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 dimensionpersonal dimensionethical dimensionaesthetic 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 systemHealth: equilibrium resulting from effective
copingEnvironment internal and external systems
that impact on equilibriumNursing: 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