Nursing theories have been considered in terms of their contrasting and competitive views. In the first section of this chapter, an attempt was made to address how these views may complement each other as theories and as different schools of thought. In this section, areas of agreement among the various schools of thought are identified.
• Nursing theories offer a beginning articulation of what nursing is and what roles nurses play.
• Nursing theories offer a view of the philosophical underpinnings in nursing (e.g., interaction, phenomenology, and existentialism).
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TABLE 9-26 ROLES AND IMAGES OF NURSES IN DIFFERENT CATEGORIES OF THEORIES
Theorists Roles Nurses Play Image
Needs Theorists
Abdellah Problem solver and performer of They provide an image of a nurse who is 21 physiologic and psychosocial active and busy working and a patient activities for the patient who is striving for independence. The Henderson Complementing, supplementing nurse’s work is focused on doing a
knowledge deliberate and well-planned activity.
The will to perform daily activities Orem Temporary self-care agent for universal
health deviation and development of self-care needs
Interaction Theorists
King Goal attainer or else! They provide an image of a nurse as a
Teach, counsel, guide, give care, gather present-oriented, situational, a humanist, information, set mutual goals a process-oriented professional whose Orlando Deliberate, repetitive, and situational interest is the interaction and, for some,
interactions also the person. The nurse, to some, is
Paterson and Zderad Existentialist and phenomenological also important in the interaction.
nurturer of the human potential (self and patient)
Peplau Freudian helper
Stranger who works hard to become a surrogate
Travelbee Meaning finder (more than a dictionary meaning) and existentialist
Wiedenbach Deliberate helper who focuses on extrasensory perception and does not forget to validate the process
Outcomes Theorists
Johnson The external manipulator: external They provide an image of the nurse as goal regulatory force to preserve setter, a futurist, environmentalist, who organization and integration of has extrasensory and energy preservation
patient’s behavior powers.
Controller
Levine Conservator of all
Rogers The environmental nurse, the symphony player: promotion of person–environment interaction
The healer without touch
Roy The pace setter: external regulatory force to modify stimuli affecting adaptation to create four modes of adaptation
CHAPTER 9 Nursing Theories Through Mirrors, Microscopes, or Telescopes 177
• Nursing theories provide descriptions of how to help patients become comfortable, how to deliver treatment with the least damage, and how to enhance high-level wellness.
• Nursing theories offer a beginning common language and a beginning agreement about who nursing care recipients are.
• It is obvious that we should not view the recipients only through biologic glasses (as biologic systems) or psychological glasses (as id, ego, and superego), but rather through holistic glasses. Nursing clients are more than the sum total of their psychological, socio- logical, cultural, or biologic parts.
• Recipients of care respond to events in a holistic way.
• The recipient is a member of a reference group set, and interventions are only meaningful if the whole unit is considered.
• Recipients have needs, and nursing assists them in meeting those needs.
The theories have other themes in common. These emerge when one considers images evolv- ing from the theories when compared with nursing realities. In this process, several concepts emerge as central to nursing. These are addressed in the following conclusion.
CONCLUSION
The discipline of nursing deals with people who are assumed to be in constant interaction with their environment and yet have unmet needs, are not able to care for themselves, or are not adapting to the environment due to interruptions or potential interruptions in health. Nursing focuses on therapeutics to help in meeting the needs of the person and to enhance adaptation capability, self-care ability, health, and well-being. Nursing theories capture and reflect differ- ent visions of this domain; they mirror different aspects of nursing realities as they are and as they ought to be. The mission of nursing, the processes by which nursing care is provided, and the images of nursing portrayed in these theories continue to be shared by nurses around the globe. Considering the theories in the categories presented in this chapter may lead to many productive explorations and explanations of the processes of clinical judgment and clinical decision making.
TABLE 9-26 ROLES AND IMAGES OF NURSES IN DIFFERENT CATEGORIES OF THEORIES (Continued )
Theorists Roles Nurses Play Image
Caring/Human Becoming Theorists
Watson Coparticipant and time investment Centered healing person, aware, reflective with embodiment of caring. Spiritual and humanist caring.
person helping people gain . self-knowledge. A person with self-control and ability to self-heal (Baldursdottir and Jonsdottir, 2002; Watson and Smith, 2002).
Parse Understands patient’s lived experience, A present-oriented, situational, process- brings out the best in patients to be oriented and interactive.
able to make choices (Cowling,1989;
Cody, 2000).
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REFLECTIVE QUESTIONS
1. What are the advantages and disadvan- tages of classifying nursing theories?
2. What categories do you consider as more productive in creating a critical discourse about the theoretical heritage of nursing?
3. As you assess the current climate and structure of health care systems, what group of theories may provide frame- works for better quality care? Which group of theories may be antithetical or
complementary to the needs of patients in the 21st century?
4. Compare and contrast the societal and professional contexts for any two of the four sets of theory categories.
5. How else would you categorize the theo- ries presented in this chapter and why?
6. Identify and discuss metaphors about nurses that reflect the different theories.
In what ways do these metaphors stereo- type or enhance nurses’ roles?
C H A P T E R 10
A Model for Evaluation of Theories:
Description, Analysis, Critique, Testing, and Support*
A critical review of evidence before and while translating it into practice, and a critical assessment and evaluation of theories before and while utilizing them in practice or research are activities that nurses have always engaged in. Quality care, as well as coherent research programs, requires crit- ical analyses and judgment of theories. Nurses evaluate theories to apply to practice, to develop curricula, to operationalize for research, or to use in daily decision making. These evaluations may be deliberate, systematic, criteria-based, objective, conscious, and elaborate, or they may be sub- jective, experiential, quick, and based on a limited set of criteria. Both types of evaluations are essential; neither type is sufficient by itself.
Evaluation of theory is an essential component of nursing practice and of knowledge develop- ment to:
1. Decide which theory is more appropriate to use as a framework for research, teaching, administration, or consultation
2. Identify effective theories in exploring some aspect of practice or in guiding a research project
3. Compare and contrast different explanations of the same phenomenon 4. Enhance the potential of constructive changes and further theory development
5. Identify epistemological approaches of a discipline through attention to the sociocultu- ral context of the theorist and the theory
6. Critically examine and question the ontological beliefs in a discipline 7. Identify competing and complementary schools of thought in a discipline
8. Effect changes in clinical practice, define research priorities, and identify content for teaching and guidelines for nursing administration
9. Utilize coherent and integrative frameworks to communicate to the public the rationales and goals of nursing practice
10. Identify strategies that could be used to advance the development of theories 11. Define and articulate the discipline’s demand and perspective
12. Be a critical consumer of theories, as well as a critical consumer of evidence-based practice
Before going any further in reading this chapter, you should take a few minutes to identify one or two theories (nursing or nonnursing) that you have used in your work or personal life.
Whether you are a critical care nurse, a primary care provider, or a researcher who may be studying biomarkers of pain responses, you can reflect on frameworks from which your care or questions emanate. For example, you may identify role theory as a framework for your research on women’s daily activities in a nursing home and their health; endorphin theory linking stress with exercise; or Maslow’s theory in understanding a patient’s needs. The next set of questions to ask and reflect on are: Why did you select these theories to apply in your work? Why not other theories that may provide a different set of equally plausible explanations? To complete this
*This chapter is adapted, with considerable changes, from an earlier manuscript written by A.I. Meleis and published in Chaska, N. (1982). The nursing profession: Time to speak. New York: McGraw-Hill, 1982.
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exercise, you should be able to identify the criteria you used in making a decision about what theory to use.
Over a 30-year span of teaching, I have asked students, faculty, clinicians, and administrators in the United States, as well as in many other countries, the questions outlined in the preceding text. In reviewing the answers and analyzing their content, I noticed the emergence of a number of criteria for selection and use of theory. Now, compare your criteria with those identified in Box 10-1.