Uses and Value of Nursing Theory

Uses of Nursing Theory

• Define relationships among the variables of a given field of inquiry.
• Guide research, practice and communication
• Allow the prediction of the consequences of care
• Allow the prediction of a range of patient responses

Value of Theory

• Enhances understanding and explanation for events.
• Influence our behavior.
• Makes to think differently about a problem or a situation.
• Helps to try new approaches or altering behavior.
• We can gain a new perspective of events.
• basis for challenge of its speculative tenets or propositions.
• challenges subsequent discovery of new ideas or knowledge that might explain and predict events not yet understood.

In practice

• Assist nurses to describe, explain and predict everyday experiences.
• Serve to guide assessment, intervention and evaluation of nursing care.
• Provide a rationale for collecting reliable and valid data about the health status of clients.
• Helps to establish criteria to measure the quality of nursing care.
• Help build a common nursing terminology.
• Enhance autonomy of nursing by defining its own independent functions.

In education

• Provide a general focus for curriculum design.
• Guide curricular decision making.

In research

• Offer a framework for generating knowledge and new ideas.
• Assist in discovering knowledge gaps in specific field or study.
• Offer a systematic approach to identify question for study, select variables, interpret findings and validate nursing interventions.

Galen's Four Temperaments

1. Sanguine personality is fairly extroverted.
2. Melancholic is a person who is a thoughtful ponderer.
3. Phlegmatic tends to be self-content and kind.
4. Choleric is a do-er.

4 Main Elements to Clinical Nursing by Ernestine Weidenbach

1. Philosophy
2. Purpose
3. Practice
4. Art

7 Susbsystem in Behavioral System Model by DorothyJohnson

1. Ingestive
2. Eliminative
3. Affiliative
4. Aggressive
5. Dependence
6. Achievement
7. Sexual

Nursing Theories

• Abraham Maslow - Hierarchy of Needs
• Adolf Meyer - Totality of Man or the holistic Approach to man
• Betty Neuman - Health Care System Model
• Carl Jung - Introversion and extroversion-persona
• Dorothea Orem - Self-Care Deficit, Self - Care, Nursing System theory
• Dorothy Johnson - Bhavioral System Model
• Erik Erickson - Psychosocial Development of Man
• Alfred Adler - Superiority and inferiority complex and birth order
• Faye Abdellah - 21 Nursing Problems
• Florence Nightingale - Environmental Theory
• Galen - Four Temperaments
• Harry Stack Sullivan - Interpersonal theory and anxiety
• Hildegard Peplau - Interpersonal Model
• Ida Jean Orlando - Nursing Process Theory
• Imogene King - Goal Attainment Theory
• Jean Piaget - Cognitive development Theory
• Jean Watson - Human Caring Model
• Lawrence Kohlberg - 3 Levels of Moral Development
• Madeleine Leinger - transcultural Nursing
• Margaret Newman - Human as unitary beings
• Matha Rogers - Science of Unitary Human Beings
• Myra Levine - Four Conservation Principles
• Sigmund Freud - Psychosexual theory and Psychoanalytic Theory
• Sister Calista Roy - Adaptation Model
• Virginia Henderson - Identified 14 basic needs

Four Conservation Principles by Myra Levine

1. Conservation of Energy
2. Structural Integrity
3. Personal Integrity
4. Social Integrity

TEN Major Concepts of Environmental Theory

10 Major Concepts:

1. Ventilation and warming.
2. Light and noise
3. Cleanliness of the area
4. Health of houses
5. Bed and beddings
6. Personal cleanliness
7. Variety
8. Offering hope and advice
9. Food
10. Observation 

7 Assumptions Made in the Environmental Theory by Florence Nightingale

1. Natural laws
2. Mankind can achieve perfection
3. Nursing is a calling.
4. Nursing is an art and a science.
5. Nursing is achieved through environmental alteration.
6. Nursing requires a specific educational base.
7. Nursing is distinct and separate from medicine.

21 Nursing Problems of Abdellah

Basic to all patients

1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, and sleep.
3. To promote safety through prevention of accident, injury, or other trauma and through the prevention of the spread of infection.
4. To maintain good body mechanics and prevent and correct deformity.
5. Facilitate the maintenance of a supply of oxygen to all body cells.
6. To facilitate the maintenance of nutrition of all body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiological responses of the body to disease conditions.
10. To facilitate the maintenance of regulatory mechanisms and functions.
11. To facilitate the maintenance of sensory function.
12. To identify and accept positive and negative expressions, feelings, and reactions.
13. To identify and accept inter-relatedness of emotions and organic illness.
14. To facilitate the maintenance of effective verbal and nonverbal communication.
15. To promote the development of productive interpersonal relationships.
16. To facilitate progress toward achievement of personal spiritual goals.
17. To create and/or maintain a therapeutic environment.
18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs.
19. To accept the optimum possible goals in the light of limitations, physical, and emotional.
20. To use community resources as an aid in resolving problems arising from illness.
21. To understand the role of social problems as influencing factors in the cause of illness.

Elements of Theory

Concept - building blocks of theory; it classify the phenomena of interest.
         1. Theoretical Concepts:
                   Abstract concepts - are mentally constructed, independent of a specific time or place.
                               Example: transport; cardiovascular disease
                   Concrete Concepts - are directly experienced and related to a particular time or place.
                               Example: wheelchair; myocardial infarction
         2. Operational Concept:
                   Discrete concepts - identifies categories or classes of phenomena, such as patient, nurse, health                                                  or environment.
                               Example: Marital Status; Patients
                   Continuous concepts - permits classification of dimension or gradation of a phenomenon on a                                                      continuum.
                               Example: number of children; degree of temperature

St    Statement - in a theory, may state definitions or relations among concepts; are the chains that link the blocks (concepts) to build a theory; propose relationships between the properties of two or more concepts or variables.

When a statement is relating two or more concepts or variables we can identify the independent from the dependent variable.

Ø Independent – cause, can be manipulated; antecedent or determined

Ø Dependent – effect, can be measured; consequent or resultant

Example: 

If a scientist conducts an experiment to test the theory that a vitamin could extend a person’s life-expectancy, then:

• The independent variable is the amount of vitamin that is given to the subjects within the experiment. This is controlled by the experimenting scientist. 
• The dependent variable, or the variable being affected by the independent variable, s the life span.

Types of Statement:

1. Theoretical Statement - relate concepts to one another; permits analysis

2. Operational Statement - relate concepts to measurements.

Theory - are set of interrelated concepts that give a systematic view of a phenomenon that is explanatory and predictive in nature.

Theory construction:

    1. Deductive - reasoning is narrow and goes from general to specific.

Example: All men are mortal;

              Socrates is a man

              Therefore, Socrates is mortal

  2. Inductive - reasoning is much broader and explanatory un nature as one goes from specific to general.

  3. Abductive - reasoning begins with an incomplete set of observations and proceeds to the likeliest possible explanation for the set.

 

Characteristics of Grand, Middle-Range and Practice Theories Based on McEwen and Wills

	Grand Theories	Middle-Range (Text calls High-Middle and Middle-Middle)	Practice (text calls Low-Middle and Microrange)
Characteristics	Comprehensive, global covering all aspects of the human experience	Middle view reality	Focused on a narrow view of reality, simple and straightforward
Generalizability	Non-specific, general application irrespective of setting or area	More specific to practice areas	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	Single, concrete concept that is operationalized
Characteristics of propositions	Propositions are 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 theories
Examples	Martha Rogers, Margaret Newman, Parse, Systems theory, Feminist theory	Benner's Model of Skill Acquisition, Leninger's Cultural Care, Pender's Health Promotion Model, Health Belief Model	Theories used for direct patient care such as theories of caring, pain, empowerment, clinical decision-making, describe patient outcomes such as parent-infant bonding or pain management. They tend to be developed from grounded theory studies

7 STAGES IN THE DEVELOPMENT OF NURSING DISCIPLINE

1. APPRENTICESHIP STAGE - a nurse who learns a job or skill by working; not theory-based, more on bedside skills but not oriented with the rationale; GN Program; single female stays at dormitory.
2. STAGE OF EDUCATION AND ADMINISTRATION - curriculum devlopment and training program for nurses; BSN - 1951 UST first nursing school.
3. STAGE OF RESEARCH -  improve the practice of nursing through research. 1960's with male nurses.
4. STAGE OF THEORY -  research should proves the essence of nursing; that nursing makes a difference.
5, STAGE OF PHILISOPHY - development of outlook in life or career; vision to grow; questions related to values.
6. STAGE OF INTEGRATION - improves nursing by integrating to other discipline.
7. STAGE OF INTERDISCIPLINARY - utilizing other discipline such as medicine, psychology, etc.