Nursing theories: Shaping the nursing practice and enhanced care delivery

Nursing theories, in essence, are an organized framework of information that define what nurses do, what nursing is, and the why of nursing. Whether the nurses are treating patients in an emergency room or treating a child in a clinic, the intervention is selected only after considering several factors. Nursing theories are like the backbone for determining the best practices and interventions. These theories separate nursing from other healthcare disciplines like medicine. Nursing is a unique discipline.

Nursing is a profession committed to the paradigms set by nursing science. The source of knowledge on which the delivery of care is based is completely different from all other sciences, including medicine.

Nursing theories include concepts like a description of the nurse-patient relationship, definitions of nursing, collaboration, and more. These theories guide nurses in their activities and help them make clinical decisions by providing a clear foundation. They offer a clear direction to develop specific practices that can improve quality patient care.

History of nursing theories

Nursing theories have been around since the late 1800s when the emphasis was placed on nursing education for the first time. Florence Nightingale, in 1860 was the first to define nursing in her ‘Environmental Theory.’ Nightingale defined nursing as “an act of utilizing the environment of the patient to assist him in his recovery.” Basically, she emphasized the importance of having a clean environment, proper food, and pure water for patients’ recovery. Some of the nursing principles established by Nightingale are still valid over 150 years later.

Different levels of nursing theories

Nursing theories are principles and concepts that help guide nursing practice and improve patient outcomes. Understanding nursing theories can provide nurses with valuable information about the best practices in the delivery of care. There are many different types of nursing theories classification, but here are some of the most common ones – based on the level of abstraction and goal orientation.

Grand nursing theories (abstraction): These are overarching, abstract theories that aim to explain the entire scope of nursing practice. These theories are abstract, and it is difficult to understand their concepts without in-depth research. Examples include the Adaptation Model by Sister Callista Roy and Ida Jean Orlando-Pelletier’s Deliberative Nursing Process Theory.

Middle-range nursing theories (abstraction): These are more focused and practical theories developed from grand nursing theories, thereby, less abstract. They provide specific guidance for nursing practice and research and focus on more defined subjects. Examples include the Theory of Comfort by Katharine Kolcaba and Imogene King’s Theory of Goal Attainment.

Practice-based nursing theories (abstraction): These theories are developed directly from nursing practice and aim to improve patient care and outcomes. They are grounded in the experience and knowledge of practicing nurses rather than theoretical frameworks. These theories are specific about addressing a particular situation rather than being generic. Examples include the Clinical Decision-Making Model by Sharon Tucker and the Life Perspective Rhythm Model by Dr. Joyce Fitzpatrick.

Descriptive nursing theories (goal orientation): These theories describe and explain phenomena related to nursing practice. They provide a framework for understanding the nature of nursing and the nurse’s role in patient care. These theories are not action-oriented and do not create guidelines for changing a situation. Examples include the Self-Care Deficit Theory by Dorothea Orem and the Theory of Symptom Management by Merle Mishel.

Prescriptive nursing theories (goal orientation): These theories provide specific guidelines for nursing practice and intervention. They are designed to improve patient outcomes and help nurses achieve specific goals in patient care. Examples include the Theory of Goal Attainment by Imogene King and the Theory of Self-Transcendence by Pamela Reed.

By understanding and applying nursing theories, nurses can improve their practice and provide better care for their patients. These are just a few examples of the many different types of nursing theories that exist. Each theory has strengths and limitations, and different theories may be more applicable in different nursing contexts.

Some of the nursing theories that have shaped the nursing profession

Faye’s 21 Nursing Problems: Faye Abdellah redirected the nursing care delivery to focus on patients rather than the disease. It described ten steps for identifying a patient’s problems and 11 skills nurses could use to develop nursing care plans. A standard for assessing the quality of healthcare, Patient Assessment of Care Evaluation (PACE), was also developed by Abdellah.

Roy’s Adaptation Model: Sister Callista Roy’s nursing theory of Adaptation Model takes up the point of view that humans are essentially a set of interrelated systems that focus on maintaining a balance between all the available stimuli. Developed in 1976, this theory was based on explaining the nature of nursing as a service to the community.

King’s Goal Attainment Theory: Imogene M. King’s Theory of Goal Attainment was mainly focused on creating a better nurse-patient relationship. A better relationship with the patient through proper communication can help meet health goals. If a nurse communicates with the patient and sets goals in collaboration with them, taking action to achieve these goals is easier and better for the patient’s health.

Benner’s Novice to Expert Theory: Patricia Benner described the nursing concept of what is meant by a nursing expert in her theory From Novice to Expert. She defined five levels of experience for nurses and how they can build up their skills. Knowledge and patient understanding through education and clinical experience. These five levels include novice, advanced beginner, competent, proficient, and expert.

Lewin’s Change Theory of Nursing: The Change Theory of Nursing by Kurt Lewin describes a three-stage model which explains that to achieve any meaningful change, previous learnings will need to be rejected and replaced. A change is basically anything, ranging from new behaviors to new thoughts. Practically, it meant that nurses could help patients discard their unhealthy habits and adopt changes that can help in their overall well-being.

Orem’s Self-Care Deficit Nursing Theory: Dorothea Orem’s nursing theory brings together the theory of self-care, the theory of self-care deficit, and the theory of nursing systems. It guides nurses on how to help patients work on self-care to remain healthy. According to this theory, patients experience better recovery when they have some control over self-care activities.

Watson’s Nursing Theory of Caring: Jean Watson’s nursing theory is about what role caring and love play in nurse-patient interactions. It sets the framework for nurses to be compassionate, altruistic, spiritual, trustworthy, dignified, and have good listening skills while performing their nursing services.

Henderson’s Nursing Need Theory: Virginia Avenel Henderson, a nurse theorist, researcher, and educator, emphasized that helping patients become more independent will benefit them when they are released from the hospital. Independence will help them make steady progress toward improvement without any delays. It outlines 14 human needs, including breathing, eating, drinking, sleeping, and more, that are essential.

Leininger’s Transcultural Nursing Theory: This nursing theory by Madeleine Leininger sheds light on the significance of nurses understanding that patients come from diverse cultural backgrounds and that the care they provide should be in line with their cultural and personal values. It allows nurses to tailor their delivery of care to the patients, depending on their culture. This theory also helps nurses to design a recovery plan that matches the patient’s values and beliefs.

Lydia Hall’s Care, Cure, Core Theory: Hall’s nursing theory focuses on vital elements of nursing, namely care, cure, and core. Care is basically the role of nurses delivering care to the patients, the cure is the treatments delivered by other medical professionals, and the core is the care a patient gets from nurses. Ultimately, it concentrates on patients being the main focus of nursing care, with each patient having a different set of requirements.

Why are nursing theories important?

Nursing theories are important for several reasons:

  • Guide nursing practice: Nursing theories provide a framework for understanding the nature of nursing, the role of the nurse in patient care, and the relationships between the nurse, the patient, and the healthcare system. By providing a theoretical basis for nursing practice, these theories help nurses make informed decisions about patient care and interventions.
  • Improve patient outcomes: Nursing theories are designed to improve patient outcomes by guiding nursing practice and helping nurses achieve specific goals in patient care. By using nursing theories, nurses can be more effective and efficient in providing patient care, which can lead to better patient outcomes.
  • Provide a basis for research: These theories provide a foundation for nursing research by guiding the development of research questions, hypotheses, and study designs. They help researchers identify the key variables to study and the best methods for measuring them.
  • Support professional development: By understanding and applying nursing theories, nurses can improve their professional practice and develop new skills and competencies. They can also use theories to identify areas where they need to improve their knowledge or skills, leading to opening doors for professional advancement. Nursing theories are also the base for creating nursing education and training programs.
  • Advance the nursing profession: Nursing theories help to advance the nursing profession by providing a basis for collaboration, education, and advocacy. By using theories, nurses can work together to develop best practices, advance healthcare policies, and promote nursing as a profession.

In summary, nursing theories are important because they guide nursing practice, improve patient outcomes, provide a basis for research, support professional development, and advance the nursing profession. By using nursing theories, nurses can provide high-quality, evidence-based care that benefits both patients and the healthcare system as a whole.

Applying nursing theory in your profession

Almost all the nurses who work in the nursing profession use these nursing theories at some point in their careers. These theories are covered in formal education and training. For example, Elmhurst University’s Accelerated Bachelor of Science in Nursing (ABSN) and Master’s Entry into Nursing Program (MENP) programs may have a class-like theoretical practice that can help student nurses understand how nursing care has evolved over the years. These programs and courses will certainly be important in the future as the impact of aging population on nursing will be huge. To meet the demands of this aging population, nurses will need to be better equipped with skills, education, and technology.

As the world’s population ages, the demand for healthcare services, including nursing, is expected to increase. The nursing profession will play a crucial role in meeting the healthcare needs of the elderly and promoting their health and well-being. With over 73 million baby boomers in America, these individuals are making a large impact on healthcare services. The nursing profession in any aging country will require a greater focus on geriatric nursing, advanced education and training, interprofessional collaboration, prevention and health promotion, and technological advancements.

Wrapping up

In conclusion, nursing theories have played a significant role in shaping the practice of nursing and enhancing the delivery of care to patients. Through the years, nursing theorists have developed and refined various theories that have provided a framework for understanding the complexities of the nursing profession and the human experience of illness.

Theories such as the nursing care theory, the goal attainment theory, the transcultural nursing theory, and the self-care deficit theory have all influenced the way nurses approach patient care, from understanding the patient as a whole person to empowering them to take an active role in their own health and wellness.

These nursing theories have also paved the way for evidence-based practice, a crucial aspect of modern nursing that incorporates research and critical thinking into clinical decision-making.

As the field of nursing continues to evolve, nursing theories will remain a critical component of the profession and delivery of care. By embracing and applying these theories to practice, nurses can ensure that they are providing the highest quality care to their patients and making a positive impact on the health and well-being of individuals, families, and communities.

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