NURSING THEORIES & MODELS

Professor Sue Frost

By the end of this session you should:

• Be able to explain what is meant by a model and a theory of nursing

• understand the main features of at least two models of nursing

• understand how to critically review a model

• Identify how the application of models to practice influences the activity of the nurse and the experience for the patient or client

References………………….

• Models of nursing practice. McGee P. Stanley Thornes 1998

• Conceptual bases of professional nursing. Leddy S. Pepper J. Lippincott 4th ed.. 1998

• Foundations of nursing practice. Hogston R & Simpson P. Macmillan 1999 (Ch 14)

Nature of theory:

“represent a scientist’s best effort to describe and explain phenomena”

Pollitt & Hungler 1997

Theory……

“…is a general statement that summarizes and organizes knowledge by proposing a general relationship between events - if it is a good one it will cover a large number of events and predict events that have not yet occurred or been observed”

Robson C.

“an internally consistent group of relational statements (concepts, definitions & propositions) that present a systematic view about phenomenon and that is useful for description, explanation, prediction and

control. A theory ….is the primary means of meeting the goals of the nursing profession concerned with a clearly defined body of knowledge”Walker & Avant 1996 (cited by Jasper M in Hogston & Simpson))

Purpose of theory

• Support the development of knowledge through thesis and contestability

• Explains and predicts outcomes

• Supports decision making

• Embeds goals and outcomes for the client and by implication for the nurse

• Supports modeling of processes of nursing

Classifying theories• Meta-theory (Theory building - values etc)

• Grand theory (Broad conceptual frameworks - not testable e.g. Leininger theory of transcultural care)

• Middle range theory (Narrower and testable e.g. Peplau)

• Practice Theory(situational theory - focuses on the way in which nursing is practised e.g. Norton’s theory of nursing elderly people))

Typology:

• Descriptive theory: Explains through describing relationships and patterns within the framework (e.g. Roper et al)

• Predictive Theories: Address the consequences of interventions (e.g. Noddings theory of care)

The medical model

• Bio-reductionist

• Differential diagnosis: signs & symptoms

• Provision of treatment

• Scientific theory - testable and not contestable

• Goals - cure and therapy

• Evaluation of treatment efficacy

Nursing models

• Located in social science

• Constructed

• Contestable knowledge

• Capable of change and development

• Embed values and culture

What sort of theories would you use?

• Tony Archer (18 years) underwent surgery to have a below knee amputation of his left leg

• Peggy Mountford is 82 years old, lives alone with no family and is becoming increasingly confused and depressed

What sort of theories did you identify?

• Physiology

• Psychology

• Sociological theory

• Nursing theories

• Descriptive theory

• Predictive theory

Metaparadigm: constructs in all nursing theories

• The person

• the environment

• health

• nursing

Commonly used models

• Roper, Logan & Tierney (ADL)

• Peplau (interpersonal communication)

• Orem (Self-Care)

• Roy (adaptation model)

• Wolfensberger (social role valorisation)

• Carper (personal explanations)

Roper, Logan & Tierney• Developmental model - emphasises growth &

development

• Person oriented

• Focus on change

• Sees process over time

• Sees a range of activities of daily living changing with maturation

• Supporting and enabling

• Draws on Henderson’s work strongly

Callister Roy’s model• Systems model - person is made up of systems• Systems interact with the environment • Health is equilibrium and managed systems• Nursing is supporting adaptation to

environment• Is holist, purposeful and unifying• Adaptive modes: physiologic, self concept,

role function, interdependence• Health is a process of responding positively to

environmental changes

Hildegarde Peplau

• Inter-actional model

• concerned with interpersonal relationships

• nursing is organised through building relationships to support communication

• nurse must be able to use self therapeutically

Dorothea Orem

• Nursing as part of a social care paradigm

• supporting client to self care

• caring as a part of moral consciousness

• care as the core and essence of nursing

• caring and community

• collective responsibilities to support and enable

Carpers model

• Four dimensions of nursing:

empirical dimension

personal dimension

ethical dimension

aesthetic dimension

Exercise

• What does the Roper et al model suggest about the person, environment, health, nursing?

• What might Roy say about the person? - how may it be different?

Roper et al

• Person: A developing maturing individual throughout the life span moving from dependence to independence

• Health: meeting a range of needs - health changes with many separate facets

• Environment: Anything external to the person and is a framework of the activities of living

• Nursing restoring or maintaining ADL when person cannot cope independently

Roy’s modelPerson: a biopsychosocial being with a

unified system

Health: equilibrium resulting from effective coping

Environment internal and external systems that impact on equilibrium

Nursing: Manipulating environment to enable coping

exercise

• How is assessment likely to be undertaken in Roper modeling?

• How might nursing be different in a model based on interpersonal relationships? (e.g. Peplau)

Criticising a model

• Models are constructions & conceptual

• They enable us to explore how the nature of nursing is defined

• Models are not facts - they evolve and emerge

• You do not “do” models - they inform your thinking

• Models imply different nursing processes

Questioning models & theories• What methodologies were used to develop?

(?draws on other/theories/research/evidence)

• How clear is it (overly complex jargon?)

• What does the theory say - what is the central assertion- is it clear and coherent - is there thesis?

• What type of theory is it? (e.g. a mid-range theory that can be tested in practice)

• Can the theory be used

• Is this theory relevant to my area of practice

Can you…..

• explain what is meant by a model and a theory of nursing

• understand the main features of at least two models of nursing

• understand how to critically review a model • Identify how the application of models to

practice influences the activity of the nurse and the experience for the patient or client