Nursing theories provide a foundation for clinical decision-making. These theoretical models in nursing shape nursing research and create conceptual blueprints, ultimately determining the how and why that drive nurse-patient interactions.
Nurse researchers and scholars naturally develop these theories with the input and influence of other professionals in the field.
Nursing theory concepts are essential to the present and future of the profession. The first nursing theory — Florence Nightingale's Environmental Theory — dates back to the 19th century. Nightingale identified a clear link between a patient's environment (such as clean water, sunlight, and fresh air) and their ability to recover. Her discoveries remain relevant for today's practitioners. As health care continues to develop, new types of nursing theories may evolve to reflect new medicines and technologies.
Education and training showcase the importance of nursing theory. Nurse researchers and scholars share established ideas to ensure industry-wide best practices and patient outcomes, and nurse educators shape their curricula based on this research. When nurses learn these theories, they gain the data to explain the reasoning behind their clinical decision-making. Nurses position themselves to provide the best care by familiarizing themselves with time-tested theories. Recognizing their place in the history of nursing provides a validating sense of belonging within the greater health care system. That helps patients and other health care providers better understand and appreciate nurses’ contributions.
Nursing theories fall under three tiers: grand nursing, middle-range, and practical-level theories. Inherent to each is the nursing metaparadigm, which focuses on four components:
Each of these four elements factors into a specific nursing theory.
Grand theories are the broadest of the three theory classifications. They offer wide-ranging perspectives focused on abstract concepts, often stemming from a nurse theorist’s lived experiences or nursing philosophies. Grand nursing theories help to guide research in the field, with studies aiming to explore proposed ideas further.
Hildegard Peplau's Theory of Interpersonal Relations is an excellent example of a grand nursing theory. The theory suggests that for a nurse-patient relationship to be successful, it must go through three phases: orientation, working, and termination. This grand theory is broad in scope and widely applicable to different environments.
As the name suggests, middle-range theories lie somewhere between the sweeping scope of grand nursing and a minute focus on practice-level theories. These theories are often phenomena-driven, attempting to explain or predict certain trends in clinical practice. They’re also testable or verifiable through research.
Nurse researchers have applied the concept of Dorothea E. Orem's Self-Care Deficit Theory to patients dealing with various conditions, ranging from hepatitis to diabetes. This grand theory suggests that patients recover most effectively if they actively and autonomously perform self-care.
Practice-level theories are more specific to a patient’s needs or goals. These theories guide the treatment of health conditions and situations requiring nursing intervention. Because they’re so specific, these types of nursing theories directly impact daily practices more than other theory classifications. From patient education to practicing active compassion, bedside nurses use these theories in their everyday responsibilities.
Theory and practice inform each other. Nursing theories determine research that shapes policies and procedures. Nurses constantly apply theories to patient interactions, consciously or due to training. For example, a nurse who aims to provide culturally competent care — through a commitment to ongoing education and open-mindedness — puts Madeleine Leininger's Transcultural Nursing Theory into effect. Because nursing is multifaceted, nurses can draw from multiple theories to ensure the best course of action for a patient.
Applying theory in nursing practice develops nursing knowledge and supports evidence-based practice. A nursing theoretical framework is essential to understand decision-making processes and to promote quality patient care.
Images sourced from Getty Images
