Nursing theory

Nursing theory is the term given to the body of knowledge that is used to support nursing practice. In their professional education nurses will study a range of interconnected subjects which can be applied to the practice setting. This knowledge may be derived from experiential learning, from formal sources such as nursing research or from non-nursing sources. To speak of nursing theory is often difficult. Nursing is many things to many people. Most universally agreed upon is that Nursing is a science involving people, environment and process fueled by a vision of transcendence in the context of healthcare. It is interesting to note that 90% of all Nursing theories have been generated in the last 20 years. Many schools encourage students to formulate theories of Nursing as part of their curriculum. Some might argue that this multiplicity of theory is detrimental to the practice and undermines common vision. Others would say that the nature of the young science is sufficiently far reaching to require such tactics in order to elicit true consensus. It cannot be denied, however, that there is much vanity involved in the formulation of nursing theory. The pages of "Nursing Science Quarterly", a major mouthpiece for Nursing Theory, are rife with examples of semantical hair-splitting.

Nursing models are conceptual models, constructed of theories and concepts. They are used to help nurses assess, plan, and implement patient care by providing a framework within which to work. They also help nurses achieve uniformity and seamless care.

Universal features of nursing models
Unlike most sciences, Nursing theories seem primarily concerned with what "Nursing" is or should do, rather than a phenomenon within the discipline. In lieu of "theory," a more accurate title could be "Definition", as in "Rogers's "Definition of Nursing".

All nursing models involve some method of assessing a patient's individual needs and implementing appropriate patient care. An essential portion of each nursing model is measurable goals in order that the process can be evaluated in order to provide better care for the patient in the future. Almost all nursing models are used to produce a document known as a care plan that is used to determine a patient's treatment by nurses, doctors and other healthcare professionals and auxiliary workers. These documents are considered to be living documents — they are changed and evaluated on a daily basis as the patient's condition and abilities change.

Theories of Nursing fall into roughly 5 categories. There are metatheories, grand theories, mid-range theories, min-theories and micro-theories. “Neuman’s model focuses on the person as a complete system, the subparts of which are interrelated physiological, psychological, sociocultural, spiritual, and developmental factors.” Polit & Henderson p. 103

History of nursing models
The original role of the nurse was primarily to care for the patient as prescribed by a physician. This evolved into the biomedical model of nursing care which still strongly influences nursing practice today. The biomedical model focuses heavily upon pathophysiology and altered homeostasis but fails to identify individual differences and whilst it works well for traditional medical and physical care, it focuses solely on the treatment of disease, making little account of psychological, sociocultural, or politcoeconomic differences between individuals. The Biomedical Model essentially views all patients with the same disease as the same problem regardless of their religion, culture, or ethnicity. This is in contrast to the social model of healthcare that places emphasis on changes that can be made in society and in people's own lifestyles to make the population healthier.

The first theorist to clearly articulate a role of nurses distinct from the medical profession was Florence Nightingale. Her theories were developed during the Crimean War and published in Notes on Nursing:What It Is, and What It Is Not in 1859. Nightingale's model is based on the idea that the nurse manipulates the environment to promote the patient's well being.

Nurses quickly realised that treating patients based upon their disease rather than making a holistic assessment was not a satisfactory way of attending patient care.

Presently, some of today contributing theorist include C.Roy (Kansas), L.Newman (Harvard), P.Waga (Rutgers), and J.Johnson (Yale)

Further information may be found in ANA (American Nursing Association)(2007)

Major nursing theorists
Purposely left off this list is that most famous of all nurses, Florence Nightingale. Ms. Nightingale never actually formulated a theory of nursing science but was posthumously accredited with same by others who categorized her personal journaling and communications into a theoretical framework.
 * Helen Erickson
 * Virginia Henderson
 * Imogene King
 * Madeleine Leininger
 * Betty Neuman
 * Dorothea Orem
 * Ida Jean Orlando (Pelletier)
 * Hildegard Peplau
 * Rosemarie Rizzo-Parse
 * Isabel Hampton Robb
 * Martha E. Rogers
 * Calista Roy
 * Katherine Kolcaba

Also left off are the many nurses who improved on these theorists' ideas without developing their own theoretical vision.

Examples of nursing models
The models used vary greatly between institutions and countries. However, different branches of nursing have different "preferred" nursing models. These are summarized below:

Psychiatric nursing

 * Roy's model of nursing
 * Tidal Model

Children's nursing

 * Casey's model of nursing

Perinatal nursing

 * Ramona T Mercer maternal role attainment

Adult nursing

 * Nightingale's model of nursing
 * Roper, Logan and Tierney
 * Orem's Model of Nursing

Community and rehabilitation nursing

 * Orem's Model of Nursing

Critical care nursing

 * Synergy model of nursing

Holistic nursing

 * Rogers: Unitary Human Beings
 * McGill Model of Nursing
 * Parse: Human Becoming
 * Erickson, Tomlin & Swain: Modeling and Role-Modeling
 * Newman: Health as Expanding Consciousness

Future of nursing models
Nursing models have been criticised for failing to provide holistic care, and preventing nurses from thinking "outside of the box". This has been compounded by many hospitals who have developed "pre-printed" care plans that have been misused by nurses who have failed to customise these generic care plans to the patient. An example of this would be using a standard care plan for appendectomy for an elderly patient with multiple pathology (for instance diabetes, angina pectoris and a history of myocardial infarction). Evidently, the patient's care needs would be very different from a fit-and-healthy 20 year old male with no previous medical history who neither smokes nor drinks. It is up to the professional to tailor the care plan to suit the individual patient.

Models of nursing have always been accused of being "out of touch" with the harsh reality of patient care, and creating yet more unnecessary paperwork for nurses to complete.

Technological advances may produce client specific nursing models.