Theoretical Foundations of Nursing Lecture 3 Theoretical Foundations of Nursing

OBJECTIVES 1. Explain the relationships of concepts and propositions to theory. 2. Discuss the purpose of theory. 3. Describe the link between nursing theory and the continuing development of the nursing profession. 4. Explain the interdependent roles of nursing practice, nursing theory, and nursing research. 5. Identify the three categories relating to the scope of theories. 6. Apply the principles of selected nursing theories.

COMPONENTS OF THE THEORETICAL FOUNDATION The basic elements that structure a nursing theory are concepts and propositions. In a theory, propositions represent how concepts affect each other. What Is a Concept? A concept is the basic building block of a theory. A concept is a vehicle of thought. The term concept refers to a “complex mental formulation of . . . [our] perceptions of the world.” A concept labels or names a phenomenon, an observable fact that can be perceived through the senses and explained.

What Is a Proposition? A proposition (another structural element of a theory) is a statement that proposes a relationship between concepts. An example of a nonnursing proposition might be the statement “people seem to be happier in the springtime.” This proposition establishes a relationship between the concept of happiness and the time of the year. A theory is a set of concepts and propositions that provide an orderly way to view phenomena.

What Is the purpose of the theory What Is the purpose of the theory ? The purpose of a theory in scientific disciplines are - to guide research - to enhance the science by supporting existing knowledge or generating new knowledge”. - A theory not only helps us to organize our thoughts and ideas, but it may also help direct us in what to do and when and how to do it. The use of the term theory is not restricted to the scientific world, however. It is often used in daily life and conversation.

THE IMPORTANCE OF NURSING THEORIES ARE TO Provide a framework for thought in which to examine situations. Provide a structure for communicating with other nurses and with other members of the health care team. Assist the discipline of nursing in clarifying beliefs, values, and goals. Define the unique contribution of nursing in the care of clients. Provide the continued development and evolution of the discipline of nursing.

Nursing research is the systematic application of formalized methods for generating valid and dependable information about the phenomena of concern to the discipline of nursing. The relationship between nursing theory, practice, and research is an interdependent one. As a practice oriented discipline, nursing theory and research inform and transform nursing practice.

Nursing Practice Nursing Theory Process of knowledge development. Nursing practice, theory, and research are interdependent. Nursing theory development and nursing research activities are directed toward developing nursing practice standards. Nursing Practice Nursing Theory Nursing Research

SCOPE OF THEORIES Scope refers to the relative level of substantive specificity of a theory and the concreteness of its concepts and propositions”. Essentially, three different categories relate to the scope of theories are 1-grand theories. 2-middle-range theories. 3-micro-range theories. This classification is applicable to both nursing and nonnursing theories.

SCOPE OF THEORIES 1-A grand theory is composed of concepts representing global and extremely complex phenomena. 2-Middle-Range Theory is a theory that addresses more concrete and more narrowly defined phenomena than a grand theory. 3-Micro-Range Theory explains a specific phenomenon of concern to the discipline such as the effect of social supports on grieving and would establish nursing care guidelines to address the problem.

Contemporary Nursing Theories “When is nursing needed?” The work of contemporary theorists such as Levine, Orem, and Roy form the theoretical basis for many interventions in current nursing practice. Dorothea Orem Dorothea Orem was searching for a pragmatic framework to organize nursing knowledge. She presented the Self- Care Deficit Theory of Nursing (S-CDTN) in the book Nursing Concepts of Practice and has continually revised and updated her theory. As a grand theory, the S-CDTN has three interconnecting theories: 1-Theory of Self-Care. 2- Theory of Self-Care Deficit. 3-Theory of Nursing Systems.

Dorothea Orem 1-Theory of Self-Care Orem identified three categories of self-care requisites: 1-Universal self-care requisites, 2- Developmental self-care requisites, 3-Health-deviation self-care requisites. 1-Universal self-care requisites are common to all human beings and include both physiological and social interaction needs as the following. 1- Air, water and food 2-Elimination and excrements

Dorothea Orem 3- Activity/rest 4- Solitude (aloneness) /social interaction 5-Prevention of hazards to life and well-being (physical , social & psychological hazards). 6-Promotion of function and development within social group based on group norms.

Dorothea Orem 2-Developmental self-care requisites are the needs that arise as the individual grows and develops. 3-Health-deviation self-care requisites result from the needs produced by disease or illness states.

Roy defines a person as “an adaptive system . . . a Sister Callista Roy Sister Callista Roy combined general systems theory with adaptation theory to produce the Roy Adaptation Model. Roy defines a person as “an adaptive system . . . a whole comprised of parts that function as a unity for some purpose”. The purposes of adaptation are survival, growth, reproduction, and mastery. According to the Roy Adaptation Model, the person has coping mechanisms that are broadly categorized in either the regulator or cognator subsystem. Adaptation is accomplished through these coping mechanisms that are innate, “genetically determined . . . and automatic processes”.

Sister Callista Roy 1- The regulator subsystem functions through the autonomic nervous system, which “responds automatically through neural, chemical, and endocrine coping processes”. 2- The cognator subsystem enables the person to respond to stimuli through processing stimuli, learning, judgment, and emotion. All input into the system (the person) is channeled through the regulator and cognator subsystems. If the regulator or cognator subsystem fails, there is ineffective adaptation.

Theories for the New Worldview of Nursing Theories for the new worldview of nursing describe, explain, and predict the phenomena of concern to nursing from a unique, more holistic perspective. Theories by Jean Watson, Martha Rogers, and Rosemarie Parse exemplify the new worldview. Jean Watson In the 1980s, Jean Watson developed the Theory of Human Caring, which focuses on the art and science of human caring. According to Watson (1985, “caring is the essence of nursing and the most central and unifying focus of nursing practice.” This theory offers a new way of conceptualizing and maximizing human-to human transactions that occur daily in nursing practice.

Jean Watson Watson’s theory is composed of 10 carative factors, which are classified as nursing actions or caring processes. Watson’s carative factors are: 1. Formation of a humanistic-altruistic system of values 2. Nurturing of faith-hope 3. Cultivation of sensitivity to one’s self and to others 4. Developing a helping-trusting, human caring relationship

Jean Watson 5. Promotion and acceptance of the expression of positive and negative feelings 6. Use of creative problem-solving method processes 7. Promotion of transpersonal teaching and learning 8. Provision for a supportive, protective, or corrective mental, physical, sociocultural, and spiritual environment 9. Assistance with gratification of human needs 10. Allowance for existential-phenomenological forces

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