Over the past century, nursing has become one of health care professions that has witnessed immense growth. The move towards nursing practice that is hinged on theory has brought the skills of nursing into view as a discipline that is both academic and professional.
A theory is a group of concepts that are related and which propose actions that are meant to guide certain practices (Tonney, 2006). When it comes to the nursing profession, nursing theories comprises of a set of concepts, definitions, relationships and assumptions which result from different nursing models and other interrelated disciplines and provide a purposive view of phenomena which is systematic and it occurs through designing relationships that are specific among different concepts for the key aim of describing and making explanations. Nursing theories either take a deductive or inductive reasoning to explain different kinds of nursing phenomena. Nursing theories play a very important role in the medical profession because assists in not only explaining and predicting, they also provide the necessary foundation through which the practice of nursing is hinged on (George, 2002). They further help in generating additional knowledge and provide the future directions of the nursing profession. Having a definite set of theories in nursing is also important because it leads to better care of patients, enhances the professional status of nurses, and leads to better communication and guides research and education.
Nursing theories; Mirrors, Microscopes or Telescopes
Nursing theories can be viewed from the point of mirrors, microscopes or telescopes. Mirrors provide a reflection of all or some parts of reality and give them different shapes. Microscopes on the other hand focus on another party of reality and magnifies that part within or outside its context (Meleis, 1997). Telescopes bring objects and events that are far away to point that are within the reach of people and can be observed. Therefore, the study of theories used in the nursing profession is a reflection of different realities of life as seen from mirrors, microscopes or telescopes.
In the course of their development, these theories have served as a reflection of the interests of the nursing profession as at a specific point in time. They have reflected the socio-cultural contexts of the nurses, their educational backgrounds and the experiences they have gained working as nursing professionals. When all these theories are considered and put together to reflect the realities of the nursing profession, other images are formulated. However, these images are not always distinct, well formulated and true images, but nevertheless, they are also not just images or imaginations made up by nursing theorists either. In most cases, they are a reflection of the realities of the nursing profession at the time when these theories were being developed and they further assist in shaping the direction of the nursing profession in the course of time. Viewing these theories from the perspectives of mirror, telescopes or microscopes is crucial because neither theory is mutually exclusive or inclusive but they present ways through which stimulating and innovative ways can be put in place to explain and classify theories used in the nursing profession (Orlando, 1961). Thus by using these models of classification, it is possible to achieve two goals, the first being the ability to see different images and details when we try to analyze a phenomena; images which cannot be readily seen when only viewed from one perspective. The second reason has some resemblance to the first one, in that it, by using theories to achieve different needs, it is possible to enhance the theories since they are viewed from different perspectives.
Application of the mirrors, microscopes and telescopes to the nursing profession provides an opportunity to highlight and detail the theoretical development of the nursing profession. Thus, the nursing profession can be viewed from the point of view of time when the nursing profession was developed according to the images of nursing at that time. And in this case, it is during the period of 1950 to 1980 (Tonney, 2006). The second perspective is viewing the theories according to their primary focus and how they are evaluated, while the third viewpoint is seen through the images and roles that are played by nurses. Each of this analysis whether through the mirror, telescope or microscope provides opportunities for critical thinking in the nursing profession and provide an opportunity to use analytical frameworks to understand the nursing profession.
Images of Nursing, 1950-1970
This school of thought is made up of theories that reflect an image of nursing as being able to meet the needs of clients, interactions between clients and providers and the outcomes. The needs theories were developed to answer critical questions regarding the work of nurses; in particular, in relation to what nurses do, their functions and the roles they play. The answers to these questions put emphasis on a number of theorists describing the functions and roles that are played by nurses. These functions were conceptualized through viewing a nursing client in terms of a hierarchy of needs (Kim & Kollak, 2006). Thus, when some of the needs in the hierarchy are not fulfilled, the care provided by nurses becomes necessary. The nurses are therefore able to provide the necessary functions and play the roles that will assist the clients fulfill their needs. Thus, the needs theory is concerned with the problems and needs of the patients as seen from the point of view of the practioners and the roles played by nurses in assessing these needs.
On the other hand, interaction theories started developing in the late 1950’s and early 1960’s by nursing theorists who viewed the profession as an interaction process whose key focus is on the development of relationships between nurses and clients (George, 2002). Their main focus was on the process of care and the various instances of interactions between nurses and their patients. Specifically, these theories argued that the interaction between the nurse and the patient is mainly to provide care and nursing is a deliberate process that can be explicated.
Furthermore, it posits that the profession of nursing is an interpersonal one between a person who need care and another who has the ability to provide the care and that nurses should be able to clarify their own values to be able to provide quality care. It concludes by emphasizing that care is not a mechanistic act, but one that is should be done in a humanistic way. The third theoretical perspective which is the outcomes is related to the question of ‘whys’ in nursing. Theorists under this school of thought attempted to conceptualize the outcomes of nursing as a well articulated concept describing a human as a client and the nursing profession as an external regulatory mechanism.
Theories as viewed from their primary focus.
In viewing nursing theories in terms of mirrors, telescopes and microscopes, they can further be conceptualized from the point of view of the primary focus of the theories. Through classifying the theories for analysis, the assumption is that each system of classification leads to a better understanding of the each theory. Thus these theories are classified into four broad categories which include interactions between the clients, person-environment interactions, interactions, and nursing therapeutics (Orlando, 1961). Theories focusing on the client provide a comprehensive analysis of the client as viewed from the point of view of the nursing professional. The client focused theories have played an important role in changing the way human beings are defined from a biomedical view to that one which is psychosocial. One of the key theorists focused on the relationship between the client and the environment and emphasized that the two cannot be viewed in separation. The major significant contributors to these theories of the client in the nursing profession include Dorothy Johnson, Callista Roy and Betty Neumann (Orlando, 1961). In their theories, they posits that what makes nursing different from medicine and other health sciences is the way the client is viewed as a behavioral system with different adaptive modes in the environment they live in.
Images of Nurses and Roles that they play.
Under this theoretical model, the major of focus by the nurses is on different dimensions of care at different times and for different purposes. Nursing as a professional practice is not exemplified by one group of theories at the expense of the others. Instead, the situation may dictate the time when the focus of nursing should be on needs, interaction or outcomes. In the same breath, the focus on clients, their environment, interactions and interventions may necessitate the use of other theories. According to Meleis (1997):
One of the factors that determine how a theory can be applied is the temporal frame of reference. Thus, if one is viewing a time-frame that is relatively short, it is possible to make use of the adaptation model, but when it comes to a time frame that is relatively longer, the phenomena would be obvious and it would not be possible to explain it using adaptation alone.
Nurses are engaged in different roles at different times and they also project images that are different. The theories have further served to assist in developing different images and the roles played by nurses. Thus, nurses who use the needs approach are actively doing by relying on solving problems through carefully planned interventions and use the activities they perform to weigh their work. Interaction-oriented nurses on the other hand rely on the process of interaction and include themselves in the sphere of their actions. They therefore use themselves to evaluate the therapeutic actions they provide. The nurses who use this perspective focus more on guiding, counseling and teaching and aim to help their clients find meaning s in the conditions they are in. among the interaction theorists, there exists existentialists who majorly focus on the support and development of the potential of human beings. Some of these potentials include both then client and the nurse achieving a being that is authentic and creating options that bring about openness to the present and also future experiences (Tonney, 2006). Nurses who are outcome oriented pursue the goal of maintaining and promoting energy and harmony with the environment and on ensuring that they enhance an environment that is healthy. To them, they just don’t view themselves as therapeutic nurses, but they also put in mind the being that is brought about as a result of being authentic in their process to promote healing. On the other hand, theorists who are care-oriented focus on the personal development of both the client and the nurse. They therefore focus on the transformation that is brought about by self-reflections of both the patient and the nurses.
How Nursing Theory views Leadership or Education
In trying to understand how different theories view leadership and education, Ida Jean Orlando’s theory of Deliberate Nursing Process is used as an example. According to this theory, the role of nursing is to find out causes and alleviate suffering among patients and hence deliver health care that is goal-oriented, holistic and which is majorly focused on the patient (Orlando, 1961). Although the nurse is the one who initiates the process, both the client and the nurse are affected by the actions or inactions of each party. Thus this theory involves exploring the personal perceptions, attitudes and vie points with regard to a patient and trying to verify if these perceptions are true. This theory is very important because it tries to conceptualize a nurse’s view of the patient through various images which can in the end influence the type of care the nurse will provide to the patient. The theory argues that the nurse has to take the leadership role of trying to understand the meaning behind behavioral patterns of the patients. The theory puts to fore the notion that nursing is a continuous educational process through its assertions that nurses have to continuously explore their reactions to patients to prevent diagnosis which at times could be inaccurate. Thus the theory has great implication when it comes to nursing education because it aims at changing the activities of the nurses from personal and automatic to behavior that is disciplined and professional.
Nursing professionals play a very critical in life where they help in improving the quality and quantity of life for patients. The theoretical underpinnings of the nursing profession cannot be viewed in isolation however unique they may look. These theories can be viewed in terms of images and they operate to reflect realities in part or whole and hence provide different but inter-connected views about the nursing profession. This image representation of theories can be used to magnify different realities regarding the health problems affecting populations. Nonetheless, theory and practice should always complement each other since theories become irrelevant if there is no practice. Nursing theory should therefore strive to foster a continuous educational process and development in heath care.
George. B (2002). Nursing theories- The base for professional nursing practice. Chicago: Routledge
Kim, H. & Kollak, I. (2006). Nursing theories: Conceptual & philosophical foundations Boston: Bantam Books.
Meleis, A (1997). Theoretical nursing: Development and progress. Philadelphia, Lippincott.
Orlando, J. (1961). The dynamic nurse-patient relationship: Function, process and principles. New York: G. P. Putnam’s Sons.
Tomey, A. (2006). Nursing theorists and their work (6th ed.).London: Oxford University press