NURSING THEORIES

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NURSING THEORIES MODELS

• Professor Sue Frost

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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

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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)

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Nature of theoryrepresent a scientists best
effort to describe and explain phenomenaPollitt
Hungler 1997
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Theoryis 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 observedRobson C.
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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 knowledgeWalker Avant 1996 (cited by
Jasper M in Hogston Simpson))
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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

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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.
  Nortons theory of nursing elderly people))

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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)

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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

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Nursing models

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

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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

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What sort of theories did you identify?

• Physiology
• Psychology
• Sociological theory
• Nursing theories
• Descriptive theory
• Predictive theory

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Metaparadigm constructs in all nursing theories

• The person
• the environment
• health
• nursing

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Commonly used models

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

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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 Hendersons work strongly

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Callister Roys 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

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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

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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

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Carpers model

• Four dimensions of nursing
• empirical dimension
• personal dimension
• ethical dimension
• aesthetic dimension

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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?

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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

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Roys 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

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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)

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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

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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

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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