Nursing Theories and Borrowed Theories

We are beginning a section on theory. This week is devoted to a basic discussion of nursing theory. We will also we discuss some theories from other disciplines that are commonly used in nursing research or may be the basis of nursing theories. We will be building on what you are learning related to theory.

Theory may seem so dry and removed from actual nursing practice that it is only found in textbooks...end of discussion. Not true! We use theory all of the time, but we just don't call it theory. If we didn't use theory in our practices, every day we walked into clinicals or onto our units, you would be starting from scratch! Theories in their most basic forms are ways of connecting patient symptoms and disease progression. We use theories to understand individual behaviors, family or workplace dynamics or community and cultural patterns. We look for patterns and those patterns are theory based. The emphasis this time around is on the connection between theory, practice and research. You will have an opportunity to specifically examine theories and apply that information.

Content What I Need To Do

Theory categories:

  • Grand theories: The abstract concepts are used as an appraisal of existing ideas.
  • Middle range theories: Used to describe, explain or predict.
  • Practice theories: These are situational specific and contain few concepts. I would also call these Low-Middle.

Theories can be categorized by purpose (each one builds on the ones preceding them

  • Descriptive: Describes aspects of practice, but do not show the interrelationships among the concepts
  • Explanatory: Describes the interconnections among theory concepts
  • Predictive: Describes causal relationships among concepts
  • Prescriptive: Defines activities to reach goals and predicts those outcomes

Nursing epistemology: Nursing knowledge is a combination of empirical science and knowing (conventional wisdom, intuition). These would include: empirics, personal knowledge (a priori), intuitive, somatic, spiritual (metaphysical), esthetics and ethical concepts.

The connection between theory, practice and research: Review the Theory, Practice and Research pages listed on the left.

Practice-Theory-Research connection:

1. Theory-Practice-Theory: adapt a borrowed theory, apply to nursing practice and "tweak" the theory to make it more applicable to nursing practice. For example: Maslow-Virginia Henderson. Systems/Rogers; Dreyfus model of skill acquisition/Benner

2. Practice-Theory: theory development to provide insight into a phenomenon. Theory that evolves from rigorous research practice theories

3. Research-Theory: Baconian: inductive The aim of science is to establish laws; for this purpose an exhaustive enumeration of instances of phenomena, physiologic theories.

4. Theory-Research-Theory: Test a theory with research and refine based on research results Theory of planned behavior- theory of reasoned action actual control .

5. Theory-Research-Practice: Deductive logic (theory testing) Deductive: general to specific. Test theory: Infection causes > WBC, > temp, malaise. My patient has infection use it by monitoring changes.

6. Practice-Research-Theory: Inductive logic (theory development) Inductive: specific to general. Generate theory. Particular observations are combined into a whole: My patient has > wbc, temp, a wound:My patient has an infection.

How are theories developed? Good question!

  1. They are based on the discipline's philosophy
  2. They are based on the experiences of the theorist
  3. They are based on the theorist's assumptions (informed we hope!) which can be implicit or explicit
  4. Concepts are developed and their structure and linkages are defined
  5. Propositions are developed

How are theories tested? Through research!

How are theories used in practice?

  1. Identify standards of care
  2. Direct patient care
  3. Evaluate patient care
  4. Predict outcomes of care
  5. Assists nurses in understanding the care provided

Remember the uses are for direct patient care and for the healthcare environment in general!

Read Nieswiadomy: Chapter 7. You may also have other texts that provide an overview of nursing theorists. The WebLink below will be helpful also.

Chapter 7 study guide

Article: Borrowed Theories, Shared Theories, and the Advancement of Nursing Knowledge

Article: Modifying Kolcaba's Comfort Theory as an Institution Approach

There are TWO things you need to do for this week:

  • This week in class: Your assigned nursing theory (see below).
  • Activity 1: Bring Borrowed Theory examples are down the page).

 

 

 

Check out the theory comparison table

The Nursing Theory Page is helpful

So is this one (some duplication/some not)!

 

Theories can be concrete
or abstract!

 

Terms nobody can pronounce, but are concepts relevant to theory:

  • A priori: known independent of experience
  • Axiology: The study of the nature of values (ethics) including right and wrong (morality)
  • Cosmology: The study of the physical universe
  • Empiricism: Knowledge is gained by verifying experiences through scientific methodology. Hypothesis testing
  • Epistemology: The study of knowledge. How do we "know" things?
  • Logical positivism: Science only explains, predicts and controls. There is no room for understanding or meaning. It is value free. Note: positivism and logical positivism came under scrutiny in the 1960's and it was determined they were too controlled and therefore could never exist in the real world.
  • Ontology: The study of the theory of being
  • Perceived view of science: Depends on the perceptions of the participants and the researcher. See Table
  • Positivism: For all practical purposes, it's another word for empiricism.
  • Post-Positivism: Rigor and objectivity (quantitative methodology) are still key, but explanation of complex phenomena are contextual.
  • Praxis: The application of theory to specific patient care encountered in practice.
  • Received view of science: Denotes that individuals learn by being told or receiving knowledge. See Table
 

Nursing Theorists

  • Nursing theories tend to be grand theories and some are mid-range theories. Check out this table for an overview.
  • Specific Nursing theories: Address the nursing metaparadigm or domains including nursing, humans, health and environment.

 

 

 

 

Here are the theories we will be examining

 

1. Orem's Self-Care Theory: This theory is based on the concepts that humans need to act deliberately in their own care and also interact with their environments. Concepts include self-care, self-care, universal, developmental and health requisites, deliberate action and the nursing system.

2. Health Promotion Model (Nola Pender): This model examines how individuals perceive benefits of action, barriers to action, self-efficacy and activity affect and how these determine health promoting behaviors.

3. Benner's Model of Skill Acquisition in Nursing: Central concepts include how nurses attain competence, skill acquisition, experience, clinical knowledge and practical knowledge.

4. Paterson and Zderad Humanistic Nursing Theory: Examines presence, empathy and comfort. Nursing care is expressed in being (presence) and in doing with the client (procedures).

5. Roy's Adaptation Model: This model focuses on four adaptive modes: the physiologic-physical mode, self-concept-group identity mode, role function mode and the interdependence mode.

6. Rogers' Model of Unitary Human Being: This model is based on systems theory (and understanding that theory makes her's easier to understand!). Humans and the environment are constantly exchanging matter and energy and this exchange is the focus of nursing practice. The person is a unified whole and is different and greater than the sum of his or her parts.

7. Nightingale's Theory: She is most noted for her tenant that a nurse's role is to place the patient in the best possible condition for nature to act. She also proposed that healing is also dependent on leadership and global action.

This week in class: We are going to make visual designs of how these theories are used!

You were assigned to a group last week!

To prepare:

  • Obtain some "working" knowledge about your theorist
  • Bring your PICO(T) question with you to class
  • How would your theorist help us understand the connection among your P (Population), I (Intervention), C (Comparison), O Outcome) and T (Time)?
  • How will you advocate for your theorist's perspective?
  • Be prepared to have some fun!

 

Here is an example of a research study that used your theorist: Read the research article for your researcher. Think about how the researchers used the theory to guide the study. For example was it to explain why an intervention works, why patients experience certain conditions or why people have certain perceptions or altitudes.

1.: Orem research study

 

 

2.: Pender Research study

 

 

 

3. : Benner research study

 

4. : Paterson and Zderad Humanistic research study

 

5. : Roy research study

 

 

6. : Rogers research study

 

 

 

 

7. Nightingale study

 

 

Borrowed Theories

Nursing uses many theories from other professions (Too bad not many use our theories. We need better PR!). We "borrow" these theories from other disciplines. I consider that healthy and then nursing incorporates our holistic approach. So this week we will examine those theories and how we put our "spin" on the theory.

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How has nursing borrowed other theories? A few theories are presented with an example. There are many others! Check out Nieswiadomy: Table 7-1 page 91!

Social Sciences:

  • Exchange theory is based on economic theories. Used to explain hierarchical relationships such as physician/ nurse interactions.
  • Systems theory is based on the human trait of wanting things to be in balance. This theory has been used extensively in organizational management.
  • Symbolic interactionism: has been used to examine relationships in families and in the acquiring new roles such as the maternal role.
  • Feminist theory is based on the inequalities in gender and has been used extensively in nursing related to reproductive topics such as contraception and female genital mutilation.
  • Critical social theory is closely related to feminist theory but the inequality is based on social and economic inequalities. It has been used in nursing issues related to access to care.

Behavioral Sciences:

  • Developmental theory is based on the behavioral development of humans across the life span and has been used to examine the impact of illness on development. Erikson's theory was one of the more well-known developmental theories.
  • Cognitive development (Piaget) is based on humans' abilities to think concretely or abstractly and has been used to examine adolescent decision-making.
  • The Health Belief Model was developed as a Public Heath model to understand why people chose different health behaviors. Originally it was used to understand why people chose to be immunized or not.
  • The Theory of Planned Behavior and Reasoned Action is based on economic theory. It was originally developed to understand people's intentions to buy something like a car. It is used in nursing to examine people's intentions to implement a heath behavior such as adolescents choosing a method of contraception. I used this theory to examine pregnant adolescents' intentions to continue in school after they had their babies. (It worked!)
  • Human need theory (Maslow's hierarchy of needs) is based on humans' abilities to make choices based on an interaction between their strengths and needs. This theory has been used in nursing when examining the choices made by patients who have chronic illnesses such as Hepatitis C or AIDS.

Biomedical Sciences:

  • Disease causation has developed as scientists have gained more understanding of microorganisms. Think Florence Nightingale and the need for open windows!
  • Web of Causation is useful in understanding that diseases have multiple causes including genetics and health choices. Nursing has used the three levels of prevention (primary, secondary, tertiary) related to decreasing the impact of chronic illnesses on individuals and families as well as when examining the cascading effect of a disease on the physiological functioning as in DIC.
  • Stress and adaptation is the basis of the "flight or fight" response. This theory may be more appropriate for men than women as it turns out women secrete more oxytocin when they are stressed which makes them want to bond together for support.
  • Pain management such as the Gate-Control Pain theory which has been used extensively for different modalities of pain management for women in labor.

 

 

 

 

 

 

Everybody benefits!

 

 

 
Jeanette Koshar, RN, NP, PhD
Office: (707) 664-2649 | Office Hours: Wednesday 12-3, email and by appointment
Email: jeanette.koshar@sonoma.edu