Chapter 3 Nursing Theories and Conceptual Frameworks Kozier

Chapter 3 Nursing Theories and Conceptual Frameworks Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Learning Outcomes 1. Differentiate the terms theory, conceptual framework, paradigm, and metaparadigm for nursing. 2. Describe the major purpose of theory in the sciences and practice disciplines. 3. Identify the components of the metaparadigm for nursing. continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Learning Outcomes 4. Identify the role of nursing theory in nursing education, research, and clinical practice. 5. Identify one positive and one negative effect of using theory to understand clinical practice. Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Introduction Nursing science • Identify the unique body of knowledge that is essential to nursing practice • Develop concepts and theories specific to nursing • Define the system of ideas that distinguishes nursing from other professions Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Theory • System of ideas presumed to explain a given phenomenon • Helpful to explore theory in other disciplines before considering theory in nursing Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

§ May build on or modify previous theories § Freud theorized that the unconscious mind shapes everyday life. • Jung modified or rejected some of Freud's ideas and developed ideas about the unconscious. Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Context for Theory Development in American Universities • Universities had to demonstrate a unique body of theoretical knowledge. • Theories work like lenses to interpret the world of interest. Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Defining Terms Concepts § Often called the “building blocks” of theories • Example: Freud's theory of the unconscious Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Defining Terms Conceptual framework § Group of related ideas, statements, or concepts § Often used interchangeably with the terms “conceptual model” and “grand theories” • Example: Freud's structure of the mind (id, ego, and superego) Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Defining Terms • Paradigm § A pattern of shared understanding and assumptions about reality and the world § Includes notions of reality that are largely unconscious or taken for granted § Become clear when realities or world views clash § Paradigm of religious fundamentalism versus paradigm of evolution Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

The Metaparadigm for Nursing • Concept that can be superimposed on almost any work of nursing • Four major metaparadigms in nursing § § Client/person Environment Health Nursing Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Role of Nursing Theory • Links among nursing theory, education, research, and clinical practice • Contributes to knowledge development • May direct education, research, and practice Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Figure 3– 1 The living tree of nursing theories. From “The Living Tree of Nursing Theories, ” by C. Tourville & K. Ingalls, 2003, Nursing Forum, 38(3), p. 23. Copyright © 2003 Blackwell Publishers. Reprinted with permission. Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

In Education • In 1970 s and 80 s, nursing programs: § Identified major concepts § Organized concepts into conceptual framework § Built curriculum around framework § Elucidated central meanings of the profession § Improved status of the profession Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

In Research • Identifies philosophical assumptions or conceptual frameworks • Midlevel (mid-range) theories focus on the exploration of concepts. § Pain, self-esteem, and learning Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

In Research • Critical theory describes theory that helps elucidate how social structures affect human experiences from art to social practices. § How race, gender, sexual orientation affect patient experience and health outcomes Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

In Clinical Practice • Primary contribution in reflecting, questioning, and thinking about what nurses do • Practice theories describe relationships amongst variables as applied to specific clinical situations. § Theory of postpartum depression Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

In Clinical Practice • Debates about the role of theory in practice is evidence that nursing is maturing • Academic disciplines and clinical profession Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Philosophy § Belief system, often an early effort to define nursing phenomena, that serves the basis for later theoretical formulations Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Overview of Selected Nursing Theories • Nightingale's environmental theory • Linked health with five environmental factors • Noise-free environment Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Overview of Selected Nursing Theories • Nightingale's environmental theory § Keeping client warm § Attending to client's diet • Peplau's interpersonal relations model § Nurse–client relationship • • Orientation Identification Exploitation Resolution Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Overview of Selected Nursing Theories • Henderson's definition of nursing § Nurse concerned with both healthy and ill individuals § Independence gained through meeting 14 fundamental needs • Roger's science of unitary human beings § Person as irreducible whole greater than sum of parts Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Overview of Selected Nursing Theories • Roger's science of unitary human beings § Human, environmental field exchanges § Use of noncontact therapeutic touch • Orem's general theory of nursing § Self-care agency • Self-care agent • Dependent care agent Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen continued on next slide Copyright © 2016 Pearson Education Limited All Rights Reserved

Overview of Selected Nursing Theories • Orem's general theory of nursing § Self-care requisites • Universal • Developmental • Health deviation from illness, injury, disease, or treatment § Therapeutic self-care demand Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Overview of Selected Nursing Theories • King's goal attainment theory § Relationship of personal, interpersonal, and social systems § Ten concepts essential for nurses in concrete nursing situations • Neuman's systems model § Lines of resistance § Lines of defense • Inner and flexible Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Figure 3– 2 King's conceptual framework for nursing: dynamic interacting systems. From A Theory for Nursing: Systems, Concepts, Process (p. 11), by I. M. King, 1981, Albany, NY: Delmar. Copyright Imogene M. King. Reprinted with permission. Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Overview of Selected Nursing Theories • Neuman's systems model § Nursing interventions • Retaining or maintaining system stability • Primary, secondary, tertiary • Roy's adaptation model § Individual as biopsychosocial adaptive system that employs feedback cycle of input, throughput, and output § Response in one of four modes Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Figure 3– 3 King's model of transactions. From A Theory for Nursing: Systems, Concepts, Process (p. 145), by I. M. King, 1981, Albany, NY: Delmar. Copyright Imogene M. King. Reprinted with permission. Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Figure 3– 4 Neuman's client system. From The Neuman Systems Model, 4 th ed. (p. 15), by B. Neuman and J. Fawcett, 2002, Upper Saddle River, NJ: Prentice Hall. Reprinted with permission. Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Overview of Selected Nursing Theories • Leininger's cultural care diversity and universality theory § Health and care influenced by elements of social structure § Three intervention models § Culture care • Watson's human caring theory § Caring unifying focus for practice § 10 clinical caritas processes Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Overview of Selected Nursing Theories • Parse's humanbecoming theory § How individuals choose, bear responsibility for patterns of personal health § Client authority figure, decision maker § Nurse's role uses “true presence” Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Critique of Nursing Theory • No single global, commonly accepted definition of nursing • Existing theories/models too vague or complex to guide practice • Many theories untested, therefore no EBP • Interprofessional overlap suggest theory guiding nursing practice cannot be unique to nursing Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved

Critique of Nursing Theory • Science, world have changed that historically fundamental theories no longer fit • As a lens, theory can either illuminate or obscure. • As a tool, theory can either liberate or enslave. Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016 Pearson Education Limited All Rights Reserved