Nursing Theories

1. APPLICATION OF THEORY
IN NURSING PRACTICE
1Prof. Dr. RS Mehta

2. Review of Terminology
2Prof. Dr. RS Mehta

3. Concept :
• Concept: - Mental image, feelings eg-cat, pen.
• Concept are words that describes object,
properties, events, and are basis of theory.
Types:
1. Empirical concept: observed in real world (e.g. dog)
2. Inferential concept: Indirectly observable (e.g. Pain, BP)
3. Abstract: Non-observable (e.g. Stress, health)
3Prof. Dr. RS Mehta

4. Conceptual Model
• The “symbolic representation of
empiric experience in words,
pictorial, or graphic diagram,
mathematical notations or physical
material.”
4Prof. Dr. RS Mehta

5. Terminology (continue)
• Philosophy: - Science comprising: logic, ethics,
epistemology, view, thoughts.
• Science: - Body of knowledge, abstract idea.
• Construct: - Set / Cluster of concepts.
e.g.: - anxiety (construct): - sweating, palpitation,
restlessness, frequency of micturation.
• Propositions: - relationship among the concepts.
• Hypothesis: - expected relationships.
5Prof. Dr. RS Mehta

6. Paradigm:
• Way of looking at an issue to a clear
vision of a particular phenomenon.
6Prof. Dr. RS Mehta

7. • Pre-paradism: - not tested constructs /
models. (Theorist / research – beginning).
• Paradism: all concepts presented in model,
chart, conceptual forms called paradism.
• Meta-paradism: - gives global perspective,
world view of discipline, broadest
perspective of the discipline (tested).
(Person, nursing, health, environment).
7Prof. Dr. RS Mehta

8. Parameters of Nursing Profession
(1970s)
1. Person: recipient of nursing care (individual,
family, community, group)
2. Heath: state of wellness, High level wellness to
illness
3. Nursing: action taken by nurse (assessment,
diagnosis, planning, implementation, and
evaluation)
4. Environment: Physical surrounding.
8Prof. Dr. RS Mehta

9. Relationship between Meta-paradigm
Four Propositions:
1. Person and Health: Life process
2. Person and environment: Interaction
3. Health and nursing: nursing action for positive
health
4. Person, Environment and Health: continuous
interact with each other
9Prof. Dr. RS Mehta

10. Nature of theory:
“represent a scientist’s best effort
to describe and explain
phenomena”
- Pollitt & Hungler 1997
10Prof. Dr. RS Mehta

11. 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.
11Prof. Dr. RS Mehta

12. Definition:
• Nursing theory is a set of concepts, definitions,
relationships, and assumptions or propositions
derived from nursing models or from other
disciplines and project a purposive, systematic
view of phenomena by designing specific inter-
relationships among concepts for the purposes
of describing, explaining, predicting, and /or
prescribing..
12Prof. Dr. RS Mehta

13. The Theoretical Foundation of Nursing
• Nursing theory provides the theoretical
foundation of the profession.
• Theory defines what nursing is, what it
does, and the goals or outcomes of
nursing care.
• Nursing is the synthesis of many theories.
13Prof. Dr. RS Mehta

14. “Purpose of theory”
Why theory is needed in nursing?
1.It gives guide to care.
2.Helps in providing quality care.
3.Helps in solving problems.
4.Theory shows/gives relation
between variables.
14Prof. Dr. RS Mehta

15. 5. Helps in designing research tools, models &
analysis of data.
6. Helps in discovering facts.
7. Helps in solving social
problems/phenomenon.
8. Helps to interpret the scientific studies.
9. Theory is the ultimate goal of
research/reality.
10. Theory gives scientific base to profession.
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16. Nursing is in infancy stage, in
theory building, we utilize
theory of other disciplines.
(Psychology, learning, physics, needs etc).
16Prof. Dr. RS Mehta

17. Overall Advantages
• Research suggests a Model of Care that ensures
nurses are at full scope of practice and are
autonomous in decision-making:
• Improves patient outcomes; ↓mortality &
morbidity
• ↓ Length of Stay
• ↑ nurse job satisfaction
• ↑ communication with team members
• Creates an environment that recognizes expertise
• ↑ nursing efficiencies (orientation, mobility)
• ↑ retention & recruitment
17Prof. Dr. RS Mehta

18. Nursing Issues
• Shortage of Nurses
• Staff satisfaction
• Staff Work Situation Reports
• Nursing Care Delivery processes
• Critical Thinking skills
18Prof. Dr. RS Mehta

19. Patient issues
• Patient Satisfaction levels
• Patient concerns
• Family concerns
• Involvement in Care Plans
• Pain management
• Access to a consistent care giver
19Prof. Dr. RS Mehta

20. Desired outcomes
• Work together with staff
• Positive Nursing feedback
• Positive Patient feedback
• Coordinated patient care
• Continuity of patient care
• Good communication about patient care
20Prof. Dr. RS Mehta

21. What needed to be done?
• Create a Vision for a Patient Centered
Approach to care delivery (vision)
• Focus on Professional Practice (culture)
• Focus on the Nurse as an autonomous
professional (values)
• Support clinical expertise
• Role clarity for Nurse and ANM
• Ensure the organization supports the change
21Prof. Dr. RS Mehta

22. Create a Vision for Nursing
• Patient Centered vs Provider Centered
• Common philosophy about Care
• Where is the Nurse in relation to other health
professionals
• Relationship between Nursing satisfaction
with work environment and Patient Outcomes
• Discharge Planning
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23. Model of Clinical Nursing Practice
• Patients Perspective
• Nurses Perspective
• Clinical Decisions
• Supportive Structures
• Day to Day Support
• Educational Support
• Managerial Support
23Prof. Dr. RS Mehta

24. The Future
• Continue with the Research
• Support the Implementation Plans
• Communicate with others
• Explore other opportunities
• Tele-health conference
• Watch the Nurses grow
• Celebrate
24Prof. Dr. RS Mehta

25. Application of Nursing Theory in
clinical Nursing Practice
25Prof. Dr. RS Mehta

26. Types of Theory
In nursing there are four types of
theories:
• Needs
• Interaction
• Outcome
• Humanistic
26Prof. Dr. RS Mehta

27. In practice
• Assist nurses to describe, explain, and predict everyday
experiences.
• Serve to guide assessment, intervention, and
evaluation of nursing care.
• Provide a rationale for collecting reliable and valid data
about the health status of clients.
• Help to establish criteria to measure the quality of
nursing care
• Help build a common nursing terminology.
• Enhance autonomy of nursing by defining its own
independent functions.
27Prof. Dr. RS Mehta

28. In education
• Provide a general focus for curriculum design.
• Guide curricular decision making
In research
• Offer a framework for generating knowledge and new
ideas.
• Assist in discovering knowledge gaps in specific field of
study.
• Offer a systematic approach to identify questions for
study, select variables, interpret findings, and validate
nursing interventions.
28Prof. Dr. RS Mehta

29. Few Examples
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30. Clinical example: Cancer breast patient.
• Female –mid 40’s. –Recently diagnose ca. breast.
• Plan mastectomy & chemotherapy.
• Nurse encounter patient on 1st postoperative day.
• Patient: alert, oriented, denies pain.
• Nurses observe: facial tension, slight hand trembling.
• Nurse ask = have you talk with your surgeon.
• Express: anger, dislike-chemo but plan, not inform etc.
which theory will be appropriate?
30Prof. Dr. RS Mehta

31. key concepts of some common theory
1. Nightingale (1860): To facilitate “the body’s
reparative processes” by manipulating client’s
environment
2. Peplau 1952: Nursing is; therapeutic interpersonal
process.
3. Henderson 1955: The needs often called Henderson’s
14 basic needs
4. Abdellah 1960: The nursing theory developed by Faye
Abdellah et al (1960) emphasizes delivering nursing
care for the whole person to meet the physical,
emotional, intellectual, social, and spiritual needs of
the client and family. 21 problems.
31Prof. Dr. RS Mehta

32. 5. Johnson’s Theory 1968: Dorothy Johnson’s theory of nursing
focuses on how the client adapts to illness and how actual or
potential stress can affect the ability to adapt. The goal of
nursing to reduce stress so that; the client can move more
easily through recovery.
6. Rogers 1970: to maintain and promote health, prevent illness,
and care for and rehabilitate ill and disabled client through
“humanistic science of nursing”
7. Orem1971: This is self-care deficit theory. Nursing care becomes
necessary when client is unable to fulfill biological,
psychological, developmental, or social needs.
8. King 1971: To use communication to help client reestablish
positive adaptation to environment.
9. Neuman 1972: Stress reduction is goal of system model of
nursing practice.
10. Roy 1979: This adaptation model is based on the physiological,
psychological, sociological and dependence-independence
adaptive modes.
32Prof. Dr. RS Mehta

33. Conclusion
• The conceptual and theoretical nursing models
help to provide knowledge to improve practice,
guide research and curriculum and identify the
goals of nursing practice.
• The state of art and science of nursing theory is
one of continuing growth.
• It is important the nursing knowledge is learnt,
used, and applied in the theory based practice
for the profession and the continued
development of nursing and academic discipline
33Prof. Dr. RS Mehta

34. CONCLUSION
THEORY AS “VISION”
CONCEPTUALIZES IN USEFUL AND
PRACTICAL WAYS KNOWLEDGE AND
IDEAS THATHELPS US MAKE SENSE OF
WHAT WE DO AS NURSES
34Prof. Dr. RS Mehta

35. Thank you
35Prof. Dr. RS Mehta
Have look on some models and theory …

36. 36Prof. Dr. RS Mehta

37. 37Prof. Dr. RS Mehta

38. 38Prof. Dr. RS Mehta

39. Johnson’s Behavioural System Model
39Prof. Dr. RS Mehta

40. 40Prof. Dr. RS Mehta

41. Environment
Energy Field
Human Being
Energy Field
Roger’s Energy Field Theory
41Prof. Dr. RS Mehta

42. Maslow’s hierarchy of human needs
Physiological needs
(hunger, thirst, shelter, etc)
Safety needs
(security, freedom from danger)
Belonging and love needs
(family, affection, relationships, acceptance by others)
Self-esteem needs
(competence, respect, recognition)
Cognitive needs
(knowing, understanding, exploring)
Aesthetic needs
(symmetry,order,beauty)
Self-actualisation needs
(self-fulfilment, personal
growth realisation of
potential)
42Prof. Dr. RS Mehta

43. 43Prof. Dr. RS Mehta

44. 44
Paplu’s Theory
44Prof. Dr. RS Mehta

45. A good application of this theory is to a 55 year old male with a
history of cocaine-abuse who presents to the hospital with
chest pains.
• During the orientation phase, nurse and client through
therapeutic and effective communication identifies the
problem of the patient, which is chest pain.
• In the identification phase, the nurse acts as a counselor and
advocate and educate patient on substance abuse.
• In the exploitation phase, the nurse acts as a teacher,
counselor, resource person and mediator by utilizing available
service and implementing plan.
• The resolution phase is when patient expresses relief of chest
pain and patient has plan for health maintenance.
Application: Paplu’s theory
45Prof. Dr. RS Mehta

46. Conclusion
• The conceptual and theoretical nursing models
help to provide knowledge to improve practice,
guide research and curriculum and identify the
goals of nursing practice.
• The state of art and science of nursing theory is
one of continuing growth.
• It is important the nursing knowledge is learnt,
used, and applied in the theory based practice
for the profession and the continued
development of nursing and academic discipline
46Prof. Dr. RS Mehta

47. Thank-you
47Prof. Dr. RS Mehta