Nursing theories

 Nursing theories

Introduction

A theory, as a general term, is a notion or an idea that explains experience, interprets observation, de-scribes relationships, and projects outcomes. Theories are mental patterns or constructs created to help understand and find meaning from our experience, organize and articulate our knowing, and ask questions leading to new insights. As such, theories are not discovered in nature but are human inventions. They are descriptions of our re-flections, of what we observe, or of what we project and infer. For these reasons, theory and related terms have been defined and described in a number of ways according to individual experience and what is useful at the time. Theories, as reflections of understanding, guide our actions, help us set forth desired outcomes, and give evidence of what has been achieved.

A theory, by traditional definition, is an organized, coherent set of concepts and their relation-ships to each other that offers descriptions, explanations, and predictions about phenomena.

Early writers about nursing theory brought definitions of theory from other disciplines to direct future work within nursing. Definitions of theory emphasize various aspects of theory and demonstrate that even the conceptions of nursing theory are various and changing. Definitions of theory developed in recent years are more open and less structured than definitions created before the last decade. Not every nursing theory will fit every definition of what is a nursing theory. For purposes of nursing practice, a definition of nursing theory that has a focus on the meaning or possible impact of the theory on practice is desirable. The following definitions of theory are consistent with general ideas of theory in nursing as well as in other disciplines. They are inclusive enough to be used for purposes of nursing practice, education, and administration, as well as nursing research, but can also provide a focus on one main nursing endeavor.

Theory is a set of concepts, definitions, and propositions that projects a systematic view of phenomena by designating specific interrelationships among concepts for purposes of describing, explaining, predicting, and/or con-trolling phenomena. (Chinn & Jacobs, 1987)

Theory is a creative and rigorous structuring of ideas that projects a tentative purposeful and systematic view of phenomena. (Chinn & Kramer, 1995)

Nursing theory is a conceptualization of some aspect of reality (invented or discovered) that pertains to nursing. The conceptualization is articulated for the purpose of describing, explaining, predicting or prescribing nursing care. (Meleis, 1997)

Nursing theory is an inductively and/or deductively derived collage of coherent, creative, and focused nursing phenomena that frame, give meaning to, and help explain specific and selective aspects of nursing research and practice. (Silva, 1997)

Nursing Theories

In general, nursing theory describes and explains the phenomena of interest to nursing in a systematic way in order to provide understanding for use in nursing practice and research. Theories are less abstract than conceptual models or systems, although they vary in scope and levels of abstraction. Grand theories of nursing are those general constructions about the nature and goals of nursing. Middle-range nursing theories point to practice and are useful in a defined set of nursing situations. Theories developed at the middle range include specific concepts and are less abstract than grand theories. At the next level, nursing practice theories address issues and questions in a particular practice setting in which nursing provides care for a specific population. In addition to considering the scope and levels of abstraction of nursing theories, they are also sometimes described by the content or focus of the theory, such as health promotion, and caring and holistic nursing theories.

TYPES OF NURSING THEORY

Nursing theories have been organized into categories and types. George (1995) sets forth categories of theories according to the orientation of the theorist: nursing problems, interactions, general systems, and energy fields. Another view is that nursing theory forms a continuum of grand theories at one end and theories focused on practice at the other (Chinn & Kramer, 1995; Walker & Avant, 1995; Fitzpatrick, 1997). Meleis (1997) describes types of nursing theory based on their levels of abstraction and goal orientation. Barnum (1998) divides theories into those that describe and those that explain nursing phenomena. Types of nursing theories generally include grand theory, middle-range theory, and practice theory. These will be described below;

Grand Nursing Theory

Grand theories have the broadest scope and present general concepts and propositions. Theories at this level may both reflect and provide insights useful for practice but are not designed for empirical testing. This limits the use of grand theories for directing, ex-plaining, and predicting nursing in particular situations. Theories at this level are intended to be pertinent to all instances of nursing.

Development of grand theories resulted from the deliberate effort of committed scholars who have engaged in thoughtful reflection on nursing practice and knowledge and the many contexts of nursing over time. Nursing theorists who have worked at this level have had insights guided by nursing and related metaparadigms and sometimes have experienced leaps of knowing grounded in these insights. Al-though there is debate about which nursing theories are grand in scope, the following are usually considered to be at this level: Leininger’s Theory of Culture Care Diversity and Universality, Newman’s Theory of Health as Expanding Consciousness, Rogers’ Science of Unitary Human Beings, Orem’s Self-Care Deficit Nursing Theory, and Parse’s Theory of Human Be-coming.

Middle-range Nursing Theory

Middle-range theory was proposed by Robert Merton (1968) in the field of sociology to provide theories that are both broad enough to be useful in complex situations and appropriate for empirical testing. Nursing scholars proposed using this level of theory because of the difficulty in testing grand theory (Ja-cox, 1974). Middle-range theories are more narrow in scope than grand theories and offer an effective bridge between grand theories and nursing practice. They present concepts and propositions at a lower level of abstraction and hold great promise for in-creasing theory-based research and nursing practice strategies.

The literature presents a growing number of reports of nurses’ experiences of developing and using middlerange theory. The nursing practice issues to which these nurses are responding are complex and represent a wide range of practice arenas (Chinn, 1994). The methods used for developing middle-range theories are many and represent some of the most exciting work being published in nursing today. Many of these new theories are built on content of related disciplines and brought into nursing practice and research (Lenz, Suppe, Gift, Pugh, & Milligan, 1995; Polk, 1997; Eakes, Burke, & Hainsworth, 1998). The literature also offers middle-range nursing theories that are directly related to grand theories of nursing (Olson & Hanchett, 1997; Ducharme, Ricard, Duquette, Levesque, & Lachance, 1998). Reports of nursing theory developed at this level include implications for instrument development, theory testing through research, and nursing practice strategies.

Nursing Practice Theory

Nursing practice theory has the most limited scope and level of abstraction and is developed for use within a specific range of nursing situations. Theories developed at this level have a more direct impact on nursing practice than do theories that are more abstract. Nursing practice theories provide frame-works for nursing interventions, and predict out-comes and the impact of nursing practice. At the same time, nursing questions, actions, and procedures may be described or developed as nursing practice theories. Ideally, nursing practice theories are interrelated with concepts from middle-range theories, or may be deduced from theories at the middle range. Practice theories should also reflect concepts and propositions of more abstract levels of nursing theory. Theory developed at this level is also termed prescriptive theory (Dickoff, James, & Wiedenbach, 1968; Crowley, 1968), situation-specific theory (Meleis, 1997), and micro theory (Chinn & Kramer, 1995).

The day-to-day experience of nurses is a major source of nursing practice theory. The depth and complexity of nursing practice may be fully appreciated as nursing phenomena and relations among aspects of particular nursing situations are described and explained. Benner (1984) demonstrated that dialogue with expert nurses in practice is fruitful for discovery and development of practice theory. Research findings on various nursing problems offer data to develop nursing practice theories as nursing engages in research-based development of theory and practice. Nursing practice theory has been articulated using multiple ways of knowing through reflective practice (Johns & Freshwater, 1998). The process includes quiet reflection on practice, remembering and noting features of nursing situations, attending to one’s own feelings, reevaluating the experience, and integrating new knowing with other experience (Gray & Forsstrom, 1991).