A theory is a collection of statements that explain a relationship between two or more ideas. Theory maintains a central role in the evolution of the nursing discipline. It is something all nurses use in their daily practices, whether known or not. Relatively new, nursing theory is a structure of purposeful and systematic ideas that help to organize disciplinary thinking and influence practice. Much discussion and debate have occurred regarding the various theory definitions. Levine (1995) promoted acceptance of nursing theory, which she called the intellectual life of nursing. She identified that students often fail to embrace nursing theory and do not fully grasp the importance of nursing theory and its relevance for practice and education. Nursing Theory
Understanding nursing theory strengthens the focus of care by guiding nursing practice. It may help to think about nursing theories as various lenses used to view different perspectives of known nursing phenomena. For example, Dorothy Orem’s self-care deficit theory focuses on assisting others in managing self-care to maintain or improve human function at an effective level (Orem, 1995). Also, Sister Callista Roy’s adaptation theory explains how individuals are in constant interaction with a changing environment and that the individual must adapt to change to have a positive response (Creasia & Friberg, 2011).
Example of Dorothy Orem’s Self-Care Deficit TheoryAn elderly man recently received a total hip replacement. During the discharge process, the registered professional nurse educates the patient about many things, including activity restrictions, medications, and wound care. The nurse also reviews activities of daily living, such as showering and toileting. The nurse realizes that the patient’s balance may be altered and discusses fall precautions with the patient. Detailed discharge instructions are an example of moving the patient from a state of dependence on others for care to a state of independence and self-care.Example of Sister Callista Roy’s Adaptation TheoryThe school nurse receives a phone call from a parent of an eighth-grade female student stating that the student recently suffered a femoral fracture from a trampoline injury that required open reduction internal fixation. She has successfully recovered to the point that she can return to class next week. The nurse realizes that because of the full-leg cast the student will be excused from physical education class and likely will require assistance with mobilization and toileting. Based on the student’s age, psychosocial issues are likely to be involved due to an altered self-concept related to body image. Her balance may be altered as well. Ultimately, the student demonstrated a positive attitude and adapted well to this life-altering event.Nursing theory is present in day-to-day interactions with patients. The core values derived from theoretical assumptions can serve as a foundation upon which to build practices. The goal of applying theory is to improve practice. Nursing Theory
The nursing profession is an art and science involving a complex mix of many parts. Nurses are expected to perform the science of nursing through medical and technical competencies, such as nursing skills, academic knowledge, and professional performance. Nurses must become lifelong learners and engage in continuing education throughout their careers to maintain those nursing skills and competencies. Included in the science of nursing are theories, conceptual models, and research that is specific to nursing. The art of nursing requires a foundation of nursing skills, academic knowledge, and professional performance. It is difficult to define or measure the art of nursing other than by looking at the pronounced noticeability of its absence. Treating patients with dignity and respect, being cognizant of nonverbal cues, and using active listening and communication skills are all qualities patients and families value highly. Nurses should strive to find a balance between the science and the art of nursing in their practices (Palos, 2014). Nursing Theory
Nursing is a knowledge-based discipline and profession that incorporates a body of knowledge to guide its practice (Smith & Parker, 2015). Because nursing is a profession, nurses are required to meet specific educational qualifications. Education is systematically obtained from colleges and universities that ultimately produce knowledge-based professional nurses who can practice autonomously. The following characteristics define the meaning of a professional (Creasia & Friberg, 2011):
- Formal education required
- Lifelong mission, recognized as life work
- Encompass knowledge
- Service to society
- Practice autonomously
- Practice guided by ethics
- Professional culture and values
- Compensation received
Theories are built upon a foundation of concepts. Theoretical statements compose a theory. The concepts incorporated into theoretical statements include areas of interest to the discipline. For nursing theory, these concepts include person, environment, health, and nursing, also referred to as metaparadigm. The metaparadigm includes basic assumptions regarding the theory and highlights areas vital to the nursing discipline and ultimately patient care Nursing Theory
Person refers to the patient, client, individual, family, community, or group. These are the recipient(s) of said nursing care. Environment includes external and internal space associated with the person. Health encompasses all areas of, or lack of, the person(s) wellbeing. As the final metaparadigm component, nursing expresses the goal of nursing that is specific to the theory (McEwen, 2007).
Theories can be categorized according to their complexity. These categories include practice theories, midrange theories, and grand theories (also referred to as conceptual models). Conceptual models explain a particular way of thinking, or a mental picture of how the theory fits together, according to the theorist. A conceptual model is the organizing structure that defines the theory.
Types of Theories
Nursing theories are categorized by their level of complexity and are identified as practice theories, midrange theories, or grand theories. Nursing Theory
The purpose of nursing theory is to improve nursing practice, and the lives of patients, families, and communities served by nursing practice. Practice theory defines the delivery of nursing care in specific situations related to practice, incorporating “nurses’ clinical wisdom” (McEwen, 2007) by answering clinical questions. Practice theory is limited in scope in that it focuses on specific areas of nursing, such as a specific patient population or a certain type of nursing practice. Nursing interventions and actions in response to patient-specific needs are often prescribed. Practice theory offers a specific framing of how nurses handle situations within their scope of practice (Levine, 1995). Scenarios of practice theories are often reviewed in nursing journals that focus on management of disease or journals that discuss nursing interventions related to specific patient populations (Creasia & Friberg, 2011).
General System Theory
General system theory is a broad theory that specifies any system being studied as composed of smaller subsystems and also a part of a larger subsystem. It suggests that a system is a set of interrelated parts that are constantly interacting with the environment to attain a common goal (Creasia & Friberg, 2011). In other words, a system is more than the sum of its parts (Boettcher, 1996). When studying the circulatory system, for example, one cannot simply study the components of blood, but must also include the cardiovascular system, the vascular system, respiratory system, and so on to understand how the circulatory system functions. Nursing Theory
Change theory is one of the most commonly used theories related to nursing education and patient learning. This theory’s governing principle is that by using certain motivating factors, patients feel empowered and desire to change unhealthy habits. By setting goals and offering incentives, learning and change occur for the patient.
Kurt Lewin (1890-1947), commonly referred to as the father of psychology, was known for his life space or field theory. Kurt Lewin’s field theory states that human behavior is related to both the individual and the environment. Lewin explored human behavior by performing field research. The concepts of driving forces, restraining forces, and equilibrium were used by Lewin to explain human behavior (McEwen, 2007). Lewin believed that desired change in human behavior could occur by first identifying the undesired behavior, then understanding the cause of such behavior, and what forces would need to be strengthened or weakened to bring about change (Burnes & Cooke, 2013). This theory can be applied to many areas of nursing, including mental health, or any area that desires improved health outcomes based on patient compliance with prescribed regimens.
The ability to cope requires the body to adapt continually to a changing environment. Richard Lazarus (1922-2002) was a psychologist and author who was best known for his theoretical work related to coping. Developed in 1984, Richard Lazarus’s theory of stress, coping, and adaptation centers on how an individual copes with stressful situations (see Figure 2.4). Nursing Theory
The theory focuses on various psychological responses to stress that are considered negative, such as emotional distress, anxiety, depression, anger, and fear, to name a few. Lazarus saw these responses as coping mechanisms. Stress is viewed as more than a stimulus causing a response. Nurses can apply this theory to assess the effects of stress on the individual patient. Physical and psychological responses to stressors can occur (Smith & Parker, 2015). For example, an individual working in a stressful environment may develop emotional distress that causes disruptive outbursts and chronic overeating. Physical responses may include high blood pressure and obesity. Another example would be soldiers returning to civilian life and experiencing post-traumatic stress disorder Nursing Theory
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