Theoretical Foundations of Nursing
Definitions & Key takeaways
The field of nursing is guided by its own body of knowledge which can be divided into categories based on the level of abstraction. The most abstract is the nursing metaparadigm which includes the concepts of person, nursing, health and environment. Next, there are philosophies which are beliefs based on certain values. The more concrete categories are conceptual models and theories. Both focus on specific concepts and how they are related but theories often have testable and observable outcomes, which makes it more concrete.
The field of nursing has a unique professional culture, with particular ways of doing things and thinking about things. Broadly speaking, these ideas can be described as a Nursing knowledge, and it guides the day to day responsibilities of nurses and distinguishes nurses from other health care providers like physicians, pharmacists, and therapists.
Now this body of knowledge can be organized into categories. Going from abstract to concrete, the four categories are: a metaparadigm, philosophies, conceptual models or frameworks, and the last category is theories.
Nursing metaparadigmLet’s start by looking at the most abstract category which is the nursing metaparadigm. The metaparadigm consists of four fundamental concepts that define the nursing discipline and together they form the foundation for the field.
The four concepts are: person, nursing, health, and environment. Let’s go through them one by one.
Person refers to the recipient of nursing care. It could be an individual, a family, or a community.
It could also refer to a group of people that require a specific type of health care, for example, premature infants or people on dialysis.
Nursing refers to the care the person receives from the nurse. For example, administering a medication, taking a person’s blood pressure, or even health education.
Health refers to a person’s overall level of wellness, and not simply the absence of disease. It incorporates the physical, psychosocial, and spiritual aspects of a person’s life.
It also includes the person’s view of their own health and their health-related behaviors such as diet, level of activity, and habits like smoking.
Finally, environment refers to the context in which nursing care is provided. It could mean the physical location that the care is given, like an operating room or the patient’s home, but it also includes factors like a person’s socioeconomic situation.Now, it’s important for nurses to consider all four concepts simultaneously.
The nurse also need to consider how the person views their own health and if they are likely to adhere to the treatment plan.PhilosophyThe next category is philosophy.
This one is slightly more concrete than the metaparadigm. A philosophy is a set of beliefs that emerge from values shared by members of a nursing community.
These can help explain how processes work and guide clinical practices. For example, Florence Nightingale, who is considered to be the founder of modern nursing, valued improving the overall health of the patient rather than simply treating their illnesses.
She believed that the relationship between the patient and their environment is a vital aspect of health care, and that this explained why patients in a clean, and restful environment recovered faster.
She applied this philosophy while caring for patients during the Crimean War by making sure patients had clean and comfortable rooms, as well as balanced healthy diets, and even encouraged visits from small pets!
In fact, her philosophy became so popular that it helped shift modern healthcare towards a much more holistic view. Conceptual ModelThe next category is a conceptual model, or conceptual framework, which are even more concrete.
Concepts are concise ways of describing or generalizing complex phenomena. For example, in the metaparadigm section, we went over the concept of “environment” and how it could include a person’s home, the hospital, or their socioeconomic situation.
A conceptual model is a way of creating a comprehensive view by organizing multiple related concepts and showing the relationship between them.For example, let’s explore one conceptual model called the Roy’s adaptation model.
In brief, it ties together five main concepts: nursing intervention, environmental stimuli, adaptation, coping, and health.
To explore it, let’s assume a person develops an infection. According to the Roy’s adaptation model the infection indicates a change in the environmental stimuli, and in response the person copes by developing a fever as a way to adapt to these changes.
This adaptation influences their health, meaning they might be better off in this case because the fever helps them mount an effective response to the infection.
In this context, nursing interventions like giving antibiotics, can influence the adaptation, which in turn affect the person’s health.
TheoryOkay, the next category is theories, and these are more concrete than conceptual models. Now, both conceptual models and theories try to explain how concepts are interrelated and this can make the boundary between the two a bit fuzzy.
But what makes theories more concrete is that they often propose specific and testable outcomes that can be applied to practice or research.
Theories are broadly categorized based on the scope of what they try to explain. Grand theories focus on the broad ideas that are applicable to all aspects of nursing, and are used to guide the mission and goals of the profession.
For example, Peplau’s Theory of Interpersonal Relations in Nursing states that the foundation of nursing care is the nurse-patient relationship.
Middle-range theories are narrower in scope, less abstract, and less complex than grand theories. They usually explain or describe a specific phenomenon.
For example, Mischel’s Uncertainty in Illness theory is a middle-range theory that focuses on the uncertainty that’s caused by an illness and how it interferes with adaptation, leading to a worse outcome in terms of physical health and quality of life.
Finally, practice theories are concrete and situation-specific and they are used to guide specific nursing interventions.
An example is the Nelson Breastfeeding theory, which recommends that when educating a new mother about breast-feeding, the nurse should be respectful of the mother’s right to decide, and carefully consider how to promote breastfeeding without causing conflict.
The outcome is a more positive breastfeeding experience for the mother and infant. In order for a theory to be valid, it must be supported by evidence.
The evidence can be gathered with assessment tools or procedures that provide quantitative or qualitative data. So for example, with the Nelson’s breast feeding theory, it could be assessed and validated by evidence from a survey on the mother’s satisfaction with the breastfeeding experience.
In addition to nursing-specific theories, some theories are also incorporated from other disciplines, and these are called borrowed theories.
As an example, pediatric nurses can apply the Attachment Theory from psychology to promote bonding between the mother and her infant through skin-to-skin contact.
##SummaryAlright as a recap, the field of nursing is guided by its own body of knowledge which can be divided into categories based on the level of abstraction.
The most abstract is the nursing metaparadigm which includes the concepts of person, nursing, health and environment. Next, there are philosophies which are beliefs based on certain values.
The more concrete categories are conceptual models and theories. Both focus on specific concepts and how they are related but theories often have testable and observable outcomes,
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