Chapter 4 Theoretical Foundations of Nursing Practice During the first semester in your nursing program, you will learn to apply knowledge from nursing science, basic social science, physical science, biobehavioral science, ethics, and health policy. Recall we discussed these are the hallmarks of a profession (chapter 1). Theories help to describe, explain, and/or predict nursing care measures. Well-developed theories are an important basis for your approach to nursing care.

The Domain of Nursing Domain Paradigm Is the perspective of a profession Provides practical and theoretical orientations for a discipline Paradigm Links science, philosophy, and theories As we have been discussing since Chapter 1, nursing is a profession that draws from many areas. In nursing practice we draw from nursing history, nursing theory, education, practice, and research. A paradigm is useful in describing the domain of a discipline. A paradigm links science, philosophy, and theories accepted and applied by a discipline. Nursing’s paradigm links: person, health, environment/situation, and nursing. Figure 4-1 shows this link. To differentiate: In medicine, physicians diagnose and treat disease. In nursing, nurses diagnose and treat human responses to actual or potential health problems. In nursing, you will use critical thinking skills to integrate knowledge, experience, attitudes, and standards into the individualized plan of care for each client. As the semester unfolds, we will be discussing all of these issues.

Theory Theory Nursing theory Explains a phenomenon Is a conceptualization of some aspect of nursing Communicates the purpose of describing, explaining, predicting, and/or prescribing nursing care Theories constitute much of the knowledge of a discipline. Theory and inquiry link to each other. Nursing theories provide nurses with: 1) a perspective to view client situations, 2) a way to organize data and 3) a method to analyze and interpret information. Theories guide the design of nursing interventions.

Components of a Theory Phenomenon Concepts Definitions Assumptions A theory is a set of concepts, definitions, and assumptions/propositions that help explain a phenomenon. See Figure 4-2 Phenomenon A phenomenon is an aspect of reality that people consciously sense or experience. In nursing, phenomena include caring, self-care, and client response to stress. Concept Concepts can be simple or complex. They can related to an object or an event as a result of individual experiences. They are ideals. They are mental images. Concepts help to describe or label phenomena. Definitions Communicate the general meaning of a concept. Describe the activity necessary to measure concepts. Assumptions Are taken for granted statements that explain the nature of the concepts, definitions, purpose, relationships and structure of a theory.

Types of Theory Grand Middle-range Descriptive Prescriptive Theories have different purposes and are sometimes classified by levels of abstraction. Theories describe, predict, or prescribe activities for the phenomena of interest. See Box 4-1 for goals of theoretical nursing models. Grand theories Are broad in scope, complex, and require specification through research. A grand theory does not provide guidelines for specific nursing interventions but provides the structural framework for broad and abstract ideas related to nursing. Middle-range theories More limited in scope and less abstract They address a specific phenomenon and reflect practices of administration, clinical interventions, or teaching. These types of theories cross different nursing fields and reflect a wide variety of nursing care situations such as uncertainty, incontinence, social support, quality of life, and caring. Descriptive theories The first level of theory development. They describe phenomena, speculate on why phenomena occur, and describe the consequences of phenomena. These theories do not direct specific nursing activities but help to explain client assumptions. Prescriptive theories Address nursing interventions for a phenomenon and predict the consequence of a specific nursing intervention. In nursing, this type of theory designates the nursing intervention, the condition under which the nursing intervention occurs, and the consequences of the intervention. These theories guide nursing research to develop and test specific nursing interventions.

Relationship of Theory to Nursing Practice Theories Generate nursing knowledge for use in practice Can direct how to use nursing process Are adaptable to different clients and all care settings In Chapter 1 we discussed the attributes of a profession. As nursing continues to grow as a profession, knowledge is needed to prescribe specific interventions to improve client outcomes. It is important to discuss nursing process at this point of time. It is the basis for our practice. Nursing process is not a theory. It is a systematic set of steps for the delivery of nursing care, not the knowledge component of our discipline. Remember that a theory can direct how a nurse uses the nursing process.

Interdisciplinary Theories Systems Basic human needs Developmental Psychosocial The nursing profession draws on physical, social, and behavioral sciences. This is why you have to take prerequisite course work before you are accepted into the nursing program. Interdisciplinary theories explain systematic views of phenomena specific to the discipline of inquiry. Systems theory is comprised of different components. The systems theory can be open or closed. Open theory interacts with the environment, exchanging information between the system and the environment. Examples of an open system include: human organism, nursing process.. A closed system does not interact with the environment. Systems have three components: input, output, and feedback (see Figure 4-3) Let’s look at this in relationship to the nursing process. Input for the nursing process is the data or information obtained from assessment. Output is the end product, which indicates whether the client’s health status improves or remains stable as a result of nursing care rendered. Feedback is reflected by outcomes, which are the client’s response to nursing interventions. From developmental psychology, you remember the basic human needs. Maslow’s hierarchy of needs is an interdisciplinary theory. Ask students if they can recall the five needs: 1) physiological, 2) safety and security, 3) love and belonging, 4) esteem and self-esteem and 5) self-actualization. Developmental theories help us to determine if clients are adapting during their specific developmental stage in life. We will further discuss these in chapter 11, 12, 13, and 14. Psychosocial Theories help us to predict client responses to their physiological, psychological, sociocultural, developmental, and spiritual needs. We will further discuss these concepts in Chapter 9: Culture and Ethnicity; Chapter 10: Caring for Families; and Chapter 30: The Experience of Loss, Death, and Grief.

Selected Nursing Theories Nightingale Peplau Henderson Rogers Orem Leininger Roy Watson Benner and Wrubel During this topic, please discuss the theory you use in your nursing program. Explain how the nursing theorist you use in your nursing program guides nursing care planning and perhaps the way you evaluate students in the clinical area using a clinical evaluation tool. Table 1 presents a summary of nursing theories. Remember application of nursing theory in practice depends on nurses having knowledge of theory. These are the organizing framework for the science of nursing and approaches to nursing care.

The Link Between Theory and Knowledge Development Nursing knowledge is theoretical and practical. Theories provide direction to nursing research. Nursing theory and nursing research build nursing’s knowledge base. The goals of theoretical knowledge are to stimulate thinking and create a broad understanding of the science and practice within the nursing discipline. The practical knowledge, or art, of nursing is based on the nurse’s experience in providing care to clients. The relationship between nursing theory and nursing research helps to build nursing’s knowledge base.