What Is Nursing Theory - Article Example

What is Nursing Theory and Why Do We Need It? This report looks at the history of nursing theory and how it has evolved over the decades, most notably, since the 1970s, to be a strong influence in the processes and development of the nursing field as a whole. The question is to understand what theory is in nursing and then to show why we need nursing theory as a part of our practice. Through application of suitable theory for any given case, the outcome for the patient is far better when theory has been applied to the functions and premises of nursing. Introduction What is Theory in Nursing? Defining theory by itself means that it is ‘a set of ideas formulated by (by reasoning from known facts) to explain something’ such as Darwin’s Theory of Evolution. It can also be a set of principles based on a subject (OAD 1980). When we put it together with the nursing field, theory is a set of ideas and principles by which a nurse determines how to view the patient and determine the best solution for the patient. However, there are a number of theories in nursing and all of them are relevant to some aspect of the nursing field and how one can make decisions. Ultimately, while these are meant to be meaningful and relevant, they must also be understood in how they affect the practice of nursing as well as aspects of nursing research, management and administration, and also in nursing education (McEwan and Wills 2010). Historical Development of Nursing Theories Initially, nursing was considered more as a series of functions and tasks that were assigned initially by a doctor dictating what needed to be done to a patient, rather than a careful series of thought processes conducted by the nurse in regards to the state of the patient. As more people, usually women, became involved in nursing whether through a concentrated study of medicine, or through environmental circumstances (war), the idea of nursing became more of a career calling or profession which is now well-respected in nearly every community because of the good outcomes from what nurses do for society (McEwan and Wills 2010). It wasn’t until the 20th century that those in nursing began thinking more about the structures of the nursing profession and the principles behind how nurses operated and approached their work with patients. Hildegard Peplau was one of the first writers to publish her theory work Interpersonal Relations in Nursing in 1952. Her work was initially delayed because she was not publishing in conjunction with a medical practitioner which was standard at that time (Lakeman, 1999). This work was influenced by Harry Stack Sullivan’s theory of interpersonal relations and was considered a framework for psychodynamic nursing (Creese, 2012). Interpersonal relations, as proposed by Peplau, stressed the importance of the abilities of nurses to understand their own behavior and to help others identify their perceived difficulties. It focused on the therapeutic relationship between the nurse and patient, the six primary and six secondary roles of the nurse, and identified four phases of the nurse-patient relationship. These four stages are: orientation, identification, exploitation and resolution (Peplau, 1952; Creese, 2012). The primary and secondary roles of nurses are provided in the table below. Roles of Nurses Primary Secondary Stranger Technical expert Teacher Mediator Resource person Safety agent Counselor Researcher Surrogate Tutor Leader Manager of environment Fig. 1 (Peplau, 1952; Creese, 2012). With this first publication of nursing theory, more would soon be developed and published, including Virginia Henderson and her Principles and Practice of Nursing (5th ed.) in 1955 as well as The Nature of Nursing: A Definition and Its Implications for Practice, Research and Education in 1966. Dorothy Johnson published her first book, A Philosophy of Nursing, in 1959 and The Behavioral System Model for Nursing in 1980. Other published authors of note were Sister Callista Roy in 1976 with the Introduction to Nursing: An Adaptation Model and The Roy Adaptation Model in 1991, and Margaret Newman in 1979 with her Theory Development in Nursing (McEwen and Wills, 2010). In alignment with the increased publications of nursing theory, several journals were founded over this time, including Advances in Nursing Science (ANS) by P.L. Chinn (1978), who in her first editorial in the first publication outlined the focus and purpose of her journal, which was “…to contribute to the development of nursing science and to promote the application of emerging theories and research findings to practice. Articles (that) deal with any of the processes of science, including research, theory development, concept analysis, practical application of research and theory, and investigation of the values and ethics that influence the practice and research endeavors of nursing sciences.” (http:/www.nursing.uconn.edu/∼plchinn/ANSathgd.htm; Roy and Jones, 2007). This journal was to help alleviate delays in publications of timely research and other information that would be of great importance for imparting knowledge to the readership in a manner as to encourage further development of theory and scientific research (Roy and Jones, 2007). Two other important journals that provide dialogues on the metatheory and philosophy of nursing are the Journal of Advanced Nursing and the Australia Journal of Advanced Nursing (Roy and Jones, 2010). Stages in the Development of Nursing Theory As noted earlier in this report, nursing may have been more a job assigned by doctors who needed care givers to initially make the patients comfortable and ready for the doctor’s examination. It wasn’t until much later in the 20th century that nursing was considered to be more than just a series of tasks to be done before the doctor got there. Nurses began to take more responsibility in the results of their actions and how they regarded their interactions with patients. In reviewing the basics of nursing history and the theory process development, there are five established stages of nursing theory: 1. Silent Knowledge – medical authority governed actions and there was little regard for theory. Research was limited in data collected regarding trends, causes and patterns. 2. Received Knowledge – Learning through listening became one method of development and most research was done through the educational process or through sociology research. 3. Subjective Knowledge – nurses began to take authority and develop themselves through developing theories about the nursing process. For now, patients were only part of the process but the nurse was central to all nursing theory. 4. Procedural Knowledge – knowledge was gained through connected theory but separated knowledge was now included into theory development. Procedures for acquiring knowledge received the most emphasis, particularly through the components of research as related to methodology, evolution of research and the statistical procedures in analysis. 5. Constructed Knowledge – different types of knowledge such as intuition, reason and self-knowledge were integrated and nursing theory was now to be based on empirical studies, theoretical literature, reports of experiences in clinical practice, and the nurse’s perception on intuitive and related knowledge as concerned the subject of review, such as the patient. (McEwen and Jones, 2010). In reviewing this timeline of stages in nursing theory, the concepts of nursing and subsequent development into nursing theory, show an education through processes which then led to internal questioning for why these actions were done. This was a time of self-internalized focus on functions and the theory of applications which later, moved outwards to focus on the relationship between the patient and the nurse. It is important to note that nurses spent almost 80 years as hired labor before education changed first to promote more underlying medical training and a further highly-educated vision of scientific research in the medical field that was very necessary for advancements in nursing (McEwen and Jones, 2010). With the advent in publishing Peplau’s theory book in 1952, that event opened a whole new way of thinking about the nursing field, certainly as regards the patient, and also promoted more development on nursing theory. It wasn’t until the 1970s that theoretical structures evolved into looking more at how these theories could be applied appropriately and functionally to nurse-client relationships, the wellness of the patient and also the patient’s environment, which is to say, the social infrastructure of the patient’s life (McEwen and Jones, 2010). Summary It is interesting to review the history of nursing and subsequent development of theory in the practice of nursing. Nursing theory had to look inwards first to understand nursing in its whole internal package before it could move outwards to see how theory could impact each individual patient and the whole life package that each patient comes with. Nursing theory has certainly developed those nursing students and subsequent nursing practitioners to think along more evolved lines in their practice which, in turn, promotes new ways of doing things more efficiently and thoroughly as well. The benefits would obviously be seen in those patients who return to a state of wellness and in most cases, enjoyed the experience. Nursing theory, when efficiently and properly applied, helps the patient to rethink himself and his illness, and with a partner – the nurse who cares, is far more likely to recover and lead a better life. With this in mind, nurses are more the influencers in the field of medicine and health and wellness than might be the doctor who, generally does not have that kind of time to spend on his patients. Resources Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, vol. 1(1), pp. 13-23. Chinn, P. L. (1978). Editorial. Advances in Nursing Science, 1(1), n.p. Creese, C. (2012). Pepalu’s Powerpoint Presentation of theory. Wilmington University. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=4&sqi=2&ved=0CDwQFjAD&url=http%3A%2F%2Fpptnursingtheory.wikispaces.com%2Ffile%2Fview%2FPeplau%25E2%2580%2599s%2BInterpersonal%2BRelations%2BTheory%2Bpower%2Bpoint.ppt&ei=T-h8UMDcNsLVqAHPoYHADw&usg=AFQjCNFKLddLL_MbA-mCcc0497hqWz_kgg&sig2=UGlguTcbmvdRsDYJ-hAISw&cad=rjt Fawcett, J. (2000). Analysis and evaluation of contemporary nursing knowledge: Nursing models and theories. Davis, Philadelphia, PA. Fawcett, J. and Malinski, V.M. (1996). On the requirements for a metaparadigm: An invitation to dialogue. Nursing Science Quarterly, vol. 9(3), pp. 94-97, 100-101. http://www.ncbi.nlm.nih.gov/pubmed/8850982 Glennister, D. (2011). Towards a General Systems Theory of Nursing: A Literature Review, University of Hull, U.K., http://journals.isss.org/index.php/proceedings55th/article/viewFile/1717/569 Keck, J.F. (1998). Terminology of theory development. In Tomey, A.M. & Alligood, M.R. (eds.), Nursing theorists and their work, 4th ed., pp. 16-24, Mosby, St. Louis. Lakeman, R. (1999). Remembering Hildegard Peplau. Vision, 5(8), 29-31. http://www.testandcalc.com/richard/resources/remembering%20peplau%20-%20vision%20-%20lakeman.pdf McEwen, M. and Wills, E.M. (2010). Theoretical Basis for Nursing, 3rd ed., Lippincott Williams & Wilkins, North American Edition. Noureddine, S. (2001). Development of the ethical dimension in nursing theory, International Journal of Nursing Practice, vol. 7, pp.2-7, http://deepblue.lib.umich.edu/bitstream/2027.42/73773/1/j.1440-172x.2001.00253.x.pdf OAD. (1980). Oxford American Dictionary. Avon Dictionaries, Hearst Corporation, N.Y.C., New York Reed, P.G. (2007). Scholarly Reflection on Nursing Practice: Undergraduate Student Discoveries from Four Case Studies, University of Arizona, College of Nursing, http://www.juns.nursing.arizona.edu/articles/Fall%202007/Scholarly%20Reflection%20on%20Nursing%20Practice.pdf Roy, D. (1976). The Nursing Process and the Roy Adaptation Model. http://ahn.mnsu.edu/nursing/facultyformsandinfo/nursingprocessandram.pdf Roy, C. and Jones, D.A. (2007). Nursing Knowledge Development and Clinical Practice, Springer Publishing Company, http://www.springerpub.com/samples/9780826102997_chapter.pdf Read More