The nursing discipline is guided by a variety of factors, among them the use of nursing theories. These develop out of research and practice, providing useful frameworks to guide clinicians in their decision-making and actions. When deciding on a prospective career in nursing, it is important to be familiar with some of the core nursing theories, as they are essential to understanding how a nurse should approach patient care.
What are nursing theories?
Theories are organized, logical explanations of how a concept works or of how two or more concepts interact. Nursing theories are, therefore, an organized framework of concepts and purposes, which form the basis of nursing practice. Appearing first in the late 1800s, these theories have been used to guide the practice of nursing in order for nurses to provide safe and effective care.
Understanding the nursing metaparadigm
Nursing theories usually revolve around four core concepts or metaparadigms. These are:
- Person: This is the recipient of care, who may be an individual, a group, a family or a community. These recipients are also referred to as patients.
- Health: Refers to the degree of wellness or well-being of the recipient, and can be physical, mental or emotional.
- Environment: This is any condition that affects the ability of a person to maintain health and well-being. It carries different meanings for each person/patient, the healthcare provider, and the clinical setting.
- Nursing: Refers to the attributes, skills, and interventions that a nurse can provide to assist in a person’s recovery. The ultimate goal of nursing is to enable people to reach the highest level of health possible, while also taking into consideration their own preferences and values.
Nursing theories
The number of nursing theories is ever-growing, with theorists continuously developing and refining existing models. These theories can, however, be classified by type.
- Grand nursing theories
These are theories that provide an overarching framework from which nurses can carry out their practice. They explain the entire discipline of nursing, providing a framework for understanding the relationship between the various concepts of nursing. Examples include:
1. Leininger’s theory of cultural care diversity and universality
Madeleine Leininger developed this theory as a way to provide culturally appropriate care for patients. It is based on the idea that culture has an impact on both health and illness and therefore must be taken into consideration when delivering healthcare. Nurses must understand the beliefs, values, and practices of different cultures in order to provide effective care.
2. Newman’s theory of health as expanding consciousness
Developed by Margaret Newman, this theory suggests that health is an individual’s journey of personal growth and development. It challenges the traditional medical model by stressing the importance of each person’s inner wisdom in order to reach optimal health. Nurses should focus on helping patients find meaning in their illness, and strive for overall well-being rather than just physical health.
3. Orem’s self-care deficit theory
Dorothea Orem’s self-care deficit theory is based on the idea that patients have an innate ability to care for themselves and should be encouraged to do so. Nurses need to assess a patient’s needs, provide information and support, and enable them to become able to manage their own health and reach optimal well-being.
4. Parse’s theory of human becoming
This theory, developed by Rosemarie Rizzo Parse, is based on finding meaning in life and health. It focuses on the patient’s needs and helping them find purpose in their experiences. The theory encourages nurses to be compassionate and supportive, as well as help the patient create a unique path for themselves. By doing so, the patient can reach a meaningful and fulfilling life.
5. Roger’s science of unitary human beings
Developed by Martha E. Rogers, this theory suggests that the human body is composed of many interrelated parts and systems. In order to maintain health, each part must be in harmony with one another. Nurses need to understand that each person has different needs and preferences, and should strive to provide holistic care that addresses the individual’s needs as a whole.
- Middle-range nursing theories
Middle-range theories provide a more specific framework for nursing practice. They focus on the application of nursing knowledge in clinical settings and are intended to guide nurses in providing optimal care to their patients. Examples include:
1. Kolcaba’s theory of comfort
Developed by Katharine Kolcaba, this theory proposes that the goal of nursing is to provide comfort to patients. Comfort can be classified into three categories: physical, psychological, and spiritual. Nurses need to assess the patient’s needs and develop a plan to address them in order to promote optimal comfort and well-being.
2. Larrabee’s quality of nursing care theory
June Larrabee developed this theory to provide a framework for assessing quality of care. It suggests that the quality of care should be based on three factors: the nurse’s skills and knowledge, the patient’s preferences and values, and the resources available in the healthcare setting. Nurses need to ensure that these factors are taken into account when providing care.
3. Mishel’s theory of uncertainty in illness
This theory, developed by Merle Mishel, is based on the idea that a person’s uncertainty about their illness can have an impact on their health. Nurses need to assess a patient’s level of uncertainty and help them manage it in order to promote optimal health outcomes. This may include providing information and support, as well as helping the patient cope with their illness.
4. King’s theory of goal attainment
Developed by Imogene King, this theory suggests that nurses should help their patients reach mutually agreed-upon goals. It focuses on the nurse-patient relationship, and emphasizes the importance of understanding the patient’s needs and values in order to set realistic goals. Nurses need to provide both physical and emotional support throughout the process in order to optimize the patient’s well-being.
- Practice-level nursing theories
At this level, the theories are situation-specific and focus on how to implement nursing knowledge and skills to provide effective care. These theories may be based on concepts from grand or middle-range theories. They provide a framework for nurses to assess patient needs, develop interventions and measure outcomes. Examples include:
1. Mercer’s maternal role attainment theory
Developed by Ramona Mercer, this theory is based on the idea that pregnant women need to develop competencies and skills in order to successfully meet the demands of motherhood. Nurses can use this theory to assess a woman’s level of preparedness for motherhood and develop interventions to help her succeed.
2. Fitzpatrick’s life perspective rhythm theory
Joyce Fitzpatrick developed this theory to help nurses assess how a patient’s life rhythms (such as sleep, eating, and physical activity) may be affecting their health. Nurses can use this theory to identify any disruptions in the patient’s life and develop interventions that will help to restore balance and promote optimal health.
Other types of nursing theories include:
- Descriptive nursing theories: These theories describe a phenomenon usually related to nursing practice and patient care.
- Explanatory nursing theories: Theories explaining the cause of a phenomenon or why it occurs. For instance, a theory might explain why a patient is not responsive to certain treatments.
- Predictive nursing theories: This type of theory predicts the outcome of a phenomenon or how it will evolve over time. It can also predict how certain interventions may affect the outcome.
- Interactive nursing theories: These theories highlight the importance of interactions between people, such as the nurse-patient relationship. They seek to highlight the impact of nursing on patients and how they interact with the environment.
- Needs-based nursing theories: These focus on the needs of individuals and how they influence health outcomes. They emphasize the importance of meeting patient needs in order to promote optimal well-being.
- Descriptive theories: Theories that describe the characteristics of a phenomenon. These theories are used to help nurses understand and assess a situation in order to develop appropriate interventions. They include factor-isolation theories, which identify the components of a situation, and pattern theories, which describe how different elements interact with each other.
Importance of nursing theory in nursing education
Before nursing theories were developed, nursing work was task-oriented, with nurses performing tasks without fully understanding the rationale behind them. Nursing theory provides a framework for nurses to make sense of their work and to understand how their actions can impact patient outcomes.
Nursing students, such as those taking FNP programs in Texas, can benefit from exposure to nursing theories in the following ways:
- Clear framework for understanding nursing: Nursing theories provide students with a clear understanding of the goals and objectives of nursing, as well as an overarching framework for how to approach patient care.
- Application in practice: By learning about different theories, students can gain insight into how these theories are applied in actual practice. This will help them to become more effective nurses by developing an understanding of how their interventions can impact patient outcomes.
- Professional development: Learning about nursing theories can help students develop personally and professionally by giving them a deeper understanding of the principles that guide their practice. This knowledge can also be used to reflect on their own practice and make improvements where necessary.
- Evidence-based practice: Nursing theories provide a framework for evidence-based practice, which is an important part of modern nursing. By learning about the various theories, students will gain an understanding of how to use research and clinical evidence to make decisions about patient care.
- Collaboration and interdisciplinary teamwork: By understanding different theories, students can gain an appreciation of the role that other professionals play in patient care. This knowledge can help them collaborate more effectively with other members of the healthcare team.
- Decision-making skills: Nursing theories provide students with the skills needed to make sound decisions in practice. By learning about the different theories, they can develop the critical thinking and problem-solving skills necessary to assess patient needs and formulate appropriate interventions.
Correlation of nursing theory and nursing practice
Theory and practice are interrelated in nursing. A nurse’s practice should always be based on evidence and research, which can be informed by nursing theories. Nursing theories provide a framework nurses can use to make sense of their work and develop interventions that will have the most positive impact on patient outcomes.
Nursing theory enables nurses to plan and provide care purposefully and proactively. When nurses are aware of the different theories and understand how they can be applied in practice, they are able to make informed decisions about patient care. This can lead to better patient outcomes as well as improved professional satisfaction for the nurse.
Healthcare organizations can also designate specific nursing theories to guide their practice. For instance, a hospital may use Orem’s self-care deficit theory to inform how nurses should provide care for patients with chronic conditions. This helps to ensure that the hospital is providing its patients with quality care and adhering to the latest standards of practice.
Relationship between nursing theory and research
Nursing theory and research are interrelated and have a symbiotic relationship. Nursing theory provides a framework for understanding and explaining phenomena related to health, illness, and patient care, while nursing research generates empirical evidence to test, refine, and expand nursing theory.
Research can be used to refine and expand existing theories or create new ones. Through research, nurses can develop new strategies for providing care that has been informed by nursing theory. This helps to ensure that their practice is evidence-based and up to date with the latest standards of care. Similarly, research findings are used to inform nursing theory, as they provide evidence that can be used to refine and expand existing theories.
Nursing theory and research also inform each other in the practice setting. Nursing research can inform the development of evidence-based nursing practice guidelines and interventions, while nursing theory can provide a conceptual framework for understanding and implementing these guidelines and interventions.
Bottom line
Nursing theories provide a framework for understanding the core concepts of the nursing discipline and guiding nursing practice. They help nurses make informed decisions and take appropriate actions in delivering patient care. By understanding the different nursing theories, nurses can develop a deeper appreciation of the diverse approaches to patient care and then use this knowledge to provide more personalized and effective care to their patients.
