NURSING THEORIES &
MODELS
Professor Sue Frost
By the end of this session you
should:
• Be able to explain what is meant by a model
and a theory of nursing
• understand the main features of at least two
models of nursing
• understand how to critically review a model
• Identify how the application of models to
practice influences the activity of the nurse
and the experience for the patient or client
References………………….
• Models of nursing practice. McGee P.
Stanley Thornes 1998
• Conceptual bases of professional nursing.
Leddy S. Pepper J. Lippincott 4th ed.. 1998
• Foundations of nursing practice. Hogston R
& Simpson P. Macmillan 1999 (Ch 14)
Nature of theory:
“represent a scientist’s best effort
to describe and explain
phenomena”
Pollitt & Hungler 1997
Theory……
“…is a general statement that summarizes
and organizes knowledge by proposing a
general relationship between events - if it
is a good one it will cover a large number
of events and predict events that have not
yet occurred or been observed”
Robson C.
“an internally consistent group of relational
statements (concepts, definitions &
propositions) that present a systematic
view about phenomenon and that is useful
for description, explanation, prediction and
control. A theory ….is the primary means
of meeting the goals of the nursing
profession concerned with a clearly
defined body of knowledge”
Walker & Avant 1996 (cited by Jasper M in
Hogston & Simpson))
Purpose of theory
• Support the development of knowledge
through thesis and contestability
• Explains and predicts outcomes
• Supports decision making
• Embeds goals and outcomes for the client
and by implication for the nurse
• Supports modeling of processes of nursing
Classifying theories
• Meta-theory (Theory building - values etc)
• Grand theory (Broad conceptual frameworks
- not testable e.g. Leininger theory of
transcultural care)
• Middle range theory (Narrower and testable
e.g. Peplau)
• Practice Theory(situational theory - focuses
on the way in which nursing is practised e.g.
Norton’s theory of nursing elderly people))
Typology:
• Descriptive theory: Explains through
describing relationships and patterns within
the framework (e.g. Roper et al)
• Predictive Theories: Address the
consequences of interventions (e.g.
Noddings theory of care)
The medical model
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Bio-reductionist
Differential diagnosis: signs & symptoms
Provision of treatment
Scientific theory - testable and not
contestable
• Goals - cure and therapy
• Evaluation of treatment efficacy
Nursing models
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Located in social science
Constructed
Contestable knowledge
Capable of change and development
Embed values and culture
What sort of theories would you
use?
• Tony Archer (18 years) underwent surgery
to have a below knee amputation of his left
leg
• Peggy Mountford is 82 years old, lives
alone with no family and is becoming
increasingly confused and depressed
What sort of theories did you
identify?
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Physiology
Psychology
Sociological theory
Nursing theories
Descriptive theory
Predictive theory
Metaparadigm: constructs in all
nursing theories
• The person
• the environment
• health
• nursing
Commonly used models
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Roper, Logan & Tierney (ADL)
Peplau (interpersonal communication)
Orem (Self-Care)
Roy (adaptation model)
Wolfensberger (social role valorisation)
Carper (personal explanations)
Roper, Logan & Tierney
• Developmental model - emphasises growth
& development
• Person oriented
• Focus on change
• Sees process over time
• Sees a range of activities of daily living
changing with maturation
• Supporting and enabling
• Draws on Henderson’s work strongly
Callister Roy’s model
• Systems model - person is made up of
systems
• Systems interact with the environment
• Health is equilibrium and managed systems
• Nursing is supporting adaptation to
environment
• Is holist, purposeful and unifying
• Adaptive modes: physiologic, self concept,
role function, interdependence
• Health is a process of responding positively
Hildegarde Peplau
• Inter-actional model
• concerned with interpersonal relationships
• nursing is organised through building
relationships to support communication
• nurse must be able to use self
therapeutically
Dorothea Orem
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Nursing as part of a social care paradigm
supporting client to self care
caring as a part of moral consciousness
care as the core and essence of nursing
caring and community
collective responsibilities to support and
enable
Carpers model
• Four dimensions of nursing:
empirical dimension
personal dimension
ethical dimension
aesthetic dimension
Exercise
• What does the Roper et al model suggest
about the person, environment, health,
nursing?
• What might Roy say about the person? how may it be different?
Roper et al
• Person: A developing maturing individual
throughout the life span moving from
dependence to independence
• Health: meeting a range of needs - health
changes with many separate facets
• Environment: Anything external to the
person and is a framework of the activities
of living
• Nursing restoring or maintaining ADL
when person cannot cope independently
Roy’s model
Person: a biopsychosocial being with a
unified system
Health: equilibrium resulting from effective
coping
Environment internal and external systems
that impact on equilibrium
Nursing: Manipulating environment to
enable coping
exercise
• How is assessment likely to be undertaken
in Roper modeling?
• How might nursing be different in a model
based on interpersonal relationships? (e.g.
Peplau)
Criticising a model
• Models are constructions & conceptual
• They enable us to explore how the nature of
nursing is defined
• Models are not facts - they evolve and
emerge
• You do not “do” models - they inform your
thinking
• Models imply different nursing processes
Questioning models & theories
• What methodologies were used to develop?
(?draws on other/theories/research/evidence)
• How clear is it (overly complex jargon?)
• What does the theory say - what is the central
assertion- is it clear and coherent - is there
thesis?
• What type of theory is it? (e.g. a mid-range
theory that can be tested in practice)
• Can the theory be used
• Is this theory relevant to my area of practice
Can you…..
• explain what is meant by a model and a
theory of nursing
• understand the main features of at least two
models of nursing
• understand how to critically review a model
• Identify how the application of models to
practice influences the activity of the nurse
and the experience for the patient or client