Nursing Theory and EBP Guide Practice

Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 18
Application of Theory in
Nursing Practice

Relationship Between Theory and Practice
• In a practice discipline (such as nursing), theory and
practice are inseparable.
• Development and application of theory and research-
based practice are necessary for development of the
profession and autonomous nursing practice.

Relationship Between Theory and Practice—
(cont.)
• Theory provides the basis for understanding the reality
of nursing.
• Theory enables the nurse to understand why an event
happens—for example:
– Why does a pressure sore develop in a post-CVA
elder?
– What causes a postoperative sternal wound
infection?
– Why do college students engage in unprotected
sex?
– Why do people continue to gain weight despite all
the available information about nutrition and the
negative implications of obesity?

How Theory Influences Nursing Practice
• Organizes nursing care
• Sets standards for practice
• Specifies actions to be completed by nurses
• Describes clinical problems to be considered

How Theory Influences Nursing Practice—
(cont.)
• Describes settings in which practice should occur
• Identifies recipients of nursing care
• Sets nursing process format and content
• Specifics systems of nursing care delivery and client
classification systems

Theory-Based Nursing Practice
• “. . . application to clinical practice of knowledge of
various theories, models and principles from the
scientific, behavioral, humanistic and nursing
disciplines” (Kenney, 1995)
• In nursing, practice without theory becomes rote
performance of activities based on tradition and
following orders.

Theory-Based Nursing Practice—(cont.)
• Theory offers the nurse a basis for making informed
decisions.
• With experience, nurses combine theoretical and clinical
knowledge with critical thinking skills to make better
decisions and thereby improve practice.

• The nurse who uses theory-based practice will be
able to describe, explain, predict, and control
nursing events and initiate preventive action.

• Implied theory—those theories used by practicing nurses
during routine client care
• Frequently, theories used in nursing practice are implied
and extrapolated rather than explicitly stated.

Theory and Nursing Interventions
Classification (NIC)
• Nursing Interventions Classification System
– Comprehensive list of more than 550 nursing
interventions
– Grouped into 30 classes and 7 domains

Theory and Nursing Interventions
Classification (NIC)—(cont.)
• NIC is a research-based, standardized classification of
interventions for nurses.
• Interventions may focus on:
– Physiologic issues
– Psychosocial
– Treatment
– Health promoting
– Illness prevention
– Individuals
– Families

Nursing Interventions Classification—
Intermittent Urinary Catheterization
Activity Possible Theory Base
Perform comprehensive
assessment; focus on causes of
incontinence.
Physiology; certain disease
processes
Teach client/family purpose,
supplies, methods, and rationale.
Teaching/learning principles
and theories
Use clean or sterile technique for
catheterization.
Germ theory (principles of
infection)
Maintain on prophylactic
antibacterial therapy as
appropriated.
Pharmacology, health
promotion/prevention
Establish a schedule based on
individual needs.
Developmental theory, role
theory, needs theory

Patient Contracting
Activity Possible Theory
Base
Encourage the client to identify
own strengths and abilities.
Role theory; developmental
theory; needs theory
Assist client in identifying the
health practice to change.
Self-determinism
Assist the client in identifying
present circumstances that may
interfere with goals.
Role theory, developmental
theory, health beliefs,
motivation
Encourage the client to identify
appropriate, meaningful
reinforces/rewards.
Motivation theory

Chemotherapy Management
Activity Possible Theory Base
Monitor for side effects and toxic effects of
chemo agents.
?
Provide information to patient and family on
how chemo works on cancer cells.
?
Teach patient and family about side effects of
chemo.
?
Assist patient in obtaining a wig or other head
covering device as appropriate.
?
Discuss the possibility of sterility and other
reproductive impairments as appropriate.
?
Monitor nutritional status and weight. ?

Evidence-Based Practice (EBP)
• The concept of EBP originated in medicine in the late
1980s.
• EBP is built on the premise that health care should not be
centered on tradition and belief but grounded in
research.

Evidence-Based Practice (EBP)—(cont.)
• Until recently, EBP has been much more common in the
Canadian and English nursing literature than in U.S.
nursing literature.
• EBP and research-based practice are not synonymous.

Question
Tell whether the following statement is true or false:
Evidence-based practice and research are one in the same.

Answer
False
Rationale: Evidence-based practice is founded on research
but is not the same as research.

Evidence-Based Practice (EBP)—(cont.)
• “the conscientious, explicit and judicious use of theory-
derived, research-based information in making decisions
about care delivery to individual or groups of patients in
consideration of individual needs and references”
(Ingersoll, 2000)

Evidence-Based Practice (EBP)—Concerns
• EBP is more focused on science of nursing than the art of
nursing.
• Nursing will be reduced to a technical practice.
• Research should not be the sole basis of practice.
• Emphasizes quantitative research
• Not enough “evidence” exists to direct care in many/most
cases.

Evidence-Based Practice (EBP) and
Theory
• Where is theory in evidence-based practice?

Theory—(cont.)
• Practice theory (micro theory, prescriptive theory,
situation-specific theory)
– Addresses specific phenomena
– Limited to specific populations or practice areas
– May use knowledge from other disciplines
– Is developed from experimental research

Theory—(cont.)
• Practice theory (micro theory, prescriptive theory,
situation-specific theory)—(cont.)
– Prescribes activities to reach defined goals
– Describes the action or intervention, type of client,
and condition
– Predicts consequences

Question
All of the following are common to both EBP guidelines and
protocols and situation-specific(practice) theory EXCEPT:
A.Describes interventions, type of client, situation, or
condition
B.Developed from experimental research
C.Prescribes activities to reach goals
D.Suggests measurements or protocols for analysis

Answer
D. Suggests measurements or protocols for analysis
Rationale: EBP guidelines or protocols have much in
common with situation-specific theories, including
prescribing practice within certain parameters, being
derived from experimental research, and being targeted
toward certain goals or objectives.

Theory in Nursing Practice—Final
Thoughts
• In nursing, theory and practice are inseparable. To
improve practice, nurses need to:
– Continually search the literature
– Critically appraise research findings
– Synthesize empirical and contextually relevant
theoretical information to apply in practice
• Nurse should seek ways to enhance the knowledge base
that supports practice and bridge the theory–practice
gap.

Question
Tell whether the following is true or false:
Evidence-based practice should be used in the development
of current standards of care for nursing practice.

Answer
True
Rationale: Evidence-based practice is focused on the
science more than the art of nursing and is associated
with research. Current standards of practice should be
developed based on the current evidence in research.

Nursing Theory and EBP Guide Practice

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