1. NURSING THEORIES & MODELS
Professor Sue Frost

2. 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

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

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

5. 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.

6. “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))

7. 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

8. 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))

9. 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)

10. 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

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

12. 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

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

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

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

16. 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

17. 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

18. 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

19. 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

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

21. 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?

22. 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

23. 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

24. 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)

25. 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

26. 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

27. 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