Nursing theory
Nursing theory encompasses the frameworks and paradigms that define the nursing profession, shaping the roles and responsibilities of nurses within healthcare. As nursing has evolved into a vital and respected profession, particularly since the late 20th century, there has been a concerted effort to establish clear theoretical models that guide nursing practices. Early nursing theorists, such as Florence Nightingale, laid the groundwork for this field, which gained prominence in the mid-20th century with contributions from figures like Hildegard Peplau and Madeleine Leininger. Today, there are over a hundred established nursing theories that address various aspects of care, from interpersonal relationships to patient independence and the integration of technology in nursing.
While some critics argue that nursing theory may be overly complex and potentially restrictive in practice, proponents contend that these theories provide a necessary foundation for developing a unique nursing identity separate from medicine. Contemporary nursing theories continue to emerge, reflecting changing societal needs and advances in healthcare, with models like the Tidal Model of Mental Health Nursing and the Quality-Caring Model highlighting new dimensions of patient care. Overall, nursing theory remains an essential component of nursing education, influencing how nurses approach patient care and decision-making in diverse and often challenging environments.
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Nursing theory
With the emergence of nursing into a more prominent role in health care, there has developed a school of thought that believes that if nursing is to become its own profession and if nurses are to be considered more and more an element of direct, hands-on care, then the field needs to construct clear paradigms, or theories, that would define the extent and dimensions of nursing duties with systematic precision. This would create specific schools of nursing theories that would, in turn, define the wide array of specific nursing responsibilities and would, ultimately, outline specific ways that nurses would respond in keeping with the larger theoretical basis. That theoretical model would help direct an individual nurse through the unpredictable and high-pressure world of hands-on hospital care.
With an aging population and an explosion in new medical technologies and breakthroughs, nurses are among the most in-demand professionals in the United States. In addition, career studies suggest again and again that nurses rank below only firefighters, pure research scientists, and doctors in terms of the respect the field engenders within the wider population. Given the rapidly increasing costs of medical attention and the relative scarcity of doctors, nurses have emerged since the late 1990s to take a prominent place in direct hands-on care of patients. No longer are nurses perceived to be appendages of doctors, committed to simply carrying out carefully prescribed doctors’ orders or, if there is some anomaly in treatment response, to quickly abdicating to the authority of the doctor.
Background
Florence Nightingale, who published Notes on Nursing in 1860, is widely considered to be the first nursing theorist, but the field of nursing theory did not come to prominence until almost a hundred years after Nightingale’s pioneering publication. Before World War II, during which the nursing profession came into its own as nurses assumed prominent roles in field care and emergency operations of medical facilities, nurses were perceived to be largely an extension of the attending physician. Nurses were seen to be facilitators professionally—in an emergency, the nurse would respond in accordance with standing directives from the doctor. Nurses were said to be particularly compassionate and particularly caring—but that had little to do with their actual responsibilities or decision making. In this paradigm, nursing was defined more as an art than a science, more emotional than analytical, more heart than head. Nurses, after all, were not doctors.
Beginning in the mid-1950s, however, nursing schools began to develop more precise templates to define the theoretical basis behind critical nursing practices. In 1952 Hildegard Peplau became the first published nursing theorist since Nightingale with her theory of interpersonal relations. Others soon followed, including Madeleine Leininger, Dorothea Orem, Ernestine Wiedenbach, and Faye Abdellah. These new templates conceived of nurses as on par with doctors in terms of responding to the complicated relationships between doctor, nurse, and patient that governed hands-on care. Indeed, in significant ways, the nurse—not the attending physician—was most directly responsible for setting up a team atmosphere within the staff, for communicating directly with the patient and addressing day-to-day anxieties and fears, and even for moderating the relationship between the hospital and the patient’s friends and family.
By the mid-1970s, more than a hundred different theories of nursing practice had been developed. These theoretical models ranged from grand theory models that sought to come to terms with the big-picture dimensions of nursing to moderate-range theories that worked out the complicated dynamics between on-call nurses and the general duties of all nurses. There were also smaller-scale theories that defined the nature of how a nurse addresses specific nursing responsibilities in specific situations (putting in IV solutions, for instance, or dealing with a belligerent family member).
These nursing theories were each defined using data drawn from on-site experience, with an unprecedented interest in treating nursing less as an art and more as a science. In turn, each nursing theory, promulgated by passionate advocates, generated textbooks and sustained seminars and workshops, creating an entirely new level of nursing studies as nursing schools across the country grew to embrace one theory over others. Among the areas of nursing practice that came to define an individual theoretical approach were definitions of levels of patient independence, rehabilitation strategies, the role of spirituality in recovery, the importance of family and friends, the different levels of compassion, the actual process of on-the-spot decision making, the impact of stress, the definition of different levels of pain, and strategies for how to help patients cope with difficult news. Over nearly twenty-five years, virtually every aspect of the nurse’s job became a subject for a new theory on nursing itself, and the profession touted its emergence as a science.
Nursing Theory Today
However, some still question whether nursing is a science and whether nursing theory itself is overly complicated, hence ultimately irrelevant to actual hands-on practice. These theories are for the most part intended to directly influence how a nurse performs duties, providing each nurse with a specific protocol that aids decision making. Some critics point to the accumulating body of increasingly complex nursing theories as an overelaboration of the basics of a profession that really seeks only to help patients. More to the point, critics argue, nurses routinely face situations that would draw on a number of different theoretical models, and hence making student nurses choose a specific approach to their nursing career actually limits their ability to respond to each situation once they are involved in actual hands-on hospital care. Furthermore, these theories are most often the product of nursing instructors; that is, those who are not actually involved in this day-to-day performance of duties. (Many prominent nursing theorists, however, did work as nurses at the start of their careers, even if some had moved to an instructor role by the time they published their theories.) Such elitism, opponents argue, denies nursing what gives the profession its value: the trust in the compassion and intelligence of each individual nurse, trained to observe environment conditions and to respond with care. Despite criticism, however, nursing theory remains a major part of the curriculum for nursing students, and it is widely considered a useful foundation for practice. Nursing theory, its proponents argue, gives the profession its own identity and allows it to shape its own development rather than following in the footsteps of medicine.
While many of the best-known nursing theory paradigms originated in the twentieth century, new nursing theory continues to be published, often addressing changes in the field, or more generally in the way that people live. Phil Barker and Poppy Buchanan-Barker's Tidal Model of Mental Health Nursing, first published in 2000, addresses an area of nursing that has been largely overlooked by nursing theorists; Barker claims that the Tidal Model is the first mental health nursing model to be recognized internationally as a significant mid-range nursing theory. Joanne Duffy published the Quality-Caring Model, which foregrounds the importance of relationship-building in nursing, in 2003. Rozzano Locsin's Theory of Technological Competency as Caring in Nursing was first published in 2001. The theory deals with the need for nurses to fully master modern medical technology in order to be able to better help the patient. Through these and other modern nursing theorists, the field of nursing theory continues to grow and adapt to changing realities.
Bibliography
Alligood, Martha. Nursing Theory: Utilization and Application. 5th ed. Maryland Heights: Mosby, 2013. Print.
Alligood, Martha. Nursing Theorists and Their Work. 8th ed. Maryland Heights: Mosby, 2013. Print.
Colley, Sarah. "Nursing Theory: Its Importance to Practice" Nursing Standard 17.46 (2003): 33–37. Print.
Masters, Kathleen. Nursing Theories: A Framework for Professional Practice. 2nd ed. Burlington: Jones, 2014. Print.
McEwen, M., and E. Willis. Theoretical Basis for Nursing. 4th ed. Philadelphia: LWW, 2014. Print.
Smith, M., and M. Parker. Nursing Theories and Nursing Practice. 4th ed. Philadelphia: Davis, 2015. Print.