CHAPTER 1
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; and how theory and practice become integrated into 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 nursing theory
7. Understand the importance of nursing theory for contemporary nursing

Introduction

In the realm of nursing, understanding and defining the construction and function, as well as limitations, of nursing theory is crucial for both education and practice. Before nursing students and registered nurses recognise the content and function of theory, they often ask themselves questions such as the following. What are nursing theories? Why study them? What has this got to do with nursing? How can something so theoretical and abstract be valuable to a practical field like nursing? Nursing theories provide a structured framework that guides clinical decision-making, patient care and educational curriculums. Theory presents a description of the practice of nursing in mental images. However, recognising the limitations of these theories is essential to adapt and apply them effectively in diverse healthcare settings.

This book will help to answer these questions. Theories exist everywhere in society. There are numerous theories of the family, of the spread of fake news on social media, of how electric vehicles impact the environment, of how cancer cells multiply, of potential effects of artificial intelligence on the job market and of theories about climate change. And perhaps what you, as a student, are familiar with, because you encounter and experience the educational process on a daily basis, are theories about education. 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:

• origins of the COVID-19 outbreak
• the rise of TikTok as a social media phenomenon
• climate change
• newborn babies smiling when spoken to

Consider if there is a 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, instructions and information on how to design integrated care as to how to best care for patients or give us a broad picture of nursing care. But why have we got so many nursing theories? 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 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 can be 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 of 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. In addition, the different theories attempt to highlight different phenomena that occur in practice and thus emphasise approaches to patient care such as equal partner-like relationships, caring, adaptation or self-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, one of the most popular nursing theories in the United Kingdom 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 and mobilising. Roper et al. (1983) took this a step further by identifying 12 ADLs. They stressed that the nurses' role was to prevent people from having problems with these ADLs. If this could not be achieved, nurses should help the patients 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 use 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 observations and recognition of specific patient needs, be they physical, psychosocial, emotional or spiritual. 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, and by observing and describing phenomena in practice. Understanding the basic elements of a theory and its role and taking a critical view of it can help develop a body of knowledge that nurses need for everyday practice, education and research.

In this book, we want to highlight the need for and use of nursing theory and its function. This first chapter will introduce you to new words and ideas. You can read it in short bursts instead of tackling it all in one go. 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 and intellectually engaging. 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:

• streaming
• gaming
• music
• fitness/wellness

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

While it is true that some may argue that theories in nursing are only of concern to nursing academics and not always applicable in the practical world, we firmly stand by a different perspective. We believe 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. Thus, the theory is not abstract and reserved for academics but an integral part of the very essence of nursing. For instance, if a nurse is talking to a patient, they 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 the nurse is putting a dressing on a patient, they may be using a theory of asepsis from the field of microbiology. Nurses might not always think about these theories by name or even say they are not using them. But behind what they do, there is usually a purpose or a reason, which often links back to a theory. Fawcett (2022) explained that theories are typically thought of as formulations that are not relevant for practice, which is the source of the so-called theory-practice gap.

When providing care to a patient, we are doing something in a purposeful manner - every action we take has a purpose. While doing it, we seek to understand, uncover meaning and determine how we should act based on our understanding. This process is essentially what we mean by 'theorising' or 'theory...