Comparative Analysis of Nursing Theories - Essay Example

NURS 4343 NURSING THEORY AND RESEARCH COMPARISON OF NURSE THEORISTS Comparison of Nursing Theories: Modeling and Role Modeling, Symphonological Bioethical Theory, and Cultural Care Theory of Diversity and Universality Introduction Nursing theory has become an important part of nursing discipline and is in equal partnership with nursing research and nursing practice. It is necessary to examine how theory affects and is affected by research and practice within nursing, and philosophy and politics outside nursing. In 1965, the American Nurses Association stated that theory development was one of the most significant goals for the profession. As a result, nursing theory became the framework for structuring many nurse training programmes, leading to the unwelcome possibility that theory would be synonymous with education rather than practice. In this assignment, comparison of nursing theories of Modeling and Role Modeling, Symphonoloigcal Bioethical Theory, and Cultural Care Theory of Diversity and Universality will be made in order to examine which theory has maximum congruence with practice (Tomey & Alligood, 2006). Relationship between Nursing Research and Theory Knowledge development in nursing from the phenomenological tradition has been very active during the past two decades, as shown by numerous research articles and books published under this heading. Nursing studies from the phenomenological perspective most often have applied the phenomenological methods developed within the psychological tradition. The issue is how such studies may culminate in middle-range descriptive theories of various human experiences, a question rarely raised by the researchers in phenomenological studies. Many researches use interpretive phenomenology, where context and history are viewed in hermeneutic phenomenology as the frames within which knowledge of people's everyday practices and experiences is gained through interpretations, thus making the knowledge tentative and oriented to understanding. Theories emerging from basic foundations of research must assume a different format from those based on other ontological foci permitting explanation or prediction or both. Basically, theories with the ontological focus of existentialism or phenomenology will need to be oriented either to the specification of methodology or the descriptive features regarding the realm of human life, such as human health, and research is needed in that direction (LoBiondo-Wood & Harber, 2006). Difference between the Grand Theories and Middle-Range Theories Development of middle-range theories is a part of the natural growth in application of a conceptual framework. Middle-range theories, clearly developed from within a conceptual framework, accomplish several goals. Such theories can be directly applied to nursing situations, whereas a conceptual framework in Grand theories is usually too abstract for such direct application. Validation of middle-range theories, clearly developed within a particular conceptual framework, lends validation to the conceptual framework itself. Theories such as the classical grand theories in nursing demonstrate a variety of integrated approaches to nursing based on the worldview of an individual theorist. Ongoing research through testing and evaluation has supported the validity and reliability of the theories. Grounded or middle-range theories, however, focus on particular aspects of nursing practice and are commonly generated from nursing practice. As such, some intellectuals view middle-range theories as more relevant and useful to nursing than the application of grand theories (Tomey & Alligood, 2006). Comparison Theorists The Theory of Modeling and Role-Modeling by Erickson, Tomlin, and Swain in 1983 is considered by the authors as a theory and paradigm both. From nurses' interaction with patients, the authors constructed the theory. Helen Erickson is now in Imagine Nursing; she is a consultant in Holistic Nursing and the Executive Director, American Holistic Nurses' Certification Corporation. She earned a diploma in nursing, which followed a bachelor's degree in nursing, master's degree in psychiatric nursing, and a doctorate in educational psychology from the University of Michigan. The other author Evelyn M. Tomlin was educated at Pasadena City College in Southern California and Los Angeles General Hospital School of Nursing. From the same University, she received her bachelor's in nursing, and she did masters in nursing from the University of Michigan. Her areas of practice include medical-surgical, maternity, and pediatric nursing. During work, she was an active member of the faculty of University of Michigan, and now after retirement, she counsels single mothers in a religious environment. Mary Ann P. Swain was initially educated in Psychology at DePauw University in Indiana, which preceded her master's and doctoral degrees from the University of Michigan. She was a professor of research methods in psychology and was the chairperson of nursing research in the University of Michigan for half a decade. She currently is in the New York State and is a provost for the New York State University System (Tomey & Alligood, 2006). Symphonological Bioethical Theory has been proposed by Gladys L. Husted and James H. Husted. Gladys L. Husted is at Duquesne University; she is a professor of nursing there. She did her Master's in Nursing Education and PhD from the University of Pittsburgh on Curriculum and Supervision. She is a teacher in the BSN, MSN, and PhD programs. She was awarded the title of Distinguished Professor in 1998. Her main specialty area is bioethics and curriculum design, instructional strategies, and theory development. James H. Husted is an independent scholar who guest lectures on bioethics at Duquesne University in the BSN, MSN, and PhD programs. He has been an active members of American Catholic Philosophic Association and high IQ societies, Mensa and Intertel. He was the philosophy editor of Integra - the journal of Intertel. He writes in the area of bioethics (Tomey & Alligood, 2006). Madeleine Leininger is the founder and leader of the field of transcultural nursing with focus on comparative human care theory and research. She is founder of the worldwide Transcultural Nursing Society. Her undergraduate degree is from Mt. St. Scholastic College in Atchison, Kansas, and her master's degree was earned at the Catholic University of America in Washington, D.C. She completed her PhD in social and cultural anthropology at the University of Washington. Dr. Leininger is a fellow and distinguished living legend of the American Academy of Nursing. She is professor emeritus of the College of Nursing at Wayne State University and is adjunct professor at the University of Nebraska, College of Nursing (Tomey & Alligood, 2006). Definitions in the Theories and their Relationships Nursing is defined by this Modeling and Role-Modeling theory to be the act of holistic helping of persons with their self-care activities in relation to their health. This is accomplished with an interactive, interpersonal process that nurtures strengths in order to achieve a state of perceived holistic health. Persons are defined as human beings who have multiple interacting subsystems including genetic makeup and spiritual drive, so in him body, mind, emotion, and spirit are parts of a total unit and they act together affecting and controlling one another interactively. When these work in an effective manner these would lead to health which has been defined as a state of physical, mental, and social well being, not merely the absence of disease or infirmity. Person has a lifetime growth and development in a continuous fashion, and when these needs are met, growth and development promote health. Person in his lifetime continuously interact with internal and external environments and attempts to adapt with it in a health and growth-directed manner. Maladaptation with the environment taxes the person's system when the individual is unable to engage constructive coping methods or cannot mobilize appropriate resources to contend with the stressors (Tomey & Alligood, 2006). According to this theory, adaptation is an innate and instinctual drive in human beings irrespective of aging process or inherent malformations. The drive is toward holistic health, growth, and development. This takes the form of self-healing, recovery, and renewal. This theory assists the nurse to gain knowledge about the person, and through that, the nurse can predict the person's potential to cope. The knowledge would assess three states of the person, equilibrium, arousal, and impoverishment. People in equilibrium have the potential to mobilize resources, and those who are maladaptive have fewer resources. Nursing thus would nurture holistic self-care, so it would assist persons holistically to use their adaptive strengths to attain and maintain optimum biopsychosocial-spiritual functioning. Ultimately, it would help persons to achieve self-care to lead to optimum health, and thus nursing is an integrated and integrative helping of persons to better care for themselves. Modeling is the process by which the nurse seeks to understand the person's unique model of the world, both external and internal. Role-modeling is the process by which the nurse understands the client's unique model within the context of the scientific theories and uses the model to plan interventions that promote health of the client (Tomey & Alligood, 2006). Symphonology is a system of ethics based on the terms and preconditions of an agreement. In the nursing related healthcare setting, this means an agreement between a patient and a nurse that defines the relationship that they share. Thus it is a practice-approach to theorize this relationship. In contrast to the contemporary ethical systems, symphonological ethical systems, a nurse as a professional and ethical agent is one, a healthcare professional. By this meta-theory of nursing, a nurse is the agent of the patient. By the term agent, it means nurse would do exactly that which would have been done by the patients themselves in a state of ability. The nurse's action would be in the directions to restore the person's ability so they can take actions for themselves. The nurse who practices must possess an above average degree of personal integrity on which is built a high degree of personal satisfaction and emotional fulfillment. By this theory, a patient is one who has compromised abilities to take actions for survival and well being. This defines the nurses' role and health. Health is a condition where the person can take actions for his own survival and wellbeing, and the role of the nurse is to restore the state of health of the person, but during that process of restoration, she serves as the agent in all respects so the actions taken by her is based on an agreement (Tomey & Alligood, 2006). These elements of this theory are related through nurse patient agreement, and fidelity to the agreement on the part of the nurse is the basis of all understanding, benevolence, and trust in the healthcare setting. A nursing ethic is a source of professional pride since there are several benefits in the welfare and wellbeing of the patient. Standard bioethical actions are inherent in nursing practice, so they are inherent sub-agreements in this main agreement, and they satisfy bioethical responsibilities of a nurse. Environment is important, since ethical actions must have context, and a change in the context can change the perspectives and hence decisions (Tomey & Alligood, 2006). One of the most significant and unique contributions of Dr. Leininger was the development of her Culture Care Diversity and Universality Theory. Prior to her work, there were no theories explicitly focused on care and culture in nursing environments. By this theory, nursing has been defined as essentially a transcultural care profession and discipline, where care is essential for human growth, development, curing, healing, and survival and even to face death and dying. The nurse as a professional should be aware of the forms, expressions, patterns, and processes of human care across cultures of the world, where both generic and professional care practices vary and who is prepared to provide therapeutic nursing care with the knowledge of client culture care values, expressions and/or practices and is prepared to reduce the cultural difference between her and the person to provide beneficial, satisfying, and congruent care. Person has been defined as individual who needs care and has expectations about culturally congruent care. Health has been defined in this theory as a state of well-being that is culturally defined, valued, and practiced and reflects the ability of individuals to perform their daily role activities in culturally expressed, beneficial, and patterned ways. Environment is that which determines the cultural care values and beliefs in association with religious, kinship, social, political, cultural, economic, and historical dimensions of the social structure in the context of language (Tomey & Alligood, 2006). Leininger's theory for transcultural nursing emphasizes nursing practice be based on the understanding and analysis of culture-specific as well as universal practices of human lives, and articulation of such understanding in designing and providing nursing care to fit an individual's specific life patterns for a culturally congruent care. Leininger's key assumption for this theory is that individuals carry on their lives through culture care, which refers to multiple aspects of culture that influence and enable people to deal with conditions of their lives including health, illness, and dying. The second theoretical perspective is based on the assumption that transculturality must be accepted as an operative concept of human life. In this perspective, transculturality posits for an understanding of culture as inclusive and integrated rather than exclusive and separate, and the aim for transculturality is a pragmatic one. Because nursing is a relational practice, such a theoretical approach may provide a means through which the culturality of both patients and nurses can be acknowledged and shared. The nursing actions or decisions are studied until one realizes the care needed. The nurse discovers with the person the appropriate actions, decisions, or plans for care. Throughout this discovery process, the nurse holds his or her own etic views, presuppositions, and biases in abeyance, so that the informants' ideas will come forth, rather than the researcher's views. Transcultural nurses are taught, guided, and mentored in ways to withhold their biases or wishes and to enter the client's worldview (Tomey & Alligood, 2006). Type of Research Studies Barnfather and Ronis (2000) in their study tested a model drawn from the modeling and role-modeling theory to depict relationships among psychosocial stressors, perceived stress, and health of undereducated adults. They did this study in a purposive sample of 171 enrolled adults in an urban adult education center through several self-report measures. The results of this study validated this theory, since these authors found on the basis of structural equation modeling analysis that psychosocial development and basic need satisfaction had significant direct effects on health with the expected positive signs (Barnfather and Ronis, 2000). Folse (2007) utilized the modeling and role-modeling theory to determine the role of the family in the development and maintenance of eating disorders through a new 53-item instrument designed on the basis of this theory. This was designed to measure variables specific to families with eating disorders. A multisite sample comprising of three groups: 146 parents of individuals with eating disorders, 35 parents of adolescents with psychiatric disorders, and 100 parents of college students with no known psychiatric illness demonstrated an adequate reliability and validity. Construct validity was supported by structural equation modeling, and provisional degree of known group validity was established (Folse, 2007). Symphonology has been applicable in all areas of practice in nursing, and literally, in all areas of healthcare field, where the agreement holds good between nurse and patient, researcher and subject, employee and manager, and even student and the educator. Studies are underway, and Irwin (2004) performed a study in the acute care hospital setting. Other studies by Hardt in 2004 and Bavier in 2003 who tested this theory as postdoctoral students are also available (Tomey & Alligood, 2006). Anuforo and coworkers (2004) did a comparative study to gain insight into the meanings, beliefs, and practices involving circumcision in females among three Nigerian tribes in the United States and Nigeria. A total of 50 informants from the tribes, Igbo, Yoruba, and Hausa participated in the participant-observation study done in the framework of theory of diversity and universality. This study revealed existence of similarities and differences in cultural meanings, beliefs, and practices among these tribes perhaps differentiated by religion, education, and occupation (Anuforo, Oyedele and Pacquiao, 2004). Miller and Petro-Nustas (2002) documented, described, and analyzed the diverse and universal care patterns for Jordanian women. In their study, the authors used a qualitative design of observation-participation and interview data from 15 women in two cities and three villages in Jordan over a period of 4 months through the methodological framework of theory of culture care diversity and universality and ethno-nursing research methods. The significant themes identified were culture of caring connectedness, caring for family honor, Islam as feminist thought, political care with tribal and religious influences, and return to community care (Miller and Petro-Nustas, 2002). Personal Beliefs The theory of modeling and role-modeling is congruent with my belief since I have experienced identical situations in practice. I have seen patients in states of stress, where mobilization of resources has been indicated. I have seen impoverished clients with diminished or depleted abilities for mobilization of resources. I felt that to encounter these needs it is very important to know the needs, which at times becomes very difficult. However, with the use of this theoretical framework, the needs assessment process becomes far easier, since with that I had been able to know what had made the client sick and what would make him well. It becomes easier to design a nursing intervention that can influence the person's ability to mobilize resources to bring them back to equilibrium. Practically speaking, from the data collected in any patient encounter, I am able to model the client, and it is possible for a lay nurse to describe the functional relationships among these factors. From common nursing knowledge, etiologic factors can be determined and analyzed that can serve as a guide to design possible therapeutic interventions, and effective diagnoses and goals can be established to complete the process of planning. Coming to know the client through this process fulfills the requirements of nursing most effectively, and I can build trust, promote the client's positive orientation and control, and affirm his strength, and set mutually directed goals. Symphonological theory is, in my opinion, already incorporated in the ethic of nursing practice, and there is no need to practice it separately. Transcultural nursing is essentially important to deliver culturally congruent care in practice; however, this needs knowledge and extensive experience, and our curriculum does not provide that, and it will be difficult to practice it with incomplete knowledge. Reference List Anuforo, PO., Oyedele, L., and Pacquiao, DF., (2004). Comparative Study of Meanings, Beliefs, and Practices of Female Circumcision Among Three Nigerian Tribes in the United States and Nigeria. Journal of Transcultural Nursing; 15: 103 - 113. Barnfather, JS. and Ronis, DS., (2000). Test of a model of psychosocial resources, stress, and health among undereducated adults. Research Nursing Health; 23(1): 55-66. Folse, VN., (2007). The Family Experience with Eating Disorders Scale: psychometric analysis. Archives of Psychiatric Nursing; 21(4): 210-21. LoBiondo-Wood, G. & Harber, J. (2006). Nursing research (6th ed.). St Louis: Mosby. Miller, JE. and Petro-Nustas, W., (2002). Context of Care for Jordanian Women. Journal of Transcultural Nursing; 13: 228 - 236. Tomey, A.M., & Alligood, M.R.. (2006). Nursing Theorists and Their Work. (6th ed.).St Louis: Mosby Read More