NURSING THEORIES & MODELS Professor Sue Frost

By the end of this session you should: Be able to explain what is meant by a model and a theory of nursing understand the main features of at least two models of nursing understand how to critically review a model Identify how the application of models to practice influences the activity of the nurse and the experience for the patient or client

References…………………. Models of nursing practice. McGee P. Stanley Thornes 1998 Conceptual bases of professional nursing. Leddy S. Pepper J. Lippincott 4th ed.. 1998 Foundations of nursing practice. Hogston R & Simpson P. Macmillan 1999 (Ch 14)

Nature of theory: “represent a scientist’s best effort to describe and explain phenomena” Pollitt & Hungler 1997

Theory…… “…is a general statement that summarizes and organizes knowledge by proposing a general relationship between events - if it is a good one it will cover a large number of events and predict events that have not yet occurred or been observed” Robson C.

“an internally consistent group of relational statements (concepts, definitions & propositions) that present a systematic view about phenomenon and that is useful for description, explanation, prediction and control. A theory ….is the primary means of meeting the goals of the nursing profession concerned with a clearly defined body of knowledge” Walker & Avant 1996 (cited by Jasper M in Hogston & Simpson))

Purpose of theory Support the development of knowledge through thesis and contestability Explains and predicts outcomes Supports decision making Embeds goals and outcomes for the client and by implication for the nurse Supports modeling of processes of nursing

Classifying theories Meta-theory (Theory building - values etc) Grand theory (Broad conceptual frameworks - not testable e.g. Leininger theory of transcultural care) Middle range theory (Narrower and testable e.g. Peplau) Practice Theory(situational theory - focuses on the way in which nursing is practised e.g. Norton’s theory of nursing elderly people))

Typology: Descriptive theory: Explains through describing relationships and patterns within the framework (e.g. Roper et al) Predictive Theories: Address the consequences of interventions (e.g. Noddings theory of care)

The medical model Bio-reductionist Differential diagnosis: signs & symptoms Provision of treatment Scientific theory - testable and not contestable Goals - cure and therapy Evaluation of treatment efficacy

Nursing models Located in social science Constructed Contestable knowledge Capable of change and development Embed values and culture

What sort of theories would you use? Tony Archer (18 years) underwent surgery to have a below knee amputation of his left leg Peggy Mountford is 82 years old, lives alone with no family and is becoming increasingly confused and depressed

What sort of theories did you identify? Physiology Psychology Sociological theory Nursing theories Descriptive theory Predictive theory

Metaparadigm: constructs in all nursing theories The person the environment health nursing

Commonly used models Roper, Logan & Tierney (ADL) Peplau (interpersonal communication) Orem (Self-Care) Roy (adaptation model) Wolfensberger (social role valorisation) Carper (personal explanations)

Roper, Logan & Tierney Developmental model - emphasises growth & development Person oriented Focus on change Sees process over time Sees a range of activities of daily living changing with maturation Supporting and enabling Draws on Henderson’s work strongly

Callister Roy’s model Systems model - person is made up of systems Systems interact with the environment Health is equilibrium and managed systems Nursing is supporting adaptation to environment Is holist, purposeful and unifying Adaptive modes: physiologic, self concept, role function, interdependence Health is a process of responding positively to environmental changes

Hildegarde Peplau Inter-actional model concerned with interpersonal relationships nursing is organised through building relationships to support communication nurse must be able to use self therapeutically

Dorothea Orem Nursing as part of a social care paradigm supporting client to self care caring as a part of moral consciousness care as the core and essence of nursing caring and community collective responsibilities to support and enable

Carpers model Four dimensions of nursing: empirical dimension personal dimension ethical dimension aesthetic dimension

Exercise What does the Roper et al model suggest about the person, environment, health, nursing? What might Roy say about the person? - how may it be different?

Roper et al Person: A developing maturing individual throughout the life span moving from dependence to independence Health: meeting a range of needs - health changes with many separate facets Environment: Anything external to the person and is a framework of the activities of living Nursing restoring or maintaining ADL when person cannot cope independently

Roy’s model Person: a biopsychosocial being with a unified system Health: equilibrium resulting from effective coping Environment internal and external systems that impact on equilibrium Nursing: Manipulating environment to enable coping

exercise How is assessment likely to be undertaken in Roper modeling? How might nursing be different in a model based on interpersonal relationships? (e.g. Peplau)

Criticising a model Models are constructions & conceptual They enable us to explore how the nature of nursing is defined Models are not facts - they evolve and emerge You do not “do” models - they inform your thinking Models imply different nursing processes

Questioning models & theories What methodologies were used to develop? (?draws on other/theories/research/evidence) How clear is it (overly complex jargon?) What does the theory say - what is the central assertion- is it clear and coherent - is there thesis? What type of theory is it? (e.g. a mid-range theory that can be tested in practice) Can the theory be used Is this theory relevant to my area of practice

Can you….. explain what is meant by a model and a theory of nursing understand the main features of at least two models of nursing understand how to critically review a model Identify how the application of models to practice influences the activity of the nurse and the experience for the patient or client