Consideration of Nursing Theory in Practice

The Consideration of Nursing Theory in Practice

The objective for the development of a theory is to illustrate, define, or systematize knowledge in a professional field of study. Theory can be utilized in all facets of nursing and promotes the advancement of education, knowledge and care in the profession. Several levels of nursing theory exist; though greatest research and review was focused on grand theories and middle-range theories, as required for course completion. Appropriate selection of a theory for use in clinical practice is dependent upon the aim, the type of care setting, and intended results. The purpose of this paper is to apply a theoretical analysis framework when examining two nursing theories and illustrate potential application of these theories in practice.

Dorothy Johnson’s Behavioral Systems Model

Dorothy Johnson’s Behavioral Systems Model (JBSM), was significantly influenced by Nightingale’s Notes on Nursing, as well as other system theory nursing theorists, is considered “a behavioral system within an environment,” (Smith& Parker, 2015, p. 92).  Johnson’s background included an instructor, assistant professor then associate professor in the field of pediatrics. As such, her work is greatly founded on pediatric development. Her model asserts that “nursing’s goal is to maintain and restore the person’s behavioral system balance and stability or to help the person achieve a more optimum level of balance and functioning,” (Alligood, 2014, p. 337). When considering nursing as an art and a science, the role of the nurse in this model highlights the significance of nursing care considering the patient as a whole (Smith & Parker, 2015).

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Johnson’s Behavioral System Model has aligns with Nightingale’s philosophies. Johnson believed that nurses care for patients by preventing or alleviating diseases and injuries. This model introduces humans as a biologic system and disease occurs from disruption of the biologic system. The individual is a behavioral system with purposeful, repetitive, and patterned ways which results in the individual’s relationship with the environment.

Dorothea Orem’s Self-Care Deficit Nursing Theory

One of the earliest theorists, Dorothea Orem, has developed several nursing theories, including her Self-Care Deficit Nursing Theory. In practice, Orem had a wide background in surgical services, medical-surgical and an emergency department supervisor. Her professional role expanded to include nursing director, Indiana State Board of Health and the Office of Education. As stated in Alligood (2014) “the primary source for Orem’s ideas about nursing was her experiences in nursing,” (p. 241). Orem asserts that self-care is essential for all people; though if not maintained, illness, disease or death will occur (Alligood, 2014). The basis of Orem’s model also is established by the nurse-patient relationship and her theoretical work sought to differentiate nursing as a system.

The final theory from this module is Orem’s Self-Care Deficit Theory. This is a grand theory which provides a model for nursing practice. The theory is based on the premise that all individuals are capable of self-care which is defined as actions performed to maintain life, health, and well-being. Nursing actions are directed toward assisting the patient to assume responsibility of self-care (Smith & Parker, 2015). This theory can be applied to practically all specialties of nursing. As healthcare providers we need to treat our patient’s illnesses and meet their needs but we should also promote independence. We should allow patients to do as much as they are able to prevent unnecessary decline in their abilities.

Nightingale’s Influence on Theory Development

Nightingale’s influence is evident in many nursing theories used today. A common theme in the theories discussed is the effect of the considering the patient as an individual and health promotion. Nightingale’s philosophies focused on the patient’s environment and how it contributed to disease and illness. While these four theories may not all specify the importance of environment directly, it is discussed on it’s effect of the patient physically, socially, and mentally. The patient’s environment can play a critical role in physical health in obvious way such a dirty or contaminated environment that can cause illness with infection (Smith & Parker, 2015). Individuals can live in crowded conditions and may not be able to keep up with cleaning and hygiene. There can be physical dangers such as asbestos, cluttered homes, and limited mobility. Social environment can be important in different ways. A positive social environment could be a supportive family who helps care for the patient and provides a good support system to help with coping. Social environment can also be negative with bad habits, high stress levels, and poor coping. A full holistic approach when assessing a patient will give a full picture to help address more than just the medical needs of the patient.

Personal Reflection of theories in Practice

The analysis of nursing theory allows the nurse to determine the worth, value and significance of the theorist (Smith & Parker, 2015). Several nursing experts have identified various models for assessing relevance of nursing theories. Ultimately, Nightingale’s work did not directly develop a nursing theory, though she did help establish the profession of nursing (Alligood, 2014).

The formal discipline and development of nursing theory is a concept that was drafted in the 1900’s, after the times of Nightingale. Her journals and notes on her experiences in the profession have been translated into theory in modern time. There are four constituents of care in Nightingales’ theory: health, environment, person and nursing (Alligood, 2014). She saw nursing and medicine as separate entities, both of which were valuable to the promotion of health for the patient. Nightingale’s work signified the importance of seeing the “patient” as an individual. The role of the nurse, according to Nightingale, was to facilitate caring, by fostering the person-environment relationship (Alligood, 2014). She also proposed concepts such as empowering patient self-care and meal selections as vital components of the patient’s therapeutic environment (Alligood, 2014). Her work has described how significant one’s environment is when considering care delivery and patient health (Smith & Parker, 2015).

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When evaluating nursing theories, Smith and Parker (2014) have included six areas for appreciation: “significance, internal consistency, parsimony, testability, empirical adequacy and pragmatic adequacy,” (Smith & Parker, 2014, p. 31). When considering the significance of Nightingale’s theory, she concisely describes the importance of a clean environment and its impact on patient’s health (Alligood, 2014). The analysis of internal consistency acknowledges her concepts are clear and the theory is well-defined. Parsimony is indisputable as she is concise and based on actual reflection. Testability is evident, though may be questionable as she bases much of her values and beliefs on spirituality, as well as her direct experiences and observations.  Empirical adequacy is apparent as she can test her hypotheses specifically related to environment and promotion of care. The final area to be evaluated is Pragmatic adequacy. Nightingale’s beliefs are accepted and used in all areas of nursing.

Conclusion

Professional nursing care is multifaceted, comprised of practice, research and theory. Developing an understanding of the history and contributing factors that guide the evolution of professional nursing is vital for today’s nurses. The influences of Nightingale to the profession are monumental. Her principles, research and findings, composed into theory, continue to be relevant and are the premise for the practice and delivery of today’s nursing care. Using theoretical analysis is a consistent practice for nurses to evaluate the significance of theory and philosophy in the profession. Theoretical analysis of Nightingale’s contributions to the profession of nursing solidify how foundational, purposeful and applicable her findings remain today.

References

• Alligood, M. R. (2014). Nursing theorists and their work (8^th ed). St Louis, MO: Elsevier Mosby.
• Smith, M. C. & Parker, M. E. (2015). Nursing theories and nursing practice (4^th ed). Philadelphia, PA: F. A. Davis Company.
• Matney, S. A., Avant, K. & Staggers, N. (2015). Toward an understanding of wisdom in nursing.  The Online Journal of Issues in Nursing (OJIN), 21(2). doi: 10.3912/OJIN.Vol21No01PPT02.
• Timmins, F & Horan, P. (2007). A critical analysis of the potential contribution of Orem’s (2001) self-care deficit nursing theory to contemporary coronary care nursing practice. European Journal of Cardiovascular Nursing 6, 32-39.  doi/pdf/10.1016/j.ejcnurse.2006.03.006