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The case for nursing theory

Outline of content

This chapter covers the following: the case for theory; the argument that all intentional and rational actions, including nursing actions, by definition must have an underlying theory; an initial definition of theory; how theory and practice become integrated in nursing praxis.

Learning outcomes

At the end of this chapter you should be able to:

1. Understand what nursing theory is
2. Define theory
3. Understand the construction/development of a theory
4. Discuss the relationship between nursing theory and science
5. Evaluate the relationship between nursing theory and practice
6. Know the limitations of the nursing theory
7. Understand the importance of nursing theory for contemporary nursing

Introduction

Before nursing students and registered nurses recognise the content and function of theory, they often ask themselves question such as the following. What are nursing theories? Why study them? What has this got to do with nursing? How can something that is divorced from action, that is by definition abstract and conjectural, be of value to something like nursing, which is one of the most practical of activities?

This book will help to answer these questions. Theories exist everywhere in society. There are numerous theories of the family, of the internal combustion engine, of how cancer cells multiply, of changes in the weather. There are even lots of theories as to who killed President John F. Kennedy or Marilyn Monroe. The world is full of theories, some tested as accurate, some untested and some speculative. It is no surprise, then, that there are theories of nursing. But what do theories do? In essence, they are simply used to describe, explain or predict phenomena (see Reflective Exercise 1.1). This will be explored in detail later.

Reflective Exercise 1.1

Theory

Write down or discuss with other people two different theories for one of the following:

• the break-up of the Beatles
• the assassination of John F. Kennedy
• global warming
• newborn babies smiling when spoken to

Consider if there is the basis of truth in any of these theories.

Now, none of the theories that you outlined for any of the topics in Reflective Exercise 1.1 may be true. In fact, they may be erroneous or downright preposterous. The point is that we all use theories to explain what goes on in our lives or in the world. But if you wanted to, you could probably test or find out whether your theories are true. Later on in this chapter we will outline what theories are made of and how they are formed.

In many ways, theories are like maps. Maps are used to give us directions or to help us find our way in a complicated landscape or terrain. Maps often make simple what is a very complex picture. At their best, nursing theories also give us directions as to how to best care for patients. But why have we got so many nursing theories (over 50 at last count)? If you take any large city, there are many maps. For instance, in London, there are street maps, underground maps, electricity supply maps, Ordinance Survey maps and so on. Consider the London Underground map or the Moscow or Paris Metro maps – they are simple and easy to follow but they do not look anything like the complex reality of the underground networks they represent. In other words, they make a complex system understandable.

Similarly, nursing is highly complex and we need different theories to help us understand what is going on. A theory that can be used in emergency care may not be much use in mental health care, and a theory that can be used to help nurses in a busy surgical ward may be of little use in community care.

Nursing theories can provide frameworks for practice and in many clinical settings they have been used in the assessment of patients’ needs. For instance, in the UK one of the most popular nursing theories was designed by three nurses who worked at Edinburgh University – Nancy Roper, Winifred Logan and Alison Tierney. They based their theory on the work of an American nurse called Virginia Henderson. Her theory outlined how nurses should be focused on encouraging patients to be independent in certain activities of daily living (ADLs) such as sleeping, eating, mobilising etc. Roper et al. took this a step further by identifying 12 ADLs. They stressed that it was the nurses’ role to prevent people having problems with these ADLs. If this could not be achieved then nurses should help the patients to be independent in the ADLs. If this was not possible then nurses should give the patient and/or the patient’s family the knowledge and skills to cope with their dependence on the ADLs. Many clinical nurses used the ADL theory to assess patients. They simply see how independent the patient is for each ADL and then focus their care on those for which the patient is dependent.

Therefore, theory can help us to carry out an individual patient’s care and can contribute to better observation and recognition of specific patient needs, be they biological, social or psychological. Nursing theories are often derived from practice. In other words, nursing theorists have constructed their theories based on what they have experienced when working with patients and their families. Understanding the basic elements of a theory and its role, as well as taking a critical view of it, can help to develop a body of knowledge that nurses need for everyday work.

In this book we want to highlight the need for and use of nursing theory and its function. We will try to convince you of the importance of nursing theories to the nursing profession, to nursing education and especially to practice. This first chapter will introduce you to new words and ideas and it will take some concentration to understand the terminology. You may decide to read it in small doses, rather than all of it in one sitting. However, once you have mastered this first chapter, the rest of the book will be relatively easy to understand and, believe it or not, enjoyable. Several aspects of nursing theory are discussed in later chapters, and when reading those, dipping back into this first chapter will be helpful. Have a look at Reflective Exercise 1.2.

Reflective Exercise 1.2

Terminology

When you get involved in a new subject, you often have to learn new words to understand the topic. If you are a nursing student, you have had to learn many new anatomical or psychological words and phrases. Also, think of all the new words you would have to learn to take on any of the following hobbies:

• photography
• astronomy
• music
• gardening

See how many more you can think of. People accept learning new terms as part of understanding something in which they have an interest. The same is true in nursing theory.

The necessity and meaning of theory

Some people argue that in the real world of practice most nurses are not concerned with theories and that they are of interest only to nursing academics. However, our position is that there is no such thing as nursing without theory, because there is no such thing as atheoretical nursing. Nursing is theory in action and every nursing act finds its basis in some theory. For instance, if a nurse is talking to a patient, she may be using communication theory. At its simplest, a communication theory would include a speaker, a listener, a message and understanding between the speaker and the listener. Similarly, if she is putting a dressing on a patient, she may be using a theory of asepsis from the field of microbiology. Nurses may not always have a named theory in mind or they may even reject the notion that they are using a theory at all. Yet nurses do what they do for a reason and where there is a reason or purpose in mind, there is, more often than not, a theory.

When providing care to a patient, we are doing something in a purposeful manner. While doing it, we are seeking to understand, to uncover meaning, to determine how we should act on the basis of our understanding. This process describes theorising or theory construction. In this sense, theory is not some rarefied academic pursuit, but something that every nurse employs many times a day.

From the moment we start to think about something intentionally, we are constructing a theory. When we speak of construction, we are referring to how something is built or how the parts are put together to form a whole structure. Frequently we are referring to a building that has been constructed, such as a house or a bridge. When we bring thoughts together to form some understanding, we are also constructing. In this instance we are producing a mental building that has about it a sense of wholeness, which can be explained and shared with others through language.

This draws attention to another significant aspect of this process: when we think, we do so in language. A set of symbols that label the mental images are constructed, made up of our thoughts and the connections we make between them. In daily life too, people use different words and symbols to express meaning. In the same way, all theorists constructing their own theory use their own language and symbols to express and describe the theory. For example, an American nurse theorist, Jean Watson (1979), developed a theory that...