A concise, accessible introduction to the development, application and evaluation of nursing theories, this new edition of Fundamentals of Nursing Models, Theories & Practice provides a thorough overview of the body of knowledge on the topic, and a clear outline of their relevance to everyday nursing practice. Linking the development of theory to practice, this full-updated text features learning outcomes, key concept summaries and reflective exercises to aid the study of this key element of all modern nursing courses. Special Features * Clearly examines the relationship between nursing theory, clinical practice and nursing roles * Accessible and user-friendly with a range of features to help study, including key concepts, learning objectives and reflective exercises * Useful for all pre-registration nursing students, as well as newly qualified nurses * Accompanied by an online resource centre featuring case studies, multiple choice questions, exercises and activities
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1 The case for nursing theory
The necessity and meaning of theory
Construction of theory
Theory and science of nursing
Other interpretations of theory
Main paradigms and philosophies and their influence on the development of nursing science
Theory and practice of nursing
Do we really need theory?
Nursing theories today
2 Knowing in nursing and nursing knowledge
Defining knowing and knowledge
Philosophies of knowledge
How do nurses know?
Developing nursing knowledge
3 Theory from practice and practice from theory
First steps – reflecting on theory
The questions begged
Developing nursing theory
Levels of theory
The relationship between theory and practice
The questions begged – some answers
4 Nursing theories and new nursing roles
Background to the development of new roles in nursing
Some implications of the new nursing roles
Using theory to understand new roles in nursing
Useful web links
5 Nursing theories or nursing models
Reasons for historical nursing theory evolution
Theory or model?
The classification of theories
Current trends in nursing theories
The nursing metaparadigm
Limitations of nursing theories
Benefits of nursing theories
6 Interpersonal relationships
Types of interpersonal relationships
Interpersonal theories of nursing
Implications for nurse education
Threats to the development of interpersonal relationships in nursing and the use of interpersonal theories
Useful web links
7 How to select a suitable model or theory
Selecting an appropriate nursing theory
Potential problems when selecting a nursing theory
Choosing a suitable nursing theory
Nurses’ own philosophy as a basis for selecting a theory
A strategy for choice
Who should select the theory?
Nursing theories or theories developed by another discipline?
Useful web links
8 Research and theory
Building theory through research: an inductive approach
Is the link between theory and research strong?
Research in nursing
Theory-generating research (TGR)
Theory-testing research (TTR)
Theory-framed research (TFR)
Theory-evaluating research (TER)
Strategies for theory development through research
Useful web links
9 Criteria for theory description, analysis and evaluation
The evaluator of a nursing theory
Significance of the theory
Step 1: Theory description
Origins and logical development of a theory
Step 2: Theory analysis
Internal and external criteria
Step 3: Theory evaluation
Simplicity and complexity
Importance and significance
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Table 2.1 Philosophies of knowledge.
Table 2.2 Types of knowledge.
Table 2.3 Human science: the received view versus the perceived view.
Table 5.1 Perceived benefits of theories for practice.
Table 5.2 Perceived limitations of theories for practice.
Table 6.1 How interpersonal theories define nursing and denote the focus, goals and interventions of nursing.
Table 6.2 Phases and roles within Peplau’s theory.
Table 8.1 Types of propositional statements developed through theory-generating research.
Table 8.2 The relationship between levels of theory and levels of research.
Table 8.3 Relationships between types of theory and research methods.
Table 8.4 Carper’s ways of knowing as related to research approach.
Table 8.5 Developing concepts.
Table 9.1 Concept analysis.
Table 9.2 Analysis and evaluation of theories by various authors.
Table 9.3 Theory evaluation.
Figure 1.1 The links between theory and practice.
Figure 1.2 Theory as construction.
Figure 1.3 Nightingale theory of nursing.
Figure 1.4 Correlation: education, science and practice.
Figure 1.5 Basic structure of nursing. Reproduced from Pajnkihar M (2003) Theory development for nursing in Slovenia.
. Manchester: University of Manchester, Faculty of Medicine, Dentistry, Nursing and Pharmacy.
Figure 2.1 ‘Know that', 'know how' and 'know why' knowledge.
Figure 2.2 Patterns of knowing in nursing (Carper 1978).
Figure 2.3 Ways of knowing (Kerlinger 1986).
Figure 2.4 Hierarchy of evidence (Muir Gray 1997).
Figure 2.5 A proposed new hierarchy of evidence.
Figure 2.6 Developing nursing knowledge.
Figure 3.1 Categorisations of theory.
Figure 3.2 Levels of theory (Dickoff & James 1968).
Figure 3.3 The utility of theory in nursing.
Figure 3.4 Levels of theory.
Figure 3.5 Levels of theory-abstraction.
Figure 3.6 Classification and examples of ‘grand’ theories (Meleis 2012).
Figure 3.7 Examples of mid-range theories.
Figure 3.8 Propositional theory: from conception to application.
Figure 3.9 The theory–practice relationship.
Figure 3.10 The thing observed.
Figure 4.1 The ‘practice cross’.
Figure 4.2 Development of advanced nursing roles (Pulcini et al. 2010).
Figure 4.3 Role sets.
Figure 4.4 Classification and examples of nursing ‘grand’ theories (Meleis 2012).
Figure 5.1 The theory–model controversy: position A.
Figure 5.2 The theory–model controversy: position B.
Figure 8.1 Examples of propositional diagramming.
Figure 8.2 A typical theory testing process.
Figure 9.1 Theory description, analysis and evaluation.
Figure 9.2 Difference between inductive and deductive development of theory.
Figure 9.3 Testing theory.
Table of Contents
Review of the first edition: “Interesting and readable . . . the most important book any healthcare professional or healthcare student can own.” (Amazon reviewer)
“A purchase that you will not regret . . . As introductory texts go, this is about as good as they get.” (Amazon reviewer)
Review of the 1st edition: “This is a really useful text. Health promotion, an essential aspect of the nurse’s role, has not previously been given sufficient prominence. The chapters are written by notable authors and despite their diversity, there is continuity to it, giving it an overall coherence and sense of whole. This is a thoroughly useful text.” (Nursing Times)
“An exceptional book looking at the anatomy and physiology of the human body which would be an invaluable addition to any nursing students’ studies . . . It was a pleasure to read and will be a valuable resource for my studies.” (1st year student nurse, Glyndwr University)
This title is also available as an e-book. For more details, please seewww.wiley.com/buy/9780470657768or scan this QR code:
Hugh P. McKenna
CBE, PhD, BSc(Hons), RMN, RGN, RNT, DipN(Lond), AdvDipEd, FFN FRCSI FEANS, FRCN, FAANProfessor and Pro Vice Chancellor, Research and InnovationUniversity of Ulster, UK
PhD, RNAssociate Professor, Dean, Senior Research Fellow, Head of Institute of Nursing CareFaculty of Health SciencesUniversity of Maribor, Slovenia
Fiona A. Murphy
PhD, MSc, BN, RGN, NDN, RCNT, PGCE(FE)Associate ProfessorCollege of Human and Health SciencesSwansea University, UK
This edition first published 2014 © John Wiley & Sons, Ltd
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Library of Congress Cataloging-in-Publication Data
McKenna, Hugh P., 1954– author.Fundamentals of nursing models, theories and practice / Hugh P. McKenna, Majda Pajnkihar, Fiona A. Murphy. p. ; cm. Includes bibliographical references and index.
ISBN 978-0-470-65776-8 (paperback)I. Pankhihar, Majda, author. II. Murphy, Fiona, author. III. Title. [DNLM: 1. Nursing Theory. 2. Models, Nursing. 3. Nursing Process. WY 86] RT84.5 610.7301–dc23
A catalogue record for this book is available from the British Library.
Cover image: Reproduced from iStock © kertlisCover design by Visual Philosophy
Wiley’s Fundamentals series are a wide-ranging selection of textbooks written to support preregistration nursing and other healthcare students throughout their course. Packed full of useful features such as learning objectives, activities to test knowledge and understanding, and clinical scenarios, the titles are also highly illustrated and fully supported by interactive MCQs, and each one includes access to a Wiley E-Text: powered by VitalSource – an interactive digital version of the book including downloadable text and images and highlighting and note-taking facilities. Accessible on your laptop, mobile phone or tablet device, the Fundamentals series is the most flexible, supportive textbook series available for nursing and healthcare students today.
This book is dedicated to all the patients, families and communities with whom we have worked over the years. It is also dedicated to those scholars and students who have shaped our thinking on nursing theories.
In addition, we wish to acknowledge the patience and fortitude of our friends and families, specifically Tricia, Gowain and Saoirse McKenna, Grega and Jasna Pajnkihar, Boris Kac and Phil, Katie and Kieran Murphy. M.P. would also like to thank Dr Verena Tcshudin and Dominika Jakl for their help.
Hugh P. McKennaMajda PajnkiharFiona A. Murphy
The stimulus for this second edition was the very positive feedback we received for the first edition from nursing students, nurse lecturers and clinical nurses. It helped that the publishers were extremely keen on an updated version being produced. Initially, there was some reluctance on our part because we felt that the first book had dealt with the subject matter very thoroughly. However, on reflection we realised that in the intervening years there had been a growth in discussion and debate about nursing theory. A preface to a later edition of a book should set out to explain in what respects that edition differs from the previous one. There are a number of differences. Fiona Murphy and Majda Pajnkihar have joined the team and they bring with them new insights into how theory can inform nursing practice and research and how this, in turn, improves the quality and safety of patient care. The literature has been updated considerably and we have taken account of developments outside the USA and the UK. In particular, Majda provides information on how nursing theories are being taught and used in Slovenia, Croatia, Russia and Poland. Readers will also find that we have included more exercises. These include key concept boxes, reflective exercises, multiple choice questions, true/false questions, additional reading sources and a number of case studies.
Therefore, for these reasons and many others, we believe that this new edition is a considerable improvement on the previous book. It still takes the reader on a journey, from presenting the case for the use of theory in nursing practice through to considering the extent to which practice influences the development of theory, the definitions of theory and the different types of theory. We illustrate for readers the fact that theory is linked to science and why this is important for the profession of nursing. We spend a considerable amount of time outlining the different ways in which nurses know and the role of research and reasoning in building nursing knowledge.
One of the main movements for the profession worldwide is the emergence of new nursing roles. We show how such roles are linked to theories and we highlight the importance of ‘role theory’. We describe how grand nursing theories have evolved and the importance of mid-range and practice theories for guiding patient care. We unravel the often controversial relationship between nursing theories and nursing models, and examine these terms in detail and compare and contrast them, taking into account their advantages and disadvantages. We show how the biomedical model has influenced nurse education, practice and research over the years, and not always for the benefit of nursing.
We make a case for nursing being mainly about building and sustaining interpersonal relationships with patients, their families and communities. Several nursing theories have their roots in such relationships. We share a number of these with the readers, explaining Hildegard Peplau’s theory in considerable detail. We consider the differences between a normal interpersonal relationship and a therapeutic interpersonal relationship, stressing that practising nurses use both. We also outline the actual and potential barriers to the development of therapeutic interpersonal relationships.
Selecting an unsuitable theory can have a detrimental effect on patient care, and when this happens nurses are often reluctant to admit it and they try to mould the patient’s needs to fit the theory rather than moulding the theory to fit the patient’s needs! Conversely, we believe that a theory that is appropriate for practice will benefit patients and improve the working practices and morale of nurses. Therefore, choosing an appropriate theory to underpin nursing practice or nurse education needs a great deal of thought. We discuss 12 different criteria that can be used to help readers select a nursing theory for practice.
Since the first edition of this book, there has been a great deal written about evidence-based practice. We believe that no reasonable nurse would argue that an important part of every clinical nurse’s role is to ensure their practice is informed by the best available evidence. We show the link between theory and research and best evidence. We discuss how theory is generated by research, tested by research and evaluated by research. We also highlight how theory can help to shape a research study.
Every day in clinical practice, nurses are exposed to phenomena that influence patient care. Sometimes such phenomena are ignored because they seem commonplace or unimportant. We guide the readers through the process of identifying these phenomena, naming them and finding relationships between them. This provides an insight into how readers can construct a nursing theory.
Finally, we highlight how the worth of a theory is ascertained. The characteristics of a good theory are reviewed and these are presented as the basis for evaluating and analysing nursing theory. The particular place of testing a theory is considered, and the relationship between theory evaluation and theory testing is clarified.
We hope you enjoy reading this textbook as much as we have enjoyed writing it. We anticipate that it will open up new and interesting perspectives in your thinking about nursing theories and how they can be used to increase the knowledge base for the profession and enhance clinical practice.
Hugh P. McKennaMajda PajnkiharFiona A. Murphy
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Learning outcome boxes give a summary of the topics covered in a chapter.
Key concept boxes give definitions of theories.
Reflective exercises provide ways to put theories into practice.
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