From Nursing Career
Nursing theory is the term given to the body of knowledge that is used to support nursing practice. In their professional education nurses will study a range of interconnected subjects which can be applied to the practice setting. This knowledge may be derived from experiential learning, from formal sources such as nursing research or from non-nursing sources. To speak of nursing theory is often difficult. Nursing is many things to many people. Most universally agreed upon is that Nursing is a science involving people, environment and process fueled by a vision of transcendence in the context of healthcare. It is interesting to note that 90% of all Nursing theories have been generated in the last 20 years. Many schools encourage students to formulate theories of Nursing as part of their curriculum. Some might argue that this multiplicity of theory is detrimental to the practice and undermines common vision. Others would say that the nature of the young science is sufficiently far reaching to require such tactics in order to elicit true consensus. It cannot be denied, however, that there is much vanity involved in the formulation of nursing theory. The pages of "Nursing Science Quarterly", a major mouthpiece for Nursing Theory, are rife with examples of semantical hair-splitting.
Nursing models are conceptual models, constructed of theories and concepts. They are used to help nurses assess, plan, and implement patient care by providing a framework within which to work. They also help nurses achieve uniformity and seamless care.
Common features of nursing models
Most nursing models involve some method of assessing a patient's individual needs and implementing appropriate patient care. An essential portion of patient care is measurable goals in order that the process can be evaluated in order to see if the health goal has been met. Nursing models can be used to produce a document known as a care plan that is used to document a patient's treatment plan as set by nurses, doctors and other healthcare professionals and auxiliary workers. These documents are considered to be living documents - they are supposed to be changed and evaluated on a daily basis as the patient's condition and abilities change.
Theories of Nursing fall into roughly 5 categories. There are metatheories, grand theories, mid-range theories, min-theories and micro-theories.
History of nursing models
The original role of the nurse was primarily to care for the patient as prescribed by a physician. This evolved into the biomedical model of nursing care which still strongly influences nursing practice today. The biomedical model focuses heavily upon pathophysiology and altered homeostasis but fails to identify individual differences and whilst it works well for traditional medical and physical care, it focuses solely on the treatment of disease, making little account of psychological, sociocultural, or politcoeconomic differences between individuals. The Biomedical Model essentially views all patients with the same disease as the same problem regardless of their religion, culture, or ethnicity. This is in contrast to the social model of healthcare that places emphasis on changes that can be made in society and in people's own lifestyles to make the population healthier.
The first theorist to clearly articulate a role of nurses distinct from the medical profession was Florence Nightingale. Her theories were developed during the Crimean War and published in Notes on Nursing:What It Is, and What It Is Not in 1859. Nightingale's model is based on the idea that the nurse manipulates the environment to promote the patient's well being.
Major nursing theorists
- Imogene King
- Madeleine Leininger
- Betty Neuman
- Dorthea Orem
- Hildegard Peplau
- Rosemarie Rizzo-Parse
- Isabel Hampton Robb
- Martha Rogers
- Calista Roy
- Helen Erickson
Purposely left off this list is that most famous of all nurses, Florence Nightingale. Ms. Nightingale never actually formulated a theory of nursing science but was posthumously accredited with same by others who categorized her personal journaling and communications into a theoretical framework.
Also left off are many who simply improvised on others work and acclaimed their thoughts as new theoretical vision.
Examples of nursing models
The models used vary greatly between institutions and countries. However, different branches of nursing have different "preferred" nursing models. These are summarised below:
Community and rehabilitation nursing
Examples of mini, micro theories and student work
The Synergy Model is designed to pair the needs of the patient and their family with the strengths of the nurse providing care. For instance, if a patient comes from a different culture than the nurse, the nurse who is an expert(level 5) in the Response to Diversity competency would be able to evaluate her own biases and beliefs, respond to and anticipate the needs of the patient. The nurse must be able to integrate cultural differences into the plan of care, including alternative therapies. In this way, all the needs of the patient are met, and the nurse has established a working relationship with the patient and family. This theory is difficult to put into practice, however with the nursing shortages and tight staffing ratios.
Future of nursing models
Nursing models have been criticised for failing to provide holistic care, and preventing nurses from thinking "outside of the box". This has been compounded by many hospitals who have developed "pre-printed" care plans that have been misused by nurses who have failed to customise these generic care plans to the patient. An example of this would be using a standard care plan for appendectomy for an elderly patient with multiple pathology (for instance diabetes, angina pectoris and a history of myocardial infarction). Evidently, the patient's care needs would be very different from a fit-and-healthy 20 year old male with no previous medical history who neither smokes nor drinks! It is up to the professional to tailor the care plan to suit the individual patient. A bigger problem is that the purpose of care plans has been completely lost. They do not meet their original intention of driving the care of the patient. Rather, the care of the patient is driven by physician orders, hospital standards of care and the individual nurses workload. For example, many care plans are comlpleted at the end of the day, so that there is something on the chart.Technological advances are starting to produce software specific to nursing, based on the way nurses actually think and work.
Models of nursing have always been accused of being "out of touch" with the harsh reality of patient care, and creating yet more unnecessary paperwork for nurses to complete. However, this misses the point of a nursing model, which is to drive research, innovation and change, to connect theory with practice, but not to be practice.
- Nightingale's Notes on Nursing at project Gutenberg.
- http://www.aacn.org/certcorp/certcorp.nsf/vwdoc/SynModel#Basic Informat
- http://www.aacn.org/certcorp/certcorp.nsf/vwdoc/SynModel#Assumptions Gu