NURSING THEORIES & MODELS

1. NURSING THEORIES & MODELS Professor Sue Frost

2. 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

3. 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)

4. Nature of theory:“represent a scientist’s best effort to describe and explain phenomena”Pollitt & Hungler 1997

5. 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.

6. “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))

7. 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

8. 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))

9. 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)

10. 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

11. Nursing models • Located in social science • Constructed • Contestable knowledge • Capable of change and development • Embed values and culture

12. 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

13. What sort of theories did you identify? • Physiology • Psychology • Sociological theory • Nursing theories • Descriptive theory • Predictive theory

14. Metaparadigm: constructs in all nursing theories • The person • the environment • health • nursing

15. Commonly used models • Roper, Logan & Tierney (ADL) • Peplau (interpersonal communication) • Orem (Self-Care) • Roy (adaptation model) • Wolfensberger (social role valorisation) • Carper (personal explanations)

16. 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

17. 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

18. 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

19. 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

20. Carpers model • Four dimensions of nursing: empirical dimension personal dimension ethical dimension aesthetic dimension

21. 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?

22. 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

23. Roy’s model Person: 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

24. 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)

25. 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

26. 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

27. 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