09 Oct Week 6 Assignments This week, the usefulness of bo
Week 6 Assignments This week, the usefulness of borrowed theories will be explored. Discussions will center on how nursing uses theories borrowed from other professional healthcare disciplines to enhance knowledge and understanding of practice. Interprofessional and shared theories will also be discussed Outcomes 2 Apply nursing theory as a framework to guide the development of new knowledge and implementation of evidence-based practice in future professional settings. (PO 1 and 4) Weekly Objectives • Illustrate the role and application of grand and middle-range nursing theories in healthcare and educational organizations. • Explain how nursing leaders employ grand and middle-range theories in healthcare and educational organizations. 4 Analyze theories from nursing and relevant fields with respect to the components, relationship among the components, and application to advanced nursing practice. (PO 1) Weekly Objectives • Apply aspects of a borrowed theory to a professional nursing practice area. • Explore the concepts of interprofessional and shared theories. • Examine the scope of borrowed theories and their application to the nursing profession. Reading McEwen, M., & Wills, E. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. • Chapter 13: Theories from the Sociologic Sciences • Chapter 14: Theories from the Behavioral Sciences • Chapter 15: Theories from the Biomedical Sciences • Chapter 16: Theories, Models, and Frameworks from Leadership and Management • Chapter 17: Learning Theories *Student to select readings that best align with their professional area of interest. Discussions Borrowed (non-nursing) Theories Applied to the Nursing Profession Application of a borrowed theory to nursing Borrowed Theories Used by Nursing Theories from Social Sciences Theories from social sciences are integral to the discipline of nursing. Nurses in virtually all settings caring for vast groups of patients routinely use concepts and principles from social theories (McEwen & Wills, 2014). Sociologic theories are rich and substantively diverse. Because of this richness and diversity, their theory perspectives are relevant to the discipline of nursing. Social forces have a strong impact on wellness and health of individuals. Developing a sociological perspective in caring for patients is not always comfortable because it calls for confronting and questioning existing assumptions regarding social arrangements (Parker & Smith, 2015). The knowledge gained can benefit not only patients but healthcare and professional nurses, as well. Theories from Behavioral Sciences The behavioral science theories attempt to explain an individual’s behavior in terms related to the development of the self that is formed by adulthood. There are five families of theories that try to explain human behavior. Each theory emphasizes a different concept or viewpoint, but no one theory best explains the complexity of human behavior (McEwen & Wills, 2014). The behavioral theorists believe that behavior is learned by reinforcement; whereas, cognitive theorists believe that reinforcement are related to an individual’s thought patterns. Humanistic theories propose that individuals will have within themselves the capacity to change. The potential for healthy and creative growth occurs throughout an individual’s life span; thus, the behavior of an individual is a dynamic process. The stress-adaption theories are associated with behaviors identified with the way a person adapts to stress through individual coping mechanisms. The social-psychology theory looks at how a person changes and ways to incorporate those changes through the promotion of health. The following table provides brief comparisons of the five families of behavioral theories (Parker & Smith, 2015). Theory Theorist Emphasis Enablers Psychodynamic Erikson Psychosocial factors that influence behavior Id, ego, superego, conscious, unconscious Freud The study of unconscious mental processes of behavior Personality structure: id, ego, superego , reality principle Cognitive Behavior Beck Cognitive distortions Overgeneralization, selectivity, magnification, assumptions Skinner Analysis of human behavior observed in the current situation Operant conditioning, positive and negative reinforcement Humanistic Maslow Fulfilling human potential Hierarchy of needs, safety needs through self- actualization Rogers Person centered Congruence and incongruence, positive regard and self-regard Stress Adaptation Lazarus Cognitive model of stress Appraisal, coping, outcome Social Psychology Rosenstock Perceived threat and net benefits Benefits, perceived barriers, cues of action, self-efficacy Each of the five families of behavioral theories have been extensively used in the nursing profession. For example, academic preparation, gaining an understanding of the phases of development and applying those stages in the practice setting, and understanding age-specific tendencies related to patient care (McEwen & Wills, 2014). Theories from Biomedical Science Historically, nursing theory has its roots in theories from the biomedical sciences. For example, Florence Nightingale’s theory is built on principles of Germ theory. McEwen (2014) stated biomedical theories can be separated into two categories: theories of disease causation and theories related to physiology. Nursing clinical guidelines, principles of infection control, and levels of prevention are all attributed to biomedical theories. Biomedical theories continue to be an important part of nursing knowledge and practice, particularly for nurses in direct patient care roles. Theories from Leadership and Management Master’s-prepared nurses are considered leaders in a variety of different healthcare roles and settings. As such, regardless of role or practice setting, leadership and management practices should be supported by theories, models, and frameworks (Oberleitner, 2015). Leadership and management theories include focus on leadership styles, management principles, quality improvement strategies, change management, and team building – the concepts, principles and strategies of leadership and management theories are “crucial to the viability and sustainability” of nursing leader roles (Oberleitner, 2015, p. 382). Learning Theories Learning theories describe the processes used to bring about changes in the ways individuals understand information and changes in the ways they perform a task or skill. Learning theories can help provide a focus for creating an environment and conditions in which teaching can occur more effectively. A good learning theory enables you to make choices confidentially and consistently and to explain or define why you made the choice you did (McEwen & Wills, 2014). Thus, although nursing theory provides the framework for professional assessment of the patient’s condition or needs and the specific language the nurse uses when making a diagnosis or charting, learning theory explains how this information is assimilated and suggests effective ways to present it to the patient as an intervention. Learning theory combined with nursing theory gives nurses guidance as they interact with patients (McEwen & Wills, 2014). History of Borrowed Theories As a fledgling profession in the late 1800s and early 1900s, the vast majority of the knowledge base for nursing practice was borrowed from medicine. During the 1950s and later, nursing became determined to separate itself from medicine and establish itself as a unique profession. To do so, nursing needed to demonstrate the characteristics of a profession with one of these being the presence of a unique knowledge base. Each profession needs to have a focus or object (i.e., another characteristic of a profession). The object or focus of a profession indicates the discrete aspect of reality that is the subject of the discipline (Parker & Smith, 2015). The following table assists with understanding the object of a profession. Discipline Primary Knowledge Base Focus or Object of Care Medicine Emphasis on biologic and pharmacologic theory Diagnosis and treatment of health alterations Nursing Emphasis on biologic, psychological, and social theories Emphasis on individuals as biopsychosocial beings to determine appropriate actions in order to foster health Pharmacy Emphasis placed on biologic, chemistry, and pathophysiology Provide safe and appropriate medications while educating the consumer Dieticians Emphasis on biologic, nutritional, and psychological theory Determine nutritional needs and provide appropriate interventions There is an interesting and ongoing debate in the literature regarding the use or avoidance of theories from non-nursing disciplines. On one side, borrowed theories may not adequately describe, explain, or predict nursing phenomena (Villarruel, Bishop, Simpson, Jemmott, & Fawcett, 2001). However, advocates believe nursing’s theoretical foundations depend on borrowed theories (McEwen & Wills, 2014); and are important to guiding nursing practice in a variety of settings. It is important to note the use and application of borrowed theories in nursing. McEwen and Willis (2014) cautioned that “simply adopting concepts or theories from another discipline does not convert them into nursing concepts or theories” (p.40). Borrowed theories can become shared theories as they are applied to nursing specific situations (Bond et al., 2011). Desbiens, Gagnon, and Fillion (2012) further stated shared theory, although not derived from nursing, is used to explain or predict nursing phenomena. Interprofessional Theory Knowledge is not specific to one discipline; however, the perspective or worldview of the discipline shapes how knowledge is interpreted and used. As healthcare is evolving and interprofessional practice is becoming the norm, nurse researchers have collaborated with other healthcare professionals to build upon borrowed theories and to develop new interprofessional theories to improve patient care (Bond et al., 2011). Interprofessional theory is developed through collaboration and shaping the delivery of healthcare in today’s and future practice settings. Summary Borrowed, shared, and interprofessional theories add value to nursing practices. Understanding and incorporating non-nursing theories in our practice, helps to expand our perspectives, provides enhanced person-centered care, and promotes effective work within interdisciplinary health care teams. However, it is still essential for nursing to generate new nursing specific theories for continued knowledge development of the nursing discipline and to maintain a separate identity for the profession of nursing. References Bond, A. E., Eshah, N. F., Bani-Khaled, M., Hamad, A. O., Habashneh, S., Kataua’, H., . . . Maabreh, R. (2011). Who uses nursing theory? A univariate descriptive analysis of five years’ research articles. Scandinavian Journal of Caring Sciences, 25, 404-409. doi:10.1111/j.1471-6712.2010.00835.x Desbiens, J., Gagnon, J., & Fillion, L. (2012). Development of a shared theory in palliative care to enhance nursing competence. Journal of Advanced Nursing, 68(9), 2113-2124. doi:10.1111/j.1365-2648.2011.05917.x McEwen, M. & Willis, E. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins. McEwen, M. (2014). Theories form the biomedical sciences. In M.McEwen & E. Willis (Eds.), Theoretical basis for nursing (4th ed.) (pp.331-353). Philadelphia, PA: Lippincott, Williams & Wilkins. Oberleitner, M. G. (2014). Theories, models, and frameworks from leadership and management. In M.McEwen & E. Willis (Eds.), Theoretical basis for nursing (4th ed.) (pp.354-385). Philadelphia, PA: Lippincott, Williams & Wilkins. Parker, M. E., & Smith, M. C. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: F. A. Davis Company. Villarruel, A. M., Bishop, T. L., Simpson, E. M., Jemmott, L. S., & Fawcett, J. (2001). Borrowed theories, shared theories, and the advancement of nursing knowledge. Nursing Science Quarterly, 14(2), 158-163.
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