Nursing Theory: The Basis for Professional Nursing

Chapter 13: Nursing Theory:
The Basis for Professional
Nursing
Bonnie M. Wivell, MS, RN, CNS


Nursing Theory
Latin “a viewing”; Greek

“contemplating”
A body of knowledge shaped by how
nurses see the world
A group of related concepts, definitions
& statements that propose a view of
nursing phenomena from which to
describe, explain or predict outcomes
Abstract ideas


Why is Theory Important?
Nursing is strengthened when

knowledge is built on sound theory
Criteria to be a profession: distinct body
of knowledge as the basis for practice
Nursing must be viewed as a scholarly
academic discipline hat contributes to
society
Ultimate goal is to support excellence in
practice

Theory Guides the Professional
Nurse in….
Organizing and analyzing patient data
Understanding connections between pieces

of data
Discriminating between important and less
pertinent data
Making sound clinical judgments based on
evidence
Planning effective nursing interventions
Predicting and evaluating outcomes of
interventions


Definition of Terms
Metaparadigm = the major concepts or

abstract ideas of the discipline; most
important to practice and research
Person
Environment
Health
Nursing

Philosophy = a set of beliefs about the

nature of how things work and how the world
should be viewed; begins to put together

some or all concepts of the metaparadigm


Definition of Terms Cont’d.
Conceptual Model or Framework = a

more specific organization of nursing
phenomena than philosophies; provide
an organizational structure that makes
clearer connections between concepts
Propositions = statements that
describe linkages between concepts
and are more prescriptive; they
propose an outcome that is testable in
practice and research


Florence Nightingale
Notes on Nursing: What It Is and What It Is Not

(1969, originally published in 1859)
Her philosophy of health, illness, and the nurse’s role in

caring for patients
Focused on the relationship of patients to their

surroundings
Importance of observing the patient and
recording information
Importance of cleanliness

Health and recovery from illness is related to
environment


Virginia Henderson
The “Unique function of he nurse… is to assist

the individual, sick or well, in the
performance of those activities contributing
to health or its recovery (or a peaceful death)
that he would perform unaided if he had the
necessary strength, will or knowledge.”
Nurse’s role = substitute for the patient, a
helper to the patient or a partner with the
patient
14 basic needs of the patient (see Box 13-3
on pg. 308)


Jean Watson
Studied at CU
The Philosophy and Science of Caring (1979)
Emphasized the caring aspects of nursing
10 Carative factors (see Box 13-4 on pg. 309);

these factors differentiate nursing from medicine
(curative)
Illness or disease equated with lack of harmony
within the mind, body, and soul
RN responsible for creating and maintaining an

environment supporting human caring while
recognizing and providing for patient’s primary
human requirements


Watson Continued
Proposed that nursing be concerned with

spiritual matters and the inner knowledge of
nurse and patient as they participate
together in the transpersonal caring
process
Nurses share their genuine self
Patient’s spiritual strength is recognized,

supported, encouraged
RN encourages openness to understanding of self
and others
Leads to trusting, accepting relationships where
feelings are shared and confidence is inspired


Dorothea Orem
Concept of self-care
“Ordinary people in contemporary society

want to be in control of their lives.”
Patient’s baseline ability to provide
adequate self-care is assessed
Systems of care

Wholly compensatory
Partially compensatory
Supportive-educative


Imogene King
A Theory for Nursing: Systems, Concepts, Process

(1981)
Focused on persons, their interpersonal relationships,
and social contexts with three interacting systems
Personal
Interpersonal
Social

Emphasizes goal attainment and patient’s

involvement in setting goals (Goal Attainment Model)


Sister Callista Roy
Introduction of Nursing: An Adaptation Model

(second edition 1984)
Individual as a biopsychosocial adaptive
system
Nursing is a humanistic discipline that
emphasizes the person’s adaptive and coping
abilities
The environment can be manipulated by the

RN to further patient’s adaptation


Hildegard Peplau
Interpersonal Relations in Nursing (1952 & 1988)
Relationship between patient and nurse is the

focus of attention
Therapeutic interpersonal relationship
Survival of the patient
Patient’s understand his or her health problems and

learn from them as they develop new behavior patterns
6 roles of the nurse: counselor, resource,

teacher, technical expert, surrogate, and leader


Ida Orlando
The Dynamic Nurse-Patient Relationship:

Function, Process and Principles (1961)
Observation and confirmation of patients’
verbal and non-verbal behavior, which
identify patient needs
Goal of the nurse is to determine and meet
patients’ immediate needs and improve their
situation by relieving distress or discomfort
Individualize care by attending to behavior

Madeleine Leininger
Theory of cultural care
Founder of Transcultural nursing
Patients viewed in the context of their cultures
Nursing care should be culturally congruent
“Sunrise Model” (Figure 13-2, pg. 317) guides

the assessment of cultural data for an
understanding of its influence on the patient’s
life


Theory-Based Education
PhD: a research degree that generates

new, discipline-specific knowledge
Master’s: use theoretical perspectives
focused on the patient for specific
nursing outcomes; base practice on
evidence from research & experience
BSN: introduced to research process &
the use of theory to guide it
ADN: find middle range theories useful
as they are specific to patient care


Theory-Based Practice
Occurs when nurses intentionally structure

their practice around a particular nursing
theory and use it to guide them in their
care of the patient
Provides a systematic way of thinking
about nursing that is consistent and guides
the decision-making process
Challenges conventional views of patients,
illness, the health care delivery system,
and traditional nursing interventions


Benefits
Explain practice to others
Passes on knowledge to students
Contributes to professional

autonomy
Develops analytical skills, challenges
thinking, and clarifies your values
and assumptions


Theory-Based Research
Great strides have been made in the

last 25 years in nursing research
Nursing research tests and refines the
knowledge base of nursing
Research findings enable nurses to
improve the quality of care and

understand how evidence-based nursing
influences patient outcomes
Research is vital to the future of nursing
and theory is integral to research