Home work-3 ( Theory Presentation)

THEORETICAL BASIS

for Nursing

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THEORETICAL BASIS

for Nursing

Melanie McEwen, PhD, RN, CNE, ANEF Associate Professor University of Texas Health Science Center at Houston School of Nursing Houston, Texas

Evelyn M. Wills, PhD, RN Professor (Retired) Department of Nursing College of Nursing and Allied Health Professions University of Louisiana at Lafayette Lafayette, Louisiana

F O U R T H E D I T I O N

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Acquisitions Editor: Patrick Barbera Product Development Editor: Helen Kogut Editorial Assistant: Dan Reilly Production Project Manager: Cynthia Rudy Design Coordinator: Holly McLaughlin Illustration Coordinator: Jennifer Clements Manufacturing Coordinator: Karin Duffield Prepress Vendor: Absolute Service, Inc.

4th edition

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2002 Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and services).

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Library of Congress Cataloging-in-Publication Data McEwen, Melanie, author. Theoretical basis for nursing / Melanie McEwen, Evelyn M. Wills.—Edition 4.

p. ; cm. Includes bibliographical references and indexes. ISBN 978-1-4511-9031-1 I. Wills, Evelyn M., author. II. Title. [DNLM: 1. Nursing Theory. WY 86] RT84.5 610.73--dc23

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Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the author(s), editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations.

The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dos- age set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have U.S. Food and Drug Ad- ministration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his or her clinical practice.

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To Kaitlin and Grant—You have helped me broaden my thoughts and consider all kinds of possibilities; I hope I’ve done the same for you.

Also for Helen and Keith—Our children chose well. Besides, you have given us Madelyn, Logan, Brenna, Liam, Lucy, and Andrew; they are gifts beyond words.

Melanie McEwen

To Tom, Paul, and Vicki, who light up my life, and to Marian, who is my applause. To Teddy, Gwen, Merlyn, and Madelyn, who have been so patient and loving during this process. A thousand thank yous to Peggy, who has supported me through this writing process.

Evelyn M. Wills

D E D I C A T I O N

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Grace Bielkiewicz, RN, PMHCNS-BC Assistant Professor (Retired) Department of Nursing Southern University Baton Rouge, Louisiana Chapter 13: Theories From the Sociologic Sciences

Debra Brossett Garner, DNP, APRN, ACNS-BC, PMHNP-BC Psychiatric Mental Health Nurse Practitioner Delhi Rural Health Clinic Delhi, Louisiana Chapter 14: Theories From the Behavioral Sciences

Melinda Granger Oberleitner, DNS, RN Associate Dean, College of Nursing and Allied Health Professions Professor, Department of Nursing SLEMCO/BORSF Endowed Professor of Nursing University of Louisiana at Lafayette Lafayette, Louisiana Chapter 16: Theories, Models, and Frameworks From Administration and Management Chapter 20: Application of Theory in Nursing Administration and Management

C O N T R I B U T O R S

vi

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R E V I E W E R S

Kimamer Amer, PhD Associate Professor Department of Nursing DePaul University Chicago, Illinois

Margaret Barnes, MSN, RN Assistant Professor School of Nursing, RNBSN Post-Licensure Division Indiana Wesleyan University Florence, Kentucky

Shari Cherney, RN, BScN, MHSc Professor Department of Nursing George Brown College Toronto, Ontario, Canada

Cheryl Delgado, PhD Associate Professor Department of Nursing Cleveland State University Cleveland, Ohio

Dolores Furlong, PhD Professor Department of Nursing University of New Brunswick Fredericton, New Brunswick, Canada

Maryanne Garon, DNSc Professor Department of Nursing California State University Fullerton Fullerton, California

Carol Grantham, PhD, MSN, CPNP-PC Faculty Byrdine F. Lewis School of Nursing & Health

Professions Georgia State University Atlanta, Georgia

Barbara Harris, PhD Assistant Professor School of Nursing DePaul University Chicago, Illinois

Seongkum Heo, PhD Assistant Professor Department of Nursing University of Arkansas for Medical Sciences Little Rock, Arkansas

Donna Murnaghan, PhD Associate Professor School of Nursing University of Prince Edward Island Charlottetown, Prince Edward Island, Canada

Pamela Reis, PhD, CNM Assistant Professor Department of Nursing East Carolina University Greenville, North Carolina

Sue Robertson, PhD Assistant Professor Department of Nursing California State University, Fullerton Fullerton, California

Denice Sheehan, PhD Assistant Professor Department of Nursing Kent State University Kent, Ohio

Ida Slusher, DSN Professor & Nursing Education Coordinator Department of Baccalaureate & Graduate Nursing Eastern Kentucky University Richmond, Kentucky

Sharon Van Sell, BSN, MEd, MS, EdD Professor Department of Nursing Texas Woman’s University Dallas, Texas

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P R E F A C E

viii

Frequently, nursing students respond with a cringing expression or a resounding “ugh!” when faced with the requirement of taking a course on theory. Indeed, many fail to see theory’s relevance to the real world of nursing practice and often have difficulty applying the information in later courses and in their research. This book is the result of the frustration felt by a group of nursing instructors who met a num- ber of years ago to adopt a textbook for a theory course. Indeed, because of student complaints and faculty dissatisfaction, we were changing textbooks yet again. A fairly lengthy discussion arose in which we concluded that the available books did not meet the needs of our students or course faculty. Ultimately, we determined to “build a better mousetrap.” Our intent was to write a book that was a general overview of theory per se, stressing how it is—and should be—used by nurses to improve practice, research, education, and management/leadership.

As in past editions, an ongoing review of trends in nursing theory and nursing science has shown an increasing emphasis on middle range theory, evidence-based practice, and situation-specific theories. To remain current and timely, in this fourth edition, we have added a new chapter discussing evidence-based practice, highlighting how it relates to theory in nursing, and presenting several evidence-based practice models commonly used by nurses. We have also included new middle range nursing theories and added a significant section discussing situation-specific nursing theories, describing how they relate to evidence-based practice. Updates and application exam- ples have been added throughout the discussions on the various theories.

Organization of the Text

Theoretical Basis for Nursing is designed to be a basic nursing theory textbook that includes the essential information students need to understand and apply theory.

The book is divided into four units. Unit I, Introduction to Theory, provides the background needed to understand what theory is and how it is used in nursing. It outlines tools and techniques used to develop, analyze, and evaluate theory so that it can be used in nursing practice, research, administration and management, and education. In this unit, we have provided a balanced view of “hot” topics (e.g., philosophical world views and utilization of shared or borrowed theory). Also, rather than espousing one strategy for activities such as concept development and theory evaluation, we have included a variety of strategies.

Unit II, Nursing Theories, focuses largely on the grand nursing theories and begins with a chapter describing their historical development. This unit divides the grand nursing theories into three groups based on their focus (human needs, in- teractive process, and unitary process). The works of many of the grand theorists are briefly summarized in Chapters 7, 8, and 9. We acknowledge that these analyses

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Preface ix

are not comprehensive; rather, they are intended to provide the reader with enough information to understand the basis of the work and to whet the reader’s appetite to select one or more for further study.

Chapters 10 and 11 cover the significant topic of middle range nursing theory. Chapter 10 presents a detailed overview of the origins and growth of middle range theory in nursing and gives numerous examples of how middle range theories have been developed by nurses. Chapter 11 provides an overview of some of the grow- ing number of middle range nursing theories. The theories presented include some of the most commonly used middle range nursing theories (e.g., Pender’s Health Promotion Model and Leininger’s Culture Care Diversity and Universality Theory) as well as some that are less well known but have a growing body of research sup- port (e.g., Meleis’ Transitions Theory, the Theory of Unpleasant Symptoms, and the Uncertainty in Illness Theory). The intent is to provide a broad range of middle range theories to familiarize the reader with examples and to encourage them to search for others appropriate to their practice or research. Ultimately, it is hoped that readers will be challenged to develop new theories that can be used by nurses.

Chapter 12, which discusses evidence-based practice (EBP), is new to this edi- tion. This chapter explains and defines the idea/process of EBP and describes how it relates to nursing theory and application of theory in nursing practice and research. The chapter concludes with a short presentation and review of five different EBP models that have been widely used by nurses and are well supported in the literature.

Unit III, Shared Theories Used by Nurses, is rather unique in nursing litera- ture. Our book acknowledges that “shared” or “borrowed” theories are essential to nursing and negates the idea that the use of shared theory in practice or research is detrimental. In this unit, we have identified some of the most significant theories that have been developed outside of the discipline of nursing but are continually used in nursing. We have organized these theories based on broad disciplines: theories from the sociologic sciences, behavioral sciences, and biomedical sciences, as well as from administration and management and learning. Each of these chapters was written by a nurse with both educational and practical experience in her respective area. These theories are presented with sufficient information to allow the reader to understand the theories and to recognize those that might be appropriate for her or his own work. These chapters also provide original references and give examples of how the concepts, theories, and models described have been used by other nurses.

Finally, Unit IV, Application of Theory in Nursing Practice, explains how the- ories are applied in nursing. Separate chapters cover nursing practice, nursing research, nursing administration and management, and nursing education. These chapters in- clude many specific examples for the application of theory and are intended to be a practical guide for theory use. The heightened development of practice theories and EBP guidelines are critical to theory application in nursing today, so these areas have been expanded. The unit concludes with a chapter that discusses some of the future issues in theory within the discipline.

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x Preface

■ New Chapter 12, Evidence-Based Practice and Nursing Theory ■ More detailed explanation of EBP and its relationship to theory in nursing ■ Enhanced attention to situation-specific theories and how they relate to EBP ■ Numerous recent examples of application of theories in nursing practice,

nursing research, leadership/administration, and education ■ NEW instructional support

New To This Edition

Student Resources Available on

■ Literature Assessment Activity provides an interactive tool featuring journal articles along with questions that will encourage students to think critically about the literature. Students can print or e-mail their responses to their instructor.

■ Case Studies with applicable questions guide students in understanding how the various theories link to nursing practice.

■ Learning Objectives for each chapter help focus the student. ■ Internet Resources provide live web links to pertinent sites so that students

can further their study and understanding of the various theories. ■ Journal Articles for each chapter offer opportunities to gain more knowledge

and understanding of the chapter content.

Key Features In addition to numerous tables and boxes that highlight and summarize important information, Theoretical Basis for Nursing contains case studies, learning activities, exemplars, and illustrations that help students visualize various concepts. New to this edition is a special feature called Link to Practice.

■ Link to Practice: All chapters include at least one “Link to Practice” box, which presents useful information or clinically related examples related to the subject being discussed. The intent is to give additional tools or resources that can be used by nurses to apply the content in their own practice or research.

■ Case Studies: At the end of Chapter 1 and the beginning of Chapters 2 to 22, case studies help the reader understand how the content in the chapter relates to the everyday experience of the nurse, whether in practice, research, or other aspects of nursing.

■ Learning Activities: At the end of each chapter, learning activities pose critical thinking questions, propose individual and group projects related to topics covered in the chapter, and stimulate classroom discussion.

■ Exemplars: In five chapters, an exemplar discusses a scholarly study from the perspectives of concept analysis (Chapter 3); theory development (Chapter 4); theory analysis and evaluation (Chapter 5); middle range theory develop- ment (Chapter 10); and theory generation via research, theory testing via research, and use of a theory as the conceptual framework for a research study (Chapter 19).

■ Illustrations: Diagrams and models are included throughout the book to help the reader better understand the many different theories presented.

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Preface xi

Instructor Resources Available on ■ Instructor’s Guide includes application-level discussion questions and classroom/

online activities that Melanie McEwen uses in her own teaching! ■ Strategies for Effective Teaching of Nursing Theory provide ideas for

instructors to help make the nursing theory class come alive. ■ Test Generator Questions provide multiple-choice questions that can be used

for testing general content knowledge. ■ PowerPoints with audience response (Iclicker) questions, based on

the ones used by Melanie McEwen in her own classroom, help highlight important points to enhance the classroom, experience.

■ Case Studies with questions, answers, and related activities offer opportunities for instructors to make the student case studies an exciting, fun, and rewarding classroom/online experience.

■ Image Bank provides images from the text that instructors can use to enhance their own presentations.

In summary, the focus of this learning package is on the application of theory rather than on the study, analysis, and critique of grand theorists or a presentation of a specific aspect of theory (e.g., construction or evaluation). It is hoped that practic- ing nurses, nurse researchers, and nursing scholars, as well as graduate students and theory instructors, will use this book and its accompanying resources to gain a better understanding and appreciation of theory.

Melanie McEwen, PhD, RN, CNE, ANEF Evelyn M. Wills, PhD, RN

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xii

A C K N O W L E D G M E N T S

Our heartfelt thanks to Product Development Editor, Helen Kogut, for her assis- tance, patience, and persistence in helping us complete this project. She has made a difficult task seem easy! We also want to thank Acquisitions Editor, Christina Burns, for her wonderful support and assistance in getting this project started and Patrick Barbera for seeing it through to the end. Finally, a huge word of thanks to our con- tributors who have diligently worked to present the notion of theory in a manner that will engage nursing students and to look for new examples and applications to help make theory fresh and relevant.

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C O N T E N T S

Unit I: Introduction to Theory 1 1. Philosophy, Science, and Nursing 2

Melanie McEwen Nursing as a Profession 2 Nursing as an Academic Discipline 4 Introduction to Science and Philosophy 5 Science and Philosophical Schools of Thought 7 Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing 11 Knowledge Development and Nursing Science 12 Research Methodology and Nursing Science 16

2. Overview of Theory in Nursing 23 Melanie McEwen

Overview of Theory 24 The Importance of Theory in Nursing 25 Terminology of Theory 26 Historical Overview: Theory Development in Nursing 26 Classification of Theories in Nursing 36 Issues in Theory Development in Nursing 40

3. Concept Development: Clarifying Meaning of Terms 49 Evelyn M. Wills, Melanie McEwen

The Concept of “Concept” 50 Concept Analysis/Concept Development 54 Strategies for Concept Analysis and Concept Development 57

4. Theory Development: Structuring Conceptual Relationships in Nursing 72

Melanie McEwen Overview of Theory Development 73 Categorizations of Theory 73 Components of a Theory 79 Theory Development 82

5. Theory Analysis and Evaluation 95 Melanie McEwen

Definition and Purpose of Theory Evaluation 96 Historical Overview of Theory Analysis and Evaluation 97 Comparisons of Methods 106 Synthesized Method of Theory Evaluation 106

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xiv Contents

6. Overview of Grand Nursing Theories 116 Evelyn M. Wills

Categorization of Conceptual Frameworks and Grand Theories 118 Specific Categories of Models and Theories for This Unit 124 Analysis Criteria for Grand Nursing Theories 124 The Purpose of Critiquing Theories 127

7. Grand Nursing Theories Based on Human Needs 131 Evelyn M. Wills

Florence Nightingale: Nursing: What It Is and What It Is Not 132 Virginia Henderson: The Principles and Practice of Nursing 136 Faye G. Abdellah: Patient-Centered Approaches to Nursing 139 Dorothea E. Orem: The Self-Care Deficit Nursing Theory 142 Dorothy Johnson: The Behavioral System Model 146 Betty Neuman: The Neuman Systems Model 149

8. Grand Nursing Theories Based on Interactive Process 159 Evelyn M. Wills

Myra Estrin Levine: The Conservation Model 160 Barbara M. Artinian: The Intersystem Model 164

Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain: Modeling and Role-Modeling 169

Imogene M. King: King’s Conceptual System and Theory of Goal Attainment and Transactional Process 173

Sister Callista Roy: The Roy Adaptation Model 177 Jean Watson: Caring Science as Sacred Science 182

9. Grand Nursing Theories Based on Unitary Process 192 Evelyn M. Wills

Martha Rogers: The Science of Unitary and Irreducible Human Beings 193 Margaret Newman: Health as Expanding Consciousness 198 Rosemarie Parse: The Humanbecoming Paradigm 202

10. Introduction to Middle Range Nursing Theories 213 Melanie McEwen

Purposes of Middle Range Theory 214 Characteristics of Middle Range Theory 215 Concepts and Relationships for Middle Range Theory 216 Categorizing Middle Range Theory 217 Development of Middle Range Theory 217 Analysis and Evaluation of Middle Range Theory 225

11. Overview of Selected Middle Range Nursing Theories 229 Melanie McEwen

High Middle Range Theories 230 Middle Middle Range Theories 241 Low Middle Range Theories 248

12. Evidence-Based Practice and Nursing Theory 258 Evelyn M. Wills, Melanie McEwen

Overview of Evidence-Based Practice 259 Definition and Characteristics of Evidence-Based Practice 259 Concerns Related to Evidence-Based Practice in Nursing 261 Evidence-Based Practice and Practice-Based Evidence 261

Unit II: Nursing Theories 115

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Contents xv

Promotion of Evidence-Based Practice in Nursing 263 Theory and Evidence-Based Practice 263 Theoretical Models of EBP 264

Unit III: Shared Theories Used by Nurses 277 13. Theories From the Sociologic Sciences 278

Grace Bielkiewicz Exchange Theories 279 Interactionist Frameworks 284 Conflict Theories 289 Chaos Theory 295 Postmodern Social Theory 298

14. Theories From the Behavioral Sciences 305 Debra Brossett Garner

Psychodynamic Theories 306 Behavioral and Cognitive-Behavioral Theories 313 Humanistic Theories 315 Stress Theories 318 Social Psychology 321

15. Theories From the Biomedical Sciences 331 Melanie McEwen

Theories and Models of Disease Causation 332 Theories and Principles Related to Physiology and Physical Functioning 339

16. Theories, Models, and Frameworks From Leadership and Management 354

Melinda Granger Oberleitner Overview of Concepts of Leadership and Management 355 Early Leadership Theories 355 Contemporary Leadership Theories 362 Organizational/Management Theories 365 Motivational Theories 366 Concepts of Power, Empowerment, and Change 368 Problem-Solving and Decision-Making Processes 372 Conflict Management 374 Quality Improvement 375 Evidence-Based Practice 380

17. Learning Theories 386 Evelyn M. Wills, Melanie McEwen

What Is Learning? 387 What Is Teaching? 388 Categorization of Learning Theories 388 Behavioral Learning Theories 389 Cognitive Learning Theories 392 Summary of Learning Theories 404 Learning Styles 405 Principles of Learning 406 Application of Learning Theories in Nursing 407

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xvi Contents

Unit IV: Application of Theory in Nursing 411 18. Application of Theory in Nursing Practice 412

Melanie McEwen Relationship Between Theory and Practice 413 Theory-Based Nursing Practice 414 The Theory–Practice Gap 416 Situation-Specific/Practice Theories in Nursing 418 Application of Theory in Nursing Practice 422

19. Application of Theory in Nursing Research 430 Melanie McEwen

Historical Overview of Research and Theory in Nursing 431 Relationship Between Research and Theory 432 Types of Theory and Corresponding Research 434 How Theory Is Used in Research 437 Nursing and Non-Nursing Theories in Nursing Research 444 Other Issues in Nursing Theory and Nursing Research 445

20. Application of Theory in Nursing Administration and Management 452

Melinda Granger Oberleitner Organizational Design 453 Shared Governance 456 Transformational Leadership in Nursing and in Health Care 458 Patient Care Delivery Models 459 Case Management 466 Disease/Chronic Illness Management 468 Quality Management 470

21. Application of Theory in Nursing Education 479 Evelyn M. Wills, Melanie McEwen

Theoretical Issues in Nursing Curricula 481 Theoretical Issues in Nursing Instruction 488

22. Future Issues in Nursing Theory 497 Melanie McEwen

Future Issues in Nursing Science 499 Future Issues in Nursing Theory 500

Theoretical Perspectives on Future Issues in Nursing Practice, Research, Administration and Management, and Education 502

Glossary 513 Author Index 523 Subject Index 554

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U N I T I

Introduction to Theory

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Philosophy, Science, and Nursing Melanie McEwen

C H A P T E R 1

2

Largely due to the work of nursing scientists, nursing theorists, and nursing scholars over the past five decades, nursing has been recognized as both an emerging profession and an academic discipline. Crucial to the attainment of this distinction have been numerous discussions regarding the phenomena of concern to nurses and countless efforts to enhance involvement in theory utilization, theory generation, and theory testing to direct research and improve practice.

A review of the nursing literature from the late 1970s until the present shows sporadic discussion of whether nursing is a profession, a science, or an academic discipline. These discussions are sometimes pleading, frequently esoteric, and occasionally confusing. Questions that have been raised include: What defines a profession? What constitutes an academic discipline? What is nursing science? Why is it important for nursing to be seen as a profession or an academic discipline?

Nursing as a Profession

In the past, there has been considerable discussion about whether nursing is a profes- sion or an occupation. This is important for nurses to consider for several reasons. An occupation is a job or a career, whereas a profession is a learned vocation or occupa- tion that has a status of superiority and precedence within a division of work. In gen- eral terms, occupations require widely varying levels of training or education, varying levels of skill, and widely variable defined knowledge bases. In short, all professions are occupations, but not all occupations are professions (Finkelman & Kenner, 2013).

Professions are valued by society because the services professionals provide are ben- eficial for members of the society. Characteristics of a profession include (1) defined and specialized knowledge base, (2) control and authority over training and education, (3) credentialing system or registration to ensure competence, (4) altruistic service to society, (5) a code of ethics, (6) formal training within institutions of higher education, (7) lengthy socialization to the profession, and (8) autonomy (control of professional activities) (Ellis & Hartley, 2012; Finkelman & Kenner, 2013; Rutty, 1998). Professions

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Chapter 1 Philosophy, Science, and Nursing 3

must have a group of scholars, investigators, or researchers who work to continually ad- vance the knowledge of the profession with the goal of improving practice (Schlotfeldt, 1989). Finally, professionals are responsible and accountable to the public for their work (Hood, 2010). Traditionally, professions have included the clergy, law, and medicine.

Until near the end of the 20th century, nursing was viewed as an occupation rather than a profession. Nursing has had difficulty being deemed a profession because many of the services provided by nurses have been perceived as an extension of those offered by wives and mothers. Additionally, historically, nursing has been seen as sub- servient to medicine, and nurses have delayed in identifying and organizing profes- sional knowledge. Furthermore, education for …