University , Cleveland
2. During the
mid 1970s, the National League for Nursing established an accreditation
requirement that nursing schools base their curricula on a nursing conceptual
framework.
3. In 1970,
Martha Rogers published her model in An Introduction to the Theoretical Basis of
Nursing.
4. In 1971,
Dorothea Orem published Self-Care Deficit Therory of Nursing,
Imogene King published Theory of Goal Attainment, and Joyce
Travelbee published Interpersonal Aspects of Nursing.
5. In 1972,
Betty Neuman published Health Care Systems Model.
6. In 1976,
Sister Callista Roy published Adaptation Model.
7. In 1976,
J.G.Paterson and L.T.Zderad published Humanistic Nursing.
8. In 1978,
Madeleine Leininger published Humanistic Nursing.
9. In 1979,
Jean Watson published Nursing: Human Services and Human Care - A
Theory of Nursing.
D. 1980
to the present
1. In 1980,
Evelyn Adam published To be a Nurse and Joan Riehl-Sisca
published Symbolic Interactionism
2. In 1982,
Joyce Fitzpatrick published Life Perspective Model.
3. In 1983,
Kathryn Barnard published Parent-Child Interaction Model and
Helen Erickson, Evelyn Tomlin, and Mary Ann Swain published Modeling
and Role Modeling.
4. In 1984,
Patricia Benner published from Novice to Expert: Excellence and Power in
Clinical Nursing Practice.
5. In 1985,
Ramona Mercer published Maternal Role Attainment.
6. In 1986,
Margaret Newman published Model of Health.
7. In 1994,
Parish Nursing Model:proposed by Bergquist and King.
8. In 1994,Rogers
9. In 1997,
Barbara Artinian and Margarnet Conger published “The intersystem Model:
Integrating Theory and Practice”
Conclusion:
The development of nursing
theories and models is a relatively recent occurrence. The nursing profession
has not reached a consensus on the meaning and interpretation of concepts,
theories, and models. A lack of consensus also exists whether a single model or
theory should be selected or whether multiple models and theories are more
useful to nursing practice. Areas of agreement among theorists include the
importance of the four concepts of person, environment, health, and nursing;
the goal of enhancing client comfort; a holistic approach of nursing; and a set
of distinct values of nursing. Nursing should have knowledge base like other
discipline.
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