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Nursing theories dictate the proper way that a nurse would deal with the client.
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Theoretical Foundation of Nursing Introduction to Theories
What is a theory? • Is an organized system of accepted knowledge that is composed of concepts, propositions, definitions and assumptions intended to explain a set of fact, event or phenomena. • “a creative and rigorous structuring of ideas that projects a tentative, purposeful and systemic view of phenomena” (Chinn and Kramer, 1991)
Definition of Terms Concept – an idea formulated by the mind or experience perceived and observed. Proposition – explains the relationships of different concepts. Definition – is composed of various descriptions which convey a general meaning and reduces the vagueness in understanding a set of concepts. Assumptions – is a statement that specifies the relationship or connection of factual concepts or phenomena.
The following diagram explains the relationships of concepts, propositions, assumptions and definitions with theory and phenomena. Systematically Organized VIEW
What about a Nursing Theory? • Nursing theory is a group of interrelated concepts that are developed from various studies of disciplines and related experiences. • An articulated and communicated conceptualization of invented or discovered reality (central phenomena and relationships) in or pertaining to nursing for the purpose of describing, explaining, predicting, or prescribing nursing care. (Meleis, 1991)
Another theorist, Barnum (1994), stated that a complete nursing theory is one that has context, content and process.
What are Nursing Paradigms? Nursing paradigms are patterns or models used to show a clear relationship among the existing theoretical works in nursing. • Person • Environment • Health • Nursing
What are Nursing Paradigms? 1. Patient/Client • The recipient of nursing care • It is important to know that a person is multidimensional, thus, care provided is individualized according to the needs of the patient
What are Nursing Paradigms? 2. Environment (or Situation) • Includes all possible conditions affecting the client and the setting in which health care needs occur • Internal and external surroundings that affect the person • There is continuous interaction between the client and the environment
What are Nursing Paradigms? 3. Health • The Goal of Nursing Care • The degree of wellness or well-being that the client experiences • Dynamic and continuously changing • A dynamic state of being in which the developmental and behavioral potential
What are Nursing Paradigms? 4. Nursing - The interventions of the nurse rendering care in support of, or in cooperation with the client. • The diagnosis and treatment of human responses to actual or potential health problems (ANA, 1995) • The attributes, characteristic, and nature of the nurse providing care in behalf of, or in conjunction with the client
Nursing theories and models provide information about: • Definitions of nursing and nursing practice • Principles that form the basis for practice. • Goals and functions of nursing • Clarifies the scope of nursing practice.
Nursing theories and models are derived from concepts • Concept is an idea of an object, property, or event. • Concepts are basically vehicles of thought involving mental images. • 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 behaviors). • Concepts are building blocks of theory.
Types of concepts: • 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). • Inferential concepts: These are indirectly observable concepts, e.g. pain, dyspnea and temperature. • 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.
Conceptual Models and Theoretical Models Theoretical models or frameworks are highly established set of concepts that are testable.
Conceptual Models and Theoretical Models Conceptual models or frameworks are representations of an idea or body of knowledge based on the own understanding or perception of a person or researcher on a certain topic, phenomena or theory. They can be represented thru a diagram or in narrative form which shows how concepts are interrelated.
SCIENCE Any systemic knowledge or practice in a discipline of study. In a more casual sense, science refers to a system of acquiring knowledge based on the scientific method. It is also the organized body of knowledge gained through research.
What is Knowledge? Knowledge can be defined as: • Information, skills and expertise acquired by a person through various life experiences, or through formal/informal learning such as formal education, self-study, vocational • The abstract or workable understanding of a subject or idea. • What is known in a particular field of discipline or study. • Facts and information or awareness or familiarity gained by experience of a fact or situation. • There is however no single agreed classification of knowledge.
What are the sources? • Traditional Knowledge is a nursing practice which is passed down from generation to generation. When asked about the basis of the nursing practice the answer would be as simple as “It’s always been practiced this way.” • Authoritative knowledge is an idea by a person of authority which is perceived as true because of his or her expertise. • Scientific knowledge is a type of knowledge which came from a scientific method through research. These new ideas are tested and measured systematically using objective criteria.
Phenomenon A phenomenon can be defined as sets of empirical data or experiences that can be physically observed or tangible such as crying or grimacing when in pain. It is concerned with how an individual person reacts using the human senses concerning their surrounding and assessing the different behaviors and factors that affect such behaviors.
In Nursing, phenomena can be: • Clinical or environmental setting of nursing – health center • Disease process – stomach ulcer • Client’s behavior – guarding behavior at the pain site • Interventions – care of the client in pain • Practices that are utilized in nursing theories and metaparadigms (person, nursing, health and environment)
Nursing Theory Development Education • Nursing theories were primarily used to develop and guide nursing education in universities and institutions. • They were once known to be more strongly established in the field of academics rather than in clinical practice. • In 1970s and 1980s, a number of nursing programs recognized the major concepts of some nursing models, structured these concepts into a conceptual framework, and build the complete curriculum around that framework (Kozier, 2018)
Nursing Theory Development Education • Program objectives • Course objectives • Course description • Clinical performance criteria • Prepare students for practice as members of the professional community. • To ensure adequate quality nursing delivery and to clarify and improve the status of the Nursing as a profession.
Nursing Theory Development Research • To help us identify gaps in the way we approach specific fields of study such as symptom management, quality of life • Different theoretical perspectives also help create new ideas, research questions and interpretations • Grand theories "occasionally" direct nursing research. • Based on Middle-range theories which focus on the discovery of concepts such as pain, self-esteem and learning.
Nursing Theory Development Research • Theoretical concepts from social sciences served as one of the foundations in qualitative nursing research. • Critical theory is used in the academe to describe theories that clarify how social structures influence a wide variety of human experiences from art to social practices. • In nursing, critical theory research helps elaborate more on how structures such as race, gender, sexual orientation, and economic class affect experiences and health outcomes of the patients (Kozier, 2018).
Nursing Theory Development Clinical Practice • Theories thoroughly guide critical thinking and decision-making in clinical nursing practice. • Nurses will have a better understanding on the basis and nature of their work and be able to express it clearly in collaboration with other professionals. • Nursing Theories strengthen professional independence by guiding the deepest and most important part of their practice.
Nursing Theory Development Clinical Practice • Nursing Theories are always critical in assisting nurses to facilitate questions, reflections, and critical thinking in every aspect of care. Example: The application of Leininger’s Transcultural Nursing Theory for developing culturally similar strategies is useful to nurses working with suspected child maltreatment cases.
Interdependence of Theory and Research • The relationship between nursing theory and nursing research helps in building nursing knowledge!
Nursing Knowledge • Theoretical knowledge aims to stimulate thinking and broaden understanding of the science and practice of the Nursing discipline. • Practical knowledge is referred to as the art of nursing • Nursing as an ART relies on knowledge gained from practice and reflection of past experiences. • As a SCIENCE, it is based on scientifically tested knowledge that is applied in the practice setting
