Critique of Nursing Theories SUSAN TOMLINSON-MALCOLM NSG-501-INH THEORETICAL FOUNDATION OF NURSING WILKES UNIVERSITY What is a Nursing Theory Explains, describes or predicts phenomena of interest to the discipline of nursing Primary purpose is to advance the discipline and professional practice of nursing Used as frameworks that can be tested for understanding health outcomes, intervention development, and can provide new or competing perspectives (Karnick, P. M. 2016). Central to developing nursing knowledge and to asserting nursing as a professional occupation. Helps with organizing concepts and ideas Used as a guide for everyday practice with critical thinking about what is happening to the patient in the situation that should guide nurses’ practice (Power, L. 2016) Purpose of Nursing Theory Guides nursing practice and generate knowledge Helps to explain nursing practice Helps nurses to know how, what and why they are doing something Nursing theories claim to offer guidance for nursing practice and to share unique perspectives about different nursing phenomena Application Of Nursing Theory Many nursing theorists and scholars found grand theories difficult to apply in research and practice and suggested the development of mid-range theories derived from the grand theories. Over the years several theories were developed from grand theories published in nursing literature. Mid Range Theory More specific, have fewer concepts, and encompass a more limited aspect of the real world. Concepts are relatively concrete and can be operationally defined. Contain a limited number of variables Describe, explain, and predict phenomena of concern to nursing as well as prescribe actions in response to those phenomena Mid Range theory in Nursing Mid-range theories are used as theoretical frameworks for research studies. open to use in practice and should be tested by research. Can be used as an expression to nursing knowledge. Provides a guide for nursing assessment and intervention Grand Theory These theories are abstract and give broad perspective to the goals and structures of nursing practice. They are not testable, and rather viewed as knowledgegenerated models from which hypotheses can be derived and tested, and they are useful as a theoretical framework for the development of mid-range theories (Chinn&Kramer, 2018) Comparison of Grand and Middle Range Theory Grand Theory Middle Range Theory Comprehensive/Global View of reality Not specific to specialty or setting Generalized to multiple settings Not testable May generate testable hypothesis Evolve from grand theories and practice Mid Range Vs Grand Theory More useful in research than grand theories because of their low level of abstraction and ease of operationalization Tend to support prediction better than grand theories due to circumscribed range and specificity of the concepts Are more likely to be adopted in practice because their relative simplicity eases the process of developing interventions for identified health problems. Orem’s Self Care Theory Orem's theory is a grand nursing theory Encompassing three interconnected theories: 1. The self-care theory- describes why and how human beings care for themselves 2. The self-care deficit theory- one of the common nursing theories used in nursing clinical practice. Orem’s aim was to define nursing’s concern and nursing’s goal Based on clarification of why and how human beings can be helped through nursing 3. Theory of nursing systems- describes relationships between nurses and patients and the importance of quality nursing care Individual selfcare actions to meet own self-care demands Achievement of desired outcome such as the promotion and maintenance of life, structure and functioning, and health and well-being The element of self-care is defined as regulatory action performed by the individual or performed with the individual to maintain life, health, and development. Promotes the goal of self-care Applying Orem’s Self Care It is a form of assistance used to teach patients about disease prevention, promoting health, and sustaining life One example of using self care theory for a diabetes patient. Mr. Smith was diagnose with type 2 diabetes . Orem conceptualized that nurses should provide centered care based on teaching self care and the patient must be ready for a change. The optimal goal for Mr. Smith includes education about the disease, the treatment plan and ways to manage type 2 diabetes. Also, the importance about medication, nutrition, exercise, and insulin therapy are very important. Education is the cornerstone of the treatment of type 2 to reduce diabetic complications. In type 2 diabetes, adaptation to the disease and treatment process is extremely critical, so the nurse will have to enforced the need of self-care. Katherine Kolcaba’s Theory of Comfort Middle Range Theory Includes relief, ease and transcendence Physical Psychospiritual Environmental Sociocultural In Kolcaba’s Comfort Theory comfort needs must be met for the individual to experience a sense of relief. Applying Kolcaba’s Theory of Comfort Nurses often care for patients that undergo several invasive procedures that often produce pain, fear, sadness, discomfort, and anxiety. These negative experiences are sometimes traumatic which can cause the patient to have limited ability to communicate needs. My patient was Mr. Smith a 25 year old male was admitted to our unit for diabetic ulcer on the left leg. At the time of admission his mother was at the bedside. Doctors told him that his leg would have to amputated. The news was too much to handle at the time for both Mr. Smith and his mother so they started crying . Both were anxious and were having difficulty accepting and cope with this tragic event. Kolcaba’s Theory of comfort was the best application to care of my patient. Based on my observation Mr. Smith was anxious and was encouraged to verbalized his fears and needs. My duty was to listen to his concerns and educate him about body changes and adaptation to the situation. Listening and lending reassurance offers a sense of care and trust, which gave a chance of acceptance. (Karnick,2016) Dorothy Orem Self Care theory Vs. Kolcaba theory of Comfort Both provides comfort and caring to patient Both theories are often practiced simultaneously in clinical nursing to enhance nursing practice Orem Vs Kolcaba Orem’s Theory Orem’s theory although it’s a grand theory it is very clear, language and structure very clear. Elements are defined clearly such as what is self-care, self-care agency, selfcare requisites and health deviation selfcare requisites. Conceptually, Nursing interventions to meet patient self-care, explains how patients can be helped through nursing. (Power,2016) Kolcaba’s Theory Comfort Theory is middle range theory for health practice, education, and research Very clear and includes definitions of key elements of nursing theory variables intervenes factors that are not likely to change, and over which health care providers have little control (Power,2016) References Chinn, P., & Kramer, M. (2018). Knowledge Development In Nursing (10th ed.). St. Louis, MO: Elsevier. Karnick, P. M. (2016). Evidence-Based Practice and Nursing Theory. Nursing Science Quarterly, 29(4), 283–284. https://doi.org/10.1177/0894318416661107 Power, L. (2016). Nursing theory and the delivery of compassionate care. Nursing Standard, 30(24), 41-46. Retrieved from http://gc2xt6vp5s.search.serialssolutions.com.ezproxy.wilkes.edu/ Images retrieved from google