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Theories, Frameworks, and
   Concepts in Nursing
       Donna Hinson Brown
   Winston-Salem State University
             NUR 2312
            Spring 2012
What is nursing?

•   Science?
•   Art?
•   What makes nursing different?
•   How do we know?
•   What is a theory?
•   “Theory helps us bear our ignorance of the
    facts.” George Santayana
What theory should be…
“Enthusiastic discourse that that fits the
description…a place where people work at the
very edges of their abilities, constantly
pushing each other’s thinking into new
territory, giving names to things that have
gone unnamed, dreaming of better ways,
describing common ground and finding ways
to realize shared dreams”
      Belenky, Clinchy, Goldberg, & Tarule (1996).
Person     trauma     Nurse-patient
                      relationship
  health     CARE
                           Health-
HOPE       Wellness       wellness
                         continuum
 CONCEPTS
                      Story of Hope



                      FRAMEWORK




         THEORY
Theories

• Represent abstract ideas rather than concrete
  facts
• Can be broad or limited
• Grand theories
• Middle-range or midrange theories
• Practice theories (situation-specific theories)
Grand Theories
•   Florence Nightingale’s Environmental Theory
•   Martha Rogers’ Science of Unitary Human Beings
•   Dorothea Orem’s Self-Care Deficit Theory
•   Roy’s Adaptation Model
•   Neuman’s Systems Model
•   Watson’s Science of Philosophy and Caring
•   Peplau’s Interpersonal Process
•   King’s Theory of Goal Attainment
•   Leininger’s Cultural Care Theory
Middle Range Theories
• Uncertainty in Illness (Mishel & Clayton)
• Theory of Self-Transcendence (Pam Reed)
• Theory of Community Empowerment (Persily
  & Hildebrandt)
• Theory of Self-Efficacy (Resnick)
• Theory of Unpleasant Symptoms (Lenz &
  Pugh)
• Story Theory (Smith & Liehr)
Practice Theories
• Less abstract
• Limited scope and focus (single phenomenon)
• Situational (does not transcend time, place)
• Answers a specific question
• Sociopolitical, cultural, historical in
  perspective; easily recognizable in clinical
  practice setting
• Examples
Where to begin???
• What are my interests?
• How do I think about my nursing process and
  practice?
• What do I want to know?
• Sources (original)
• Sources (secondary/ application)
Story Theory: Theoretical Model

                                 Developing story-plot


                                Intentional Dialogue
     NURSE                                                                       PERSON
                            Complicating health challenge


                                         Creating Ease
                                   Movement toward resolving


Smith, M.J., & Liehr, P.R. (2008). Middle Range Theory for Nursing, 2nd ed. New York: Springer
Purpose
• Stories as a part of human experience
• Stories bind people and time
• Stories as expressions of who we are, where
  we have been and where we are going
• Story theory = context for nurse-person health
  promoting process
• Structure to guide nursing in practice and
  research by collecting stories about health
  situations that are important to the person
Story Theory
• The major concepts:
1. Person
2. Environment
                                           NURSING
3. Health                              PRACTICE
4. Nursing

• Clinical practice use for story theory
Questions and Comments

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Theories, frameworks, and concepts in nursing

  • 1. Theories, Frameworks, and Concepts in Nursing Donna Hinson Brown Winston-Salem State University NUR 2312 Spring 2012
  • 2. What is nursing? • Science? • Art? • What makes nursing different? • How do we know? • What is a theory? • “Theory helps us bear our ignorance of the facts.” George Santayana
  • 3. What theory should be… “Enthusiastic discourse that that fits the description…a place where people work at the very edges of their abilities, constantly pushing each other’s thinking into new territory, giving names to things that have gone unnamed, dreaming of better ways, describing common ground and finding ways to realize shared dreams” Belenky, Clinchy, Goldberg, & Tarule (1996).
  • 4. Person trauma Nurse-patient relationship health CARE Health- HOPE Wellness wellness continuum CONCEPTS Story of Hope FRAMEWORK THEORY
  • 5. Theories • Represent abstract ideas rather than concrete facts • Can be broad or limited • Grand theories • Middle-range or midrange theories • Practice theories (situation-specific theories)
  • 6. Grand Theories • Florence Nightingale’s Environmental Theory • Martha Rogers’ Science of Unitary Human Beings • Dorothea Orem’s Self-Care Deficit Theory • Roy’s Adaptation Model • Neuman’s Systems Model • Watson’s Science of Philosophy and Caring • Peplau’s Interpersonal Process • King’s Theory of Goal Attainment • Leininger’s Cultural Care Theory
  • 7. Middle Range Theories • Uncertainty in Illness (Mishel & Clayton) • Theory of Self-Transcendence (Pam Reed) • Theory of Community Empowerment (Persily & Hildebrandt) • Theory of Self-Efficacy (Resnick) • Theory of Unpleasant Symptoms (Lenz & Pugh) • Story Theory (Smith & Liehr)
  • 8. Practice Theories • Less abstract • Limited scope and focus (single phenomenon) • Situational (does not transcend time, place) • Answers a specific question • Sociopolitical, cultural, historical in perspective; easily recognizable in clinical practice setting • Examples
  • 9. Where to begin??? • What are my interests? • How do I think about my nursing process and practice? • What do I want to know? • Sources (original) • Sources (secondary/ application)
  • 10. Story Theory: Theoretical Model Developing story-plot Intentional Dialogue NURSE PERSON Complicating health challenge Creating Ease Movement toward resolving Smith, M.J., & Liehr, P.R. (2008). Middle Range Theory for Nursing, 2nd ed. New York: Springer
  • 11. Purpose • Stories as a part of human experience • Stories bind people and time • Stories as expressions of who we are, where we have been and where we are going • Story theory = context for nurse-person health promoting process • Structure to guide nursing in practice and research by collecting stories about health situations that are important to the person
  • 12. Story Theory • The major concepts: 1. Person 2. Environment NURSING 3. Health PRACTICE 4. Nursing • Clinical practice use for story theory