Chapter 3 Nursing Theories and Conceptual Frameworks

Learning Outcomes Differentiate the terms theory, concept, conceptual framework, paradigm, and metaparadigm for nursing. Describe the major purpose of theory in the sciences and practice disciplines. Identify the components of the metaparadigm for nursing. continued on next slide

Learning Outcomes Identify the role of nursing theory in nursing education, research, and clinical practice. Identify one positive and one negative effect of using theory to understand clinical practice.

Introduction Nursing science Identify the unique body of knowledge that is essential to nursing practice Develop concepts and theories specific to nursing Define the system of ideas that distinguishes nursing from other professions

Theory System of ideas presumed to explain a given phenomenon Helpful to explore theory in other disciplines before considering theory in nursing

May build on or modify previous theories Freud theorized that the unconscious mind shapes everyday life. Jung modified or rejected some of Freud's ideas and developed ideas about the unconscious.

Context for Theory Development in American Universities Universities had to demonstrate a unique body of theoretical knowledge. Theories work like lenses to interpret the world of interest.

Defining Terms Concepts Often called the “building blocks” of theories Example: Freud's theory of the unconscious

Defining Terms Conceptual framework Group of related ideas, statements, or concepts Often used interchangeably with the terms “conceptual model” and “grand theories” Example: Freud's structure of the mind (id, ego, and superego)

Defining Terms Paradigm A pattern of shared understanding and assumptions about reality and the world Includes notions of reality that are largely unconscious or taken for granted Become clear when realities or world views clash Paradigm of religious fundamentalism versus paradigm of evolution

The Metaparadigm for Nursing Concept that can be superimposed on almost any work of nursing Four major metaparadigms in nursing Client/person Environment Health Nursing

Role of Nursing Theory Links among nursing theory, education, research, and clinical practice Contributes to knowledge development May direct education, research, and practice

Figure 3–1 The living tree of nursing theories Figure 3–1 The living tree of nursing theories. From “The Living Tree of Nursing Theories,” by C. Tourville & K. Ingalls, 2003, Nursing Forum, 38(3), p. 23. Copyright © 2003 Blackwell Publishers. Reprinted with permission. 13

In Education In 1970s and 80s, nursing programs: Identified major concepts Organized concepts into conceptual framework Built curriculum around framework Elucidated central meanings of the profession Improved status of the profession

In Research Identifies philosophical assumptions or conceptual frameworks Midlevel (mid-range) theories focus on the exploration of concepts. Pain, self-esteem, and learning

In Research Critical theory describes theory that helps elucidate how social structures affect human experiences from art to social practices. How race, gender, sexual orientation affect patient experience and health outcomes

In Clinical Practice Primary contribution in reflecting, questioning, and thinking about what nurses do Practice theories describe relationships amongst variables as applied to specific clinical situations. Theory of postpartum depression

In Clinical Practice Debates about the role of theory in practice is evidence that nursing is maturing Academic disciplines and clinical profession

Philosophy Belief system, often an early effort to define nursing phenomena, that serves the basis for later theoretical formulations

Overview of Selected Nursing Theories Nightingale's environmental theory Linked health with five environmental factors Noise-free environment

Overview of Selected Nursing Theories Nightingale's environmental theory Keeping client warm Attending to client's diet Peplau's interpersonal relations model Nurse–client relationship Orientation Identification Exploitation Resolution

Overview of Selected Nursing Theories Henderson's definition of nursing Nurse concerned with both healthy and ill individuals Independence gained through meeting 14 fundamental needs Roger's science of unitary human beings Person as irreducible whole greater than sum of parts

Overview of Selected Nursing Theories Roger's science of unitary human beings Human, environmental field exchanges Use of noncontact therapeutic touch Orem's general theory of nursing Self-care Self-care agency Self-care agent Dependent care agent continued on next slide

Overview of Selected Nursing Theories Orem's general theory of nursing Self-care requisites Universal Developmental Health deviation from illness, injury, disease, or treatment Therapeutic self-care demand

Overview of Selected Nursing Theories King's goal attainment theory Relationship of personal, interpersonal, and social systems Ten concepts essential for nurses in concrete nursing situations Neuman's systems model Lines of resistance Lines of defense Inner and flexible

Figure 3–2 King's conceptual framework for nursing: dynamic interacting systems. From A Theory for Nursing: Systems, Concepts, Process (p. 11), by I. M. King, 1981, Albany, NY: Delmar. Copyright Imogene M. King. Reprinted with permission.

Overview of Selected Nursing Theories Neuman's systems model Nursing interventions Retaining or maintaining system stability Primary, secondary, tertiary Roy's adaptation model Individual as biopsychosocial adaptive system that employs feedback cycle of input, throughput, and output Response in one of four modes

Figure 3–3 King's model of transactions Figure 3–3 King's model of transactions. From A Theory for Nursing: Systems, Concepts, Process (p. 145), by I. M. King, 1981, Albany, NY: Delmar. Copyright Imogene M. King. Reprinted with permission.

Figure 3–4 Neuman's client system Figure 3–4 Neuman's client system. From The Neuman Systems Model, 4th ed. (p. 15), by B. Neuman and J. Fawcett, 2002, Upper Saddle River, NJ: Prentice Hall. Reprinted with permission.

Overview of Selected Nursing Theories Leininger's cultural care diversity and universality theory Health and care influenced by elements of social structure Three intervention models Culture care Watson's human caring theory Caring unifying focus for practice 10 clinical caritas processes

Overview of Selected Nursing Theories Parse's humanbecoming theory How individuals choose, bear responsibility for patterns of personal health Client authority figure, decision maker Nurse's role uses “true presence”

Critique of Nursing Theory No single global, commonly accepted definition of nursing Existing theories/models too vague or complex to guide practice Many theories untested, therefore no EBP Interprofessional overlap suggest theory guiding nursing practice cannot be unique to nursing

Critique of Nursing Theory Science, world have changed that historically fundamental theories no longer fit As a lens, theory can either illuminate or obscure. As a tool, theory can either liberate or enslave.