Nursing Theories and Nursing Practice

Nursing Theories and Nursing Practice

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. Nursing Theories and Nursing Practice

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. Includes bibliographical references and index. 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 Nursing Theories and Nursing Practice


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Preface to the Fourth Edition


This book offers the perspective that nursing is a professional discipline with a body of knowl- edge that guides its practice. Nursing theories are an important part of this body of knowl- edge, and regardless of complexity or abstrac- tion, they reflect phenomena central to the discipline, and should be used by nurses to frame their thinking, action, and being in the world. As guides, nursing theories are practical in nature and facilitate communication with those we serve as well as with colleagues, stu- dents, and others practicing in health-related services. We hope this book illuminates for the readers the interrelationship between nursing theories and nursing practice, and that this un- derstanding will transform practice to improve the health and quality of life of people who are recipients of nursing care. Nursing Theories and Nursing Practice

This very special book is intended to honor the work of nursing theorists and nurses who use these theories in their day-to-day practice. Our foremost nursing theorists have written for this book, or their theories have been de- scribed by nurses who have comprehensive knowledge of the theorists’ ideas and who have a deep respect for the theorists as people, nurses, and scholars. To the extent possible, contributing authors have been selected by theorists to write about their work. Three middle-range theories have been added to this edition of the book, bringing the total number of middle-range theories to twelve. Obviously, it was not possible to include all existing middle-range theories in this volume; how- ever, the expansion of this section illustrates the recent growth in middle-range theory de- velopment in nursing. Two chapters from the third edition, including Levine’s conservation Nursing Theories and Nursing Practice

theory and Paterson & Zderad’s humanistic nursing have been moved to supplementary on- line resources at

This book is intended to help nursing stu- dents in undergraduate, masters, and doctoral nursing programs explore and appreciate nurs- ing theories and their use in nursing practice and scholarship. In addition, and in response to calls from practicing nurses, this book is in- tended for use by those who desire to enrich their practice by the study of nursing theories and related illustrations of nursing practice. The contributing authors describe theory de- velopment processes and perspectives on the theories, giving us a variety of views for the twenty-first century and beyond. Each chapter of the book includes descriptions of a theory, its applications in both research and practice, and an example that reflects how the theory can guide practice. We anticipate that this overview of the theory and its applications will lead to deeper exploration of the theory, lead- ing students to consult published works by the theorists and those working closely with the theory in practice or research. Nursing Theories and Nursing Practice

There are six sections in the book. The first provides an overview of nursing theory and a focus for thinking about evaluating and choos- ing a nursing theory for use in practice. For this edition, the evolution of nursing theory was added to Chapter 1. Section II introduces the work of early nursing scholars whose ideas provided a foundation for more formal theory development. The nursing conceptual models and grand theories are clustered into three parts in Sections III, IV, and V. Section III contains those theories classified within the interactive-integrative paradigm, and those in

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the unitary-transformative paradigm are in- cluded in Section IV. Grand theories that are focused on the phenomena of care or caring appear in Section V. The final section contains a selection of middle-range theories.

An outline at the beginning of each chapter provides a map for the contents. Major points are highlighted in each chapter. Since this book focuses on the relationship of nursing theory to nursing practice, we invited the authors to share a practice exemplar. You will notice that some practice exemplars were writ- ten by someone other than the chapter author. In this edition the authors also provided content about research based on the theory. Because of page limitations you can find additional chapter content online at http:// While every attempt was made to follow a standard format for each of the chapters throughout the book, some of the chapters vary from this format; for exam- ple, some authors chose not to include practice exemplars. Nursing Theories and Nursing Practice


The book’s website features materials that will enrich the teaching and learning of these nursing theories. Materials that will be helpful for teaching and learning about nursing theo- ries are included as online resources. For exam- ple, there are case studies, learning activities, and PowerPoint presentations included on both the instructor and student websites. Other online resources include additional content, more extensive bibliographies and longer biog- raphies of the theorists. Dr. Shirley Gordon and a group of doctoral students from Florida Atlantic University developed these ancillary materials for the third edition. For this edition, the ancillary materials for students and faculty were updated by Diane Gullett, a PhD candi- date at Florida Atlantic University. She devel- oped all materials for the new chapters as well as updating ancillary materials for chapters that appeared in the third edition. We are so grate- ful to Diane and Shirley for their creativity and leadership and to the other doctoral students for their thoughtful contributions to this project . Nursing Theories and Nursing Practice

We hope that this book provides a useful overview of the latest theoretical advances of many of nursing’s finest scholars. We are grateful for their contributions to this book. As

editors we’ve found that continuing to learn about and share what we love nurtures our growth as scholars, reignites our passion and commitment, and offers both fun and frustra- tion along the way. We continue to be grateful for the enthusiasm for this book shared by many nursing theorists and contributing authors and by scholars in practice and research who bring theories to life. For us, it has been a joy to renew friendships with col- leagues who have contributed to past editions and to find new friends and colleagues whose theories enriched this edition. Nursing Theories and Nursing Practice

Nursing Theories and Nursing Practice, now in the fourth edition, has roots in a series of nursing theory conferences held in South Florida, beginning in 1989 and ending when efforts to cope with the aftermath of Hurricane Andrew interrupted the energy and resources needed for planning and offering the Fifth South Florida Nursing Theory Conference. Many of the theorists in this book addressed audiences of mostly practicing nurses at these conferences. Two books stimulated by those conferences and published by the National League for Nursing are Nursing Theories in Practice (1990) and Patterns of Nursing Theories in Practice (1993).

For me (Marilyn), even deeper roots of this book are found early in my nursing career, when I seriously considered leaving nursing for the study of pharmacy. In my fatigue and frus- tration, mixed with youthful hope and desire for more education, I could not answer the question “What is nursing?” and could not dis- tinguish the work of nursing from other tasks I did every day. Why should I continue this work? Why should I seek degrees in a field that I could not define? After reflecting on these questions and using them to examine my nursing, I could find no one who would con- sider the questions with me. I remember being asked, “Why would you ask that question? You are a nurse; you must surely know what nurs- ing is.” Such responses, along with a drive for serious consideration of my questions, led me to the library. I clearly remember reading se – veral descriptions of nursing that, I thought, could just as well have been about social work or physical therapy. I then found nursing Nursing Theories and Nursing Practice

vi Preface to the Fourth Edition

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defined and explained in a book about educa- tion of nurses written by Dorothea Orem. During the weeks that followed, as I did my work of nursing in the hospital, I explored Orem’s ideas about why people need nursing, nursing’s purposes, and what nurses do. I found a fit between her ideas, as I understood them, with my practice, and I learned that I could go even further to explain and design nursing according to these ways of thinking about nursing. I discovered that nursing shared some knowledge and practices with other serv- ices, such as pharmacy and medicine, and I began to distinguish nursing from these related fields of practice. I decided to stay in nursing and made plans to study and work with Dorothea Orem. In addition to learning about nursing theory and its meaning in all we do, I learned from Dorothea that nursing is a unique discipline of knowledge and professional prac- tice. In many ways, my earliest questions about nursing have guided my subsequent study and work. Most of what I have done in nursing has been a continuation of my initial experience of the interrelations of all aspects of nursing scholarship, including the scholarship that is nursing practice. Over the years, I have been privileged to work with many nursing scholars, some of whom are featured in this book. My love for nursing and my respect for our discipline and practice have deepened, and knowing now that these values are so often shared is a singular joy Nursing Theories and Nursing Practice

Also check: Nursing Theory And Conceptual Model