Nursing Theories

Nursing Theories BT Basavanthappa

MN, PhD

Principal, Govt. College of Nursing, Fort, Bangalore PhD Guide (Recognized by INC and Indian Universities) Examiner for UG, PG and Doctoral Courses in Nursing Ex-Programme In-charge, IGNOU BSc, Nursing Course Life Member Trained Nurses Association of India, New Delhi Govt. Nurses Association of Karnataka, Bangalore Academy of Nursing Studies, Hyderabad United Writers Association of India, Chennai Nursing Research Society of India, New Delhi President RGUHS Nursing Teachers Association, Karnataka Winner Bharat Excellence Award and Gold Medal Vikas Ratan Gold Award UWA Lifetime Achievement Award Author Ten Books on Nursing

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Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd B-3 EMCA House, 23/23B Ansari Road, Daryaganj New Delhi 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672, Rel: 32558559, Fax: +91-11-23276490, +91-11-23245683 e-mail: [email protected] Visit our website: www.jaypeebrothers.com Branches  2/B, Akruti Society, Jodhpur Gam Road Satellite Ahmedabad 380 015, Phones: +91-079-26926233, Rel: +91-079-32988717, Fax: +91-079-26927094, e-mail: [email protected]  202 Batavia Chambers, 8 Kumara Krupa Road Kumara Park East, Bangalore 560 001, Phones: +91-80-22285971, +91-80-22382956, Rel: +91-80-32714073, Fax: +91-80-22281761, e-mail: [email protected]  282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza Pantheon Road, Chennai 600 008, Phones: +91-44-28193265, +91-44-28194897, Rel: +91-44-32972089, Fax: +91-44-28193231, e-mail: [email protected]  4-2-1067/1-3, 1st Floor, Balaji Building, Ramkote Cross Road Hyderabad 500 095, Phones: +91-40-66610020, +91-40-24758498, Rel:+91-40-32940929, Fax:+91-40-24758499, e-mail: [email protected]  No. 41/3098, B & B1, Kuruvi Building, St. Vincent Road Kochi 682 018, Kerala, Phones: 0484-4036109, +91-0484-2395739, +91-0484-2395740 e-mail: [email protected]  1-A Indian Mirror Street, Wellington Square Kolkata 700 013, Phones: +91-33-22451926, +91-33-22276404, +91-33-22276415, Rel: +91-33-32901926, Fax: +91-33-22456075, e-mail: [email protected]  106 Amit Industrial Estate, 61 Dr SS Rao Road Near MGM Hospital, Parel, Mumbai 400 012, Phones: +91-22-24124863, +91-22-24104532, Rel: +91-22-32926896, Fax: +91-22-24160828, e-mail: [email protected]  “KAMALPUSHPA” 38, Reshimbag, Opp. Mohota Science College, Umred Road, Nagpur 440 009 (MS), Phones: Rel: 3245220, Fax: 0712-2704275, e-mail: [email protected] Nursing Theories © 2007, BT Basavanthappa All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher. This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. First Edition: 2007 ISBN 81-8061-963-X Typeset at JPBMP typesetting unit Printed at Repro India Limited

Dedicated to My Ever Loving Parents and My Dear Students of Noble Nursing Profession

Preface It gives me an immense pleasure and satisfaction to introduce and present this book Nursing Theories to our honorable Nursing community. I have been very much pleased with utilization of my earlier nine books; namely, Community Heath Nursing, Medical Surgical Nursing, Pediatric/Child Health Nursing, Midwifery and Reproductive Nursing, Fundamentals of Nursing, Nursing Education, Nursing Administration and Nursing Research. In the past nursing was based on principles borrowed from the physical and social sciences and other disciplines. Today, however, there is a body of knowledge that is uniquely nursing, while this was not always same, amount of investigation and analysis of nursing care has expanded rapidly in recent years. Nursing is no longer based on task orientation, situation or trial and error but it increasingly relies on researcher as a basis for practice; now we have several theoretical models of nursing which have been developed by our own nursing theorists. This book is a synthesis and extension of what we believe that theoretical models now serve a newer and more important role within nursing. Nursing theories and model have come to be understood on the embodiment of nursing philosophies, presenting nursing beliefs understanding and purposes it has been believed that theoretical models are excellent and tangible sources of the perspective of nursing across time. Certainly some of the models serve as sources for extensive programmes of research, as curriculum organizers and as templates for practice. It has been suggested that the nursing perspectives may be used to guide knowledge development within nursing. Since it fulfils one of the criteria of the profession that there is special body of knowledge which continuously enlarges the body of knowledge uses and improves its techniques of education and service by the use of scientific method to fulfil the purpose. I have tried my level best to select some of the important contributions of nurse theorists and put it in an understandable language so that every one will be aware and acquainted with knowledge of nursing theories, which help them in nursing practice, nursing education and nursing research. When Nursing develops its own theory, validates research knowledge in the practice setting and relies on this knowledge to direct nursing practice, it will be recognized as an independent autonomous profession.

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I hope this book will continue to serve not only nursing student of all levels for whom it is intended but also nursing teachers and practitioners. Theory improves nursing practice by describing, explaining, predicting and controlling phenomena of interest to nurses. Theory allows professional autonomy by guiding the practice, education and research functions of the profession. The study of theory helps develop analytical skills, challenges, thinking and clarifying values and assumptions. I am aware of manifold reasons, error might be crept in and shall feel oblige, if such errors are brought to my notice. I sincerely welcome constructive criticism from readers, that would help me to enrich myself and suggestions will be incorporated in the next edition.

BT Basavanthappa

Acknowledgements I owe a great deal of thanks to many who encouraged and supported me with their time and encouragement throughout. • Shri G Basavannappa, Formerly, Minister and presently, MLA of Karnataka for having initiated and supported me to take up this “Noble Nursing Profession” as my career. • Dr (Mrs) Manjula K Vasundhra, Formerly, Professor and HOD of Community Medicine, Bangalore Medical College, who continuously encouraged me to write texts in the field of Nursing since nursing is a major force in Medical and Health Services. • My Father Shri Thukkappa, who continues his grace for the progress of my career and all-round development of my personality for the welfare of the community. • My Mother Smt Hanumanthamma, who continue to be a bright spot in the lives of all who knew her and whose grace gave me strength to progress of my life. • My Wife Smt Lalitha, who gives meaning to my life in so many ways. She is the one whose encouragement keeps me motivated, whose support gives me strength and whose gentleness gives me comfort. • My lovely children BB Mahesh and BB Gaanashree, for all the joy they provided me and all the hope that they instill me and who bare with patient throughout my works of the nursing texts. They keep me young at heart. • Finally, my warmest appreciation goes to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, for sharing my vision for this book and giving me the chance to turn vision into reality.

Contents 1. Introduction to Theory ..................................................................................................................... 1 2. Nightingale’s Environment Model ............................................................................................... 40 3. Abdellah’s Typology of 21 Problems ...........................................................................................52 4. Henderson’s Unique Function of Nurses .................................................................................... 61 5. Orem’s Self-care Theory ................................................................................................................72 6. Hall’s Core, Care and Cure Models ..............................................................................................86 7. Watson’s Philosophy and Science on Caring .............................................................................. 96 8. Peplau’s Interpersonal Relations Theory ................................................................................. 109 9. Orlando’s Nursing Process Theory ............................................................................................ 121 10. Wiedenbach’s Helping Art of Clinical Nursing ....................................................................... 130 11. King’s Theory of Goal Attainment ............................................................................................. 147 12. Paterson and Zderad Theory of Humanistic Nursing ............................................................ 169 13. Erikson, Tomlin, Mary Ann’s Theory of Modelling and Role Modelling ........................... 179 14. Boykin and Schoenhofer Theory of Nursing as Caring ......................................................... 186 15. Johnson’s Behavioural System Model ...................................................................................... 190 16. Roy’s Adaptation Model .............................................................................................................. 205 17. Neuman’s Systems Model .......................................................................................................... 225 18. Levine’s Four Conservation Principles ...................................................................................... 242 19. Leininger’s Cultural Care Theory .............................................................................................. 257 20. Rogers’ Science of Unitary Human Beings .............................................................................. 273 21. Newman’s Theory of Health ...................................................................................................... 286 22. Fitzpatrick’s Rhythm Model ....................................................................................................... 298

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23. Travelbee’s Human-to-Human Relationships ........................................................................ 304 24. Benner’s Excellence and Power in Clinical Nursing Practice ............................................... 313 25. Mercer’s Theory in Maternal Role Attainment ........................................................................ 327 26. Adam’s Conceptual Model on Nursing .................................................................................... 337 27. Parse’s Man-Living-Health Theory ........................................................................................... 348 28. Joan Riehl’s Symbolic Interactionism ....................................................................................... 366 29. Barnard’s Parent-child Interaction Model ................................................................................ 375 30. Pender’s Health Promotion Model ............................................................................................ 384 31. Other Theories .............................................................................................................................. 389 Index ................................................................................................................................................ 401

Chapter 1

Introduction to Theory

The term “theory” is used in many ways. For example, Nursing teachers and students use the term “theory” to refer to the content covered in classroom, as opposed to the actual practice of performing nursing activities. Sometimes the term “theory” is used to refer to someone’s hunches or ideas as in “My theory is that if I postpone cleaning my room, long enough, my mother will clean it for me”, or “My theory is not to tell lie or not to bluff any body”, etc. Whatever the usages the term, “theory” almost always connoted an abstraction or generalization. DEFINITIONS OF THEORY Scientists generally use the term “theory” in a precise way, i.e. theory has always been defined in a number of ways as given below. • “A theory is a statement that purports to account for or characterize some phenomenon” and that “it pulls out the salient parts of a phenomenon so that one can separate the critical and necessary factors for relationships, from the accidental and unessential factors or relationships” (Barnum 1990).

• “Theory is a systematic abstraction of reality that serves some purpose (Chinn and Kramer 1991). They describe each part of the definition, i.e. systematic implies a specific organizational pattern, abstraction means that theory is a representation of reality and purposes include description, explanation, and prediction of phenomena and control of some reality.” • “Theory enables to explain a maximum number of observable relationships, by setting limits on “What question to ask and what methods to use to pursue answers to the questions” (Meleis 1985). • “A theory is a set of interrelated constructs (concepts adapted for a scientific purpose), definitions, and prepositions that present a systematic view of phenomena by specifying relations among variables, with the purpose of explaining and predicting the phenomena” (Kerlinger 1986). This definition takes a basic view of science, that development of a general explanation about natural phenomena via theories. • Theory is a set of interrelated concepts, definitions and propositions that present

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a systematic way of viewing facts/events by specifying relations among variables, with the purpose of explaining and predicting the fact or event (Kerlinger 1973). The key ideas of this definition are, interrelation of concepts, propositions specifying relations among the variables and stated purposes of explaining or predicting facts or events. This definition states that a theory suggests a direction in how to view facts and events. For example, Nightingale proposed a beneficial relationship between fresh air and health. • Theory is a “Creative and rigorous structuring of ideas that project a tentative, purposeful and systematic view of phenomena (Chinn and Kramer 1991). This definition adds additional element, i.e. focus on the tentative nature of theory. It says that theories cannot be equated with scientific laws. Laws are the basis of natural science. Nursing is a human science. The rigour and objectivity of the laboratory are both inappropriate and impossible to duplicate. • A theory can be defined as an organizing statement about abstract concepts that gives them meaning in relation to the real world. Theories describe, explain or predict relationships among abstract concepts. Abstract concepts are mental images of reality; they may be highly abstract and non-observable, such as intelligence, or relatively concrete and directly measurable, such as caring behaviour. Theories are linked to the real world through definitions that specify how concepts will be known, experienced, observed and measured. Theories guide

decision making by providing the supporting conceptualisation for the study such as “significance of the problem, background, and problem definition or statement of the problem (Phillips, 1986). Thus, theory is an abstract generalization that presents a systematic explanation about the relationships among phenomena. Theories embody principles for explaining, predicting and controlling phenomena. So theory construction and testing are intimately related to the advancement of scientific knowledge, and it may even be claimed that theory is the ultimate goal of science. Theoretical and conceptual systems represent the highest and most advanced efforts of humans to understand the complexities of the world in which they live. The ideal of theory carries varying conceptualisations within and outside the discipline of nursing. Belief about the nature of theory arise in part from the various fields of inquiry from which nursing knowledge is developed. Some nursing theorists come from traditions in which the ideal theory is logically linked sets of confirmed hypothesis. Others view theory as loosely connected hypothetic conjectures. Still others think of theory as philosophically based sets of belief and values about human nature and action. As a result, the nursing literature contains for theory, but this diversity serves to stimulate further understanding and development of theory. The following definitions in the nursing literature emphasize important dimensions of theory. • “Theory is a logically interconnected set of confirmed hypotheses” (McKay 1969).

Introduction to Theory This definition implies a specific form of expression based on rules of logic. It also requires that hypotheses are tested and confirmed by using methods of research to qualify as a theory. • “Theory is a conceptual system of framework invented to some purpose” (Dickoff and James, 1963). In this definition, the purpose for which a theory is created is emphasized. The term invented implies a creative purpose. • “Theory is an imaginative grouping of knowledge, ideas, and experience that are represented symbolically and seek to illuminate a given phenomenon” (Watson, 1985). Here creativity again emphasized, but the purpose for which theory is created shifts away from a specific purpose to the aim of enhancing understanding of a given phenomenon. • “Theory is a conceptual and pragmatic principle forming a general frame of reference for a field of inquiry” (Ellis, 1968). This definition implies that theory provides a philosophic view that guides inquiry in a discipline and also that theory serves a pragmatic or practical purpose for the discipline. From the above definition, all theory comprises a creative and rigourous structuring of ideas. The ideas are structured as concepts that are represented by word symbols. For theory to project a systematic view of phenomena, the concepts contained within the theory must be conveyed within the relationship statement and defined within the context of the theory. The theorists created a language and structure that impart the theory for some reason. The purpose may take many forms. Theory is tentative and

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thus is grounded in assumptions, value choices and the creative and imaginative judgement of the theorist. Therefore, “theory is a creative, rigorous structuring of ideas that projects a tentative, purposeful and systemic view of phenomena. Theories are general explanations which scholars use to explain, predict, control and understand commonly occurring events. Theory is defined as a “set of propositions used to describe, explain, predict and control of events” in which Set: a group of circumstances, situations, and so on, joined and treated as a whole. For example, negative number is treated as set in mathematics. Propositions, statements about how two or more concepts are related, e.g. heart rate increase as anxiety increases. Concept. Abstract classification of data, e.g. ‘temperature’ increases. Describe: to tell about in detail. Explain: to offer reason for Predict: to foretell Control: to exercise a regulating influence over. Phenomenon: an occurrence or incident; event.

PURPOSES OF THEORY The overall purpose of theory is to make scientific finding meaningful and generalizable. Theories allow scientists to knit together observations and facts into an orderly system. They are efficient, mechanises for drawing together and summarizing accumulated facts from separate and isolated investigations. The linkage of findings into a coherent structure makes the body of accumulated knowledge more