Prior to the development of nursing theories, nursing practice was viewed as a series of tasks that required little to no rationale. The evolution of nursing theories and philosophies has facilitated the progression of nursing as a vocation to nursing as an academic discipline and profession. Nursing theory promotes autonomy when used as a guide for critical thinking and decision making. Ultimately nursing theory and philosophy has increased knowledge development and enriched the quality of nursing practice (McEwen & Wills, 2011).
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Nursing philosophy and theory are two interchangeable terms. The philosophy a nurse has on nursing will determine the theory and model he or she uses. Nursing philosophy explains what nursing is and gives insight to why nurses practice the way they do. Nursing theory describes how nurses and patients are able to produce healing and good health, by using models to explain how beliefs and aspects of health are related. Theory is used to explain and analyze what nurses do as well as facilitate communication between nurses and guide research and education. Nursing theory encompasses the foundations of nursing practice past and present and provides direction for how nursing should develop in the future (Alligood & Tomey, 2002).
According to Marilyn Parker, in Nursing Theories and Nursing Practice, nursing theory is a broad term which portrays and clarifies the “phenomena of interest.” Nursing theory provides understanding for the advanced practice nurse to use in actual practice and evidence based research. Nursing theory has many purposes, which imitate the multiples specialties in professional nursing. Ultimately the goal is to promote the delivery of the best quality of care. The functions of nursing theory are to guide thinking, define the place of nursing in health and illness care, and to provide organization for the development of nursing education (Parker, 2006). Nursing theory provides a format for professional nursing to practice and make decisions. There are three major types of nursing theory: grand theory, middle range theory, and nursing practice theory. Each of these theories helps the nurse to provide more proficient patient care (McEwen & Willis, 2011).
The purpose of nursing theories is guide encourage and increase autonomy of nursing. Nursing theory improves communication with other health professionals and develops ideas and words by building a common nursing terminology. Theories have become necessary for effective decision making and implementation because they provide a basis for collecting reliable and valid data. Nursing theory is key in the practice of nurses and advanced practice nurses because it serves as a guide to assessment, intervention, and evaluation of care. Theory provides a measurable way to evaluate the quality of nursing care (Colley, 2003).
As indicated by Afaf Ibrahim Meleis, a prominent nursing theorist, there are many beneficial uses of nursing theory. Nursing theory provides a basis for research and a frame of reference for patient assessment, diagnosis and intervention. It makes nursing practice more competent and valuable. Nursing theory provides a common platform for communication between the advanced practice nurse and other disciplines involved in a patient’s care. It supports the “professional autonomy,” responsibility, and liability of the advanced practice nurse (Meleis, 2011). Benefits of theory based practice are structure and organization, a systematic, purposeful approach, focus, coordinated and less fragmented care, and identifiable and traceable goals and outcomes.
While there are many benefits of nursing theory, there are some barriers to developing and applying nursing theory. Nurses are considered doers, not thinkers. A lot of people choose to pursue the nursing profession to be advocates and to help and assist people, not to think about philosophical or ethical issues. Financial stress and a focus on career advancement within the nursing profession is proven to be a major barrier to philosophical thinking about nursing and seeking out education and training. The biggest obstacle in trying to effectively apply a nursing theory, is trying to use the incorrect type of theory, or model, in a specific nursing situation. One type of theory cannot be applied every patient stipulation. Also, many nurses do not have sufficient knowledge of the different types of nursing theories to use them effectively (Meleis, 2011).
Three popular nursing theorists are Florence Nightingale, Jean Watson, and Dorothea Orem. Florence Nightingale published, “Notes on Nursing: What it is, What is not,” in 1860. These notes became the true basis of nursing research and practice. Between 1975 and 1979, Jean Watson developed the Theory of Human Caring. This theory brings significance and focus to nursing as an up-and-coming discipline and separate health profession with its own distinctive ethics, knowledge, and traditions. Dorothea Orem’s Self-Care Deficit Nursing Theory comes from her belief that people have the ability to care for themselves and their families. Her theory indicates that nurse have to provide the care patients need when they are unable to care for themselves (Im & Ju Chang, 2012).
“Nursing philosophy represents the belief system of the profession that provides perspectives for practice, for scholarship, and for research.” Nursing philosophy is the overview of the basic beliefs about nursing practice. It is the outline of the viewpoint regarding what nursing is, what it aims to be, and how that can be realized. Nursing philosophy examines the nature of nursing, the nurse-patient relationship, and the heart of nursing. It serves as a guide for nurses in learning and practice, and evaluates that practice. Nursing philosophy is as active picture of who we are, “what and how we know; and of what we do within the discipline” (Kikuchi & Simmons, 1994).
A nurse’s philosophy consists of the principles and approaches towards life that the nurse upholds and how it affects her outlook on nursing practice. Philosophy leads the nurse to act in a particular way. Ernestine Wiedenbach is credited with developing the theoretical model of nursing called “The Helping Art of Clinical Nursing.” Wiedenbach theorized that there are three essential parts of nursing philosophy. The first is the respect for life; the second is value for the pride, worth, independence and distinctiveness of every person; and the third is promise to act on personally and professionally held convictions (Wiedenbach, 1964). Virginia Henderson, best known for her Definition of Nursing, believed that the nurse’s main purpose is to take care of patient’s needs and to assist them with day to day activities. These are activities that the patient’s would have been proficient in doing had they not been sick or debilitated (Castledine, 1996).
Nursing philosophy and theory have provided a foundation for nursing practice today and given direction to where it is heading in the future. Although many facets of nursing have changed since Florence Nightingale and Virginia Henderson’s era, the necessity for truly understanding about overall patient care remains the same. Because of women such as these, nursing is no longer defined as a trade or vocation, but is considered a health-care profession.
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