Nursing in the 21st century is constantly changing. Nurses today are not only expected to focus on the patient’s condition but, the patient as a whole. They are expected to focus upon the patients physical, psychological and social problems (Scott, Matthews, & Kirwan, 2013). The ways we address all of these needs must be proven through research and practice (Im & Chang, 2012). These concepts should be clear, defined and specific. Nursing theory can play a role in finding ways to reach these goals and assist nurses in collaborating with patients to determine ways for patients to care for themselves.
These theories can offer concepts to nurses and patients that provide direction in teaching them the necessary skills to manage their care. The bases of many theories is knowledge and teaching, teaching what is necessary to gain a better understanding of their condition or situation and what they can do to take control. Grand Theories Grand theories are broad, their concepts are very abstract and difficult to test (Meleis, 2012). With these concepts being broad the nurse can utilize many of these concepts to formulate plans of care.
An example of this is, Dorothea Orem’s Self-Care Deficit Theory this theory could be applied to a post-operative knee replacement surgery patients. The nurse could evaluate what tasks the patient is able to complete, what tasks they need assistance with, and what tasks they are unable to accomplish. With this information the nurse is able to formulate a care plan focusing on what tasks they need assistance with so that the healthcare team can work together for these common goals.
Obstacles to utilizing this theory today is that these concepts are not specific, the patient may have deficits that are unable to be overcome, developmental factors and noncompliance (Orem, 1991). Grand theories can be applied to current nursing practices but, because they are not specific to certain areas of practice and can have many obstacles that prevent them from conforming to current practice it can be difficult. Middle-Range Theories Middle-range theories are less abstract than grand theories, they are able to be tested and can be applied to many different areas of practice (Meleis, 2012).
These theories assist in linking concepts to current practice through their bases that focus on, physical, emotional, and spiritual care and the role the nurse plays in meeting these needs (Smolowitz et al. , 2014). Even though these theories are less broad than grand theories many of these theories can be applied to specific area of practice such as pain, support and comfort. They can be defined and proven, they are easily intergraded into nursing research (Im & Chang, 2012).
An example of this is, Marion Good & Shirley Moore’s Acute Pain Management Theory. This theory focuses on three concepts, multi modal intervention, attentive and patient participation (Good, 1998). This theory can be utilized in many different areas of nursing where pain management is a situation that requires nursing interventions. Situation-Specific Theories Situation-specific theories are comprised of concepts that focus on specific areas of practice or a specific group (Meleis, 2012).
Even though these theories can be tested and proven they contain limits to the patient population that they can benefit. With these theories being specific to the area that they apply to they can be easily incorporated and utilized (Im & Chang, 2012). One situation-specific theory is Barbara Riegel’s Theory of Heart Failure Self-Care. This theory has proven to decrease hospitalization and mortality and increase the patients quality of life (Vellone et. al. , 2013).
The concepts to this theory are, symptom monitoring and adherence to treatment. Through educating patients about early symptoms and interventions many patients are able to manage the heart failure at home prior to their symptoms escalating and requiring hospitalization. Evidence-Based Practice Evidence-based practice is an upcoming set of standards in the way care is delivered to patients. The chosen pathway of care is determined based upon the patient’s diagnosis. These disciplines are mainly based on research and practice (Melesis, 2012).
These concepts are not based on nursing theory but, upon proven testing of what interventions are the most effective treatment. These interventions are able to be utilized globally but, are difficult to individualized. Type of theory that is most applicable to clinical practice in the 21st century After reviewing the many different types of theories and many of their concepts the theories that closely relate to current nursing needs and practices are that of the middle-range theories.
These theories are able to be easily incorporated into current research and practice (Im & Chang, 2012). The focuses of these theories are specific enough to apply to a variety of areas of practice but, not as narrow as that of situation-specific theories which only apply to a specific area and population. These theories are also not as broad as grand theories which can be vaguer on how they apply to specific situations. One middle-range theory that can be easily applied to a variety of areas is that of Merle Mishel’s Uncertainty in Illness Theory.
This theory relates to patients having a knowledge deficit related to their illness and are unable to formulate effective outcomes (Neville, 2013). Due to the patient’s diagnosis or prognosis the patient suffers from uncertainty and is no longer able to focus or control their normal way of life (Neville, 2013). This theory can be utilized by the nurse to determine and educate the patient on what their knowledge deficit is, what their dangers are and opportunities that are available to assist them in finding method’s to cope and adapt.
Conclusion The care nurses provide is both personal and professional, it is based on one’s knowledge, beliefs and experiences. All theories have a purpose in current nursing practice, grand theories define nursing discipline, situation-specific theories in research and practice as it relates to specific populations and situations and, middle-range theories which are important to a variety of areas and research (Im & Chang, 2012).
Understanding the different theories and how they apply to current practice is important to ensuring the care that is delivered is based on evidence and proven to be effective and appropriate. Though the current trend in nursing has been implementing evidence-based practice, nursing theory still hold an important place in ensuring that the way we practice is personal and individualized (McCrae, 2012). Combining evidence-based practice and middle-range nursing theories can ensure that the care that is being delivered is the best care possible.
