4 concepts of nursing theory

Theoretical and Conceptual Models Contributions to Advanced Nursing Practice

Overview

Our lesson for Week 2 reviewed Nursing's Ways of Knowing and Theories of Knowledge. All nursing study and knowledge development occurs within the context of nursing's four phenomena of interest: (a) person, (b) environment, (c) health, and (d) nursing. These 4 Concepts, taken together, form Nursing's Metaparadigm. The historical influences that have shaped the development of nursing's meta paradigm Theory and Parse's paradigmatic classifications of nursing theory (Parse, 1987) are introduced this week.

Nursing's Phenomena of Interest

Just as in other disciplines, there are unique phenomena of interest to nursing. Consider for a moment the study of business. One might describe the phenomena of interest to business as being administration, finance, leadership, marketing, management, and the like. Similarly, there are four phenomena of interest to our discipline: person, environment, health, and nursing. Collectively, these phenomena of interest form nursing's metaparadigm. You can think of a paradigm as a worldview, one way of looking at a subject of interest. You can think of a metaparadigm as an overarching worldview, much like an umbrella under which exist nursing's phenomena of interest and within which knowledge development and undersanding occur.

Nursing Metaparadigm

Nursing Metaparadigm

Nursing Metaparadigm (Links to an external site.)Links to an external site.

Can you identify which elements belong in the nursing Metaparadigm

Transcript (Links to an external site.)

Week 2: Nursing Metaparadigm

Can you identify which elements belong in the nursing metaparadigm?

· Person

· Pharmacology

· Environment

· Health

· Theory

· Practice

· Science

· Pathophysiology

· Nursing

· Physical Assessment

Answer:

Person, Environment, Health and Nursing

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Nursing's Metaparadigm and Related Paradigmatic Perspectives

To better understand how the phenomena of person, environment, health, and nursing form the metaparadigm of nursing, it is helpful to examine some important historical contributions to theory development in nursing. At the doctoral level, most nurses recognize the many contributions Florence Nightingale made to the development of modern nursing. Similarly, there are additional important events that have contributed either directly or indirectly to the development of nursing knowledge. Two reports by Flexner, a social scientist, made a long-term impact on the development of nursing (Flexner, 1910; 1915).

The first focused on the need for medical-education reform and was published the same year that Nightingale passed away (1910). The second was a follow-up report that focused on requisite criteria for a profession such as social work. The outcome of these reports was that certain practice disciplines such as social work and nursing fell short of meeting the criteria of a profession due to their reliance on borrowed theory from liberal arts and sciences. Flexner's reasoning was that a profession should function autonomously according to a codified set of laws, deliver an indispensable service to better society, have the ability to retain and continually educate its members, demonstrate unique language, and require a university-based level of education that engaged the scientific method (research) to build its unique knowledge base.

Following Nightingale's death, a number of events and wars greatly changed nursing. In the decades that followed 1910 through 1950, there were many grand dames of nursing who sought to demonstrate that nursing as a practice discipline indeed measured up to the criteria of a profession that Flexner had proposed. During those years, the American Nurses Association was established (1911), State Boards of Nursing implemented codified laws, and nursing developed its Code of Ethics (1950). At the same time, many nurse theorists sought to introduce unique terminology into the practice of nursing by building on prior theoretical works (Tourville & Ingalls, 2003). Many of the early nursing theories can be classified according to their roots in other theories such as general systems theory (Bertalanffy, 1950), developmental theories of Erikson (1950) and Kohlberg (1981), change theory (Lewin, 1951), and interactional theories. In addition, many societal changes resulting from women's suffrage (1920) and the civil rights movement (1955-1968) additionally served to pave the way for nursing to emerge as a profession.

Technological changes further contributed to the development of nursing as a profession. In Nightingale's era, there was no such thing as critical care and triage. Most soldiers injured on the field died on the field. With the advent of the machine gun, some of the world's bloodiest wars were fought during the years of World War I (1914-1918) and World War II (1939-1945). These wars precipitated the need for more sophisticated nursing intervention. However, the development of critical care technology in the midst of the Vietnam War (1955-1975) brought about a paradigm shift from healthcare's previous focus on quantity of life to quality of life. Triage from the battlefield could now offer life support capable of artificially maintaining life, resulting in new questions regarding the prior definition of health as absence of disease.By 1970, a new definition of a profession had emerged.

Another social scientist, Kuhn (1970), suggested that perhaps a discipline emerges as a profession when it is able to support more than one worldview. In the years since the close of the Vietnam War, while nursing continued to debate whether or not it had emerged as a profession, nursing theorists continued to define and refine nursing theory. One nursing theorist, Parse (1987), noted that the many nursing theories that emerged over the years since Nightingale each addressed common phenomena of interest regarding person, environment, health, and nursing. As she further examined these nursing theories, she noted that there existed common definitions of these phenomena of interest in two baskets that she classified as totality and simultaneity (Rose, 1999). The table below summarizes Parse's classifications of theory by phenomena of interest and paradigmatic perspective.

Phenomena of Interest

Totality Paradigm Perspective

Simultaneity Paradigm Perspective

Person

The sum of its parts (a biopsychosociospiritual being)

More than and different than the sum of its parts

Environment

That which is manipulated by the nurse to achieve health

A composite of internal and external forces that influence health

Health

The absence of disease

A continuum of wellness and/or well-being

Nursing

Holistic

Holistic

Supporting Concepts

Roots

1870s

1970s

Primary Theorist

Nightingale

Rogers

Focus

Quantity of Life

Quality of Life

Locus of Control

Nurse

Patient

Scientific Orientation

Physical Sciences

Behavioral Sciences

Level of Scientific Inquiry

Quantitative

Qualitative

According to Happell (2009), "The theory-practice gap is a familiar concept in nursing and reflects the challenges faced by nursing in enhancing a symbiotic relationship between the theory and practice of nursing" (p. 166). In the years between the origin of the totality paradigm in the 1870s and the simultaneity paradigm in the 1970s, a theory-practice gap and a research-practice gap became evident. In more recent years, there has even emerged a theory-research gap! The aspects of theory, research, and practice are vital and inseparable to nursing. With the advent of evidence-based practice, the profession of nursing emerges at the intersection of nursing theory, nursing research, and evidence-based practice, as illustrated in the diagram below.

Theory Development

Consider for a moment a stairway of theory development ranging from the lowest level of abstraction to the highest. At the lowest level are the general Assumptions regarding the phenomena of interest to nursing that extend from nursing's metaparadigm. Upon these assumptions exists the first landing or philosophical discourse of nursing. The philosophical level of discourse is the most foundational level of understanding.

From there, the building blocks of theory emerge at the theoretical level of discourse. The theoretical level of discourse is a higher level of understanding, in which the elements of theory such as concepts, Constructs, and frameworks have been examined.

Theory Development

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Click each active letter below for a list of terms.

· A

· B

· C

· D

· E

· F

· G

· H

· I

· J

· K

· L

· M

· N

· O

· P

· Q

· R

· S

· T

· U

· V

· W

· X

· Y

· Z

Philosophy

Propositional Statements

Philosophy

A philosophy is a proposed understanding. broad view of phenomena of interest to a given discipline that exists at the philosophical level of discourse. Philosophies often precipitate new worldviews

Propositional Statements

Propositional statements relate two or more concepts from a principle in a way that guides further inquiry. The proposition moves concepts from the theoretical to the empirical level of discourse.

Conceptual and Theoretical Models

You will recall that Relational Statements can be derived from conceptual frameworks and grand theory. These relational statements are used to explain how concepts relate and explain phenomenon in which nurses are interested; concepts are put together in ways that form a new framework for understanding. To exist at a level of theoretical discourse, the unique concepts of a given model must additionally specify relationships among the concepts central to nursing. Once the relationships among the applicable concepts are explicated, a conceptual or theoretical model emerges at the theoretical level of discourse. In this way, a conceptual or theoretical model formalizes related concepts together to form a new perspective.

Regardless of how a theorist titles his or her theory, remember that the degree to which the classification of nursing theory meets the criteria for theory development is most instructive for where the theory might exist among the levels of discourse. Let's explore some of these conceptual and theoretical models.

Johnson's behavioral system model (1959) was an early conceptual model that originally did not explicate assumptions about the environment. Over the next 20 years, Johnson fully addressed assumptions regarding the four phenomena of interest to nursing. However, one of Johnson's most significant contributions to nursing theory development was the recognition that nursing theory development was foundational to the emergence of the discipline of nursing as a profession (1974).

King's conceptual system model and theory of goal attainment (2007) are particularly challenging for the novice nursing theorist. Classification of King's work is complex from the standpoint that she was one of the first nursing theorists to clearly explicate a middle-range theory, that of goal attainment. However, her work through the years was expanded and refined, resulting at the least in a conceptual framework or grand theory (Lane-Tillerson, 2007), although most nursing theorists since her death recognize her work as that of a conceptual model.

Levine's conservation model (1967, 1996) was another early conceptual work that focused on four conservation principles. However, Levine was one of the first nursing theorists to differentiate holistic from wholistic terminology. Although Levine's work best fits the totality paradigm in terms of her assumptions of the phenomena of interest to nursing, she introduced holistic nursing from a perspective more commonly defined in the simultaneity paradigm.

Neuman's systems model (1995) is a fairly straightforward conceptual model that has consistently addressed the four phenomena of interest to nursing. Neuman's assumptions regarding the phenomena of interest to nursing are very representative of the totality paradigm. Neuman's work was one of the first to explicate the environment with both internal and external dimensions.

Orem's self-care deficit nursing theory (2001) is an extremely complex theoretical model that actually includes three theories: (a) self-care theory; (b) self-care deficit theory; and (c) nursing systems theory. Orem's assumptions regarding the phenomena of interest to nursing are very representative of the totality paradigm. Orem's work is one of the most tested theoretical models to date in nursing theory development (Biggs, 2008).

Roger's theory of unitary human beings (1994) is also an extremely complex theoretical model. Roger's assumptions regarding the phenomena of interest to nursing are very representative of the simultaneity paradigm. Roger's work is another of the most tested theoretical models to date in nursing theory development (Wright, 2007).

Roy's adaptation model (1984, 1988) is another fairly straightforward conceptual model that has consistently addressed the four phenomena of interest to nursing. Roy's assumptions regarding the phenomena of interest to nursing are very representative of the totality paradigm.

Further Reflection

In terms of similarities and differences among these conceptual and theoretical models, one can see that the various models presented explicate assumptions regarding the phenomena of interest to nursing: person, environment, health, and nursing. The degree to which each model offers assumptions that are more representative of the totality paradigm versus the simultaneity paradigm provides one basis upon which to assess their individual differences. In addition, each model offers unique definitions for further critical appraisal. Conceptual and theoretical models generate nursing theory as Propositional Statements. Propositional statements are "If . . . then . . ." statements that can be promulgated for further testing. If you were to compare and contrast conceptual and theoretical models, you would find that the majority fall under the totality paradigm, though some of the newer models that are humanistic in nature fit best under the simultaneity paradigm. See if you can correctly identify the paradigmatic perspective of these conceptual and theoretical models.

Conceptual and Theoretical Models

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Drag each of the terms below to the most appropriate column.

Totality Paradigm

King's conceptual systems model of goal attainment

Levine's conservation model

Johnson's behavioral system model

Roy's adaptation model

Neuman's systems model

Orem's self-care deficit nursing theory

NOTE:

One of the theorists that I would like you to include in my post is Faye Glenn Abdellah she formulated 21 nursing problem that guided nursing care.