Nursing grand theory: concepts, categories, and major theorists

Nursing Grand Theory

Grand Theory

The nursing grand theory is the framework which guides and organizes the knowledge in nursing and explains the nursing phenomena at a more specific level. The nursing grand theory was put forth by Afaf Meleis who constructed on theory which combines the set of concepts, relationships, definitions and assumptions or propositions which are derived from the models of nursing in order to give a systematic view of the specific inter-relationships among the concept for the purpose of explaining, describing, prescribing and predicting. According to the grand theory, it is possible to reflect and provide insights which are useful for practice. However, the theory is not designed to be used for empirical testing since the theory is designed to be applicable to all instances of nursing Meleis, 2011()

Despite the many nursing theories that exist, there are four common concepts that determine and influence nursing practice. These are the patient, the environment, health and lastly the goals, roles and functions of nurses. Each of these concepts is defined and described by a nursing theorist and the most important one is the patient since regardless of the theory being applied, the focus of nursing is the patient Meleis, 2011()

The grand theories can be categorized by purpose with each category building upon the preceding one. The first category is the descriptive theories which describe the aspects of nursing practice but they do not show the interrelationships that exist between the four nursing concepts discussed. The second category is the explanatory theories which describe the interrelationships between the nursing concepts. The third category is the predictive theories which are predictive. These theories describe the causal relationships that exist between the concepts. The last category is the prescriptive theories which define the nursing activities in order to reach the goals and predicts their outcomes Meleis, 2011()

Grand theorists

Educational background

Philosophy of nursing

Definition of nursing

Goal/purpose of theory

Florence Nightingale

She was educated broadly which made her begin to dislike the lack of opportunity for females in her own social circle.

She believed strongly in providing care to patients in order to help their recovery. She learnt this from her own personal experience when she was sick with brucellosis.

She defined nursing as the process and act of utilizing the patient's environment to assist them to recover.

Her theory identified five environmental factors which influenced health. These were pure or fresh air, efficient drainage, and pure water, light and especially direct sunlight and cleanliness.

Rosemary Rizzo Parse

She was educated in Pittsburgh at Duquesne University. She got her masters of science in nursing and Ph.D. from the University of Pittsburgh.

Reality is reached by harmonizing the universes of a person through their choice. Meaning is structured through imaging, valuing and languaging.

She defined nursing as helping individuals and families to choose the possibilities for changing the process of health.

Her theory emphasizes how individuals choose and bear responsibility for their patterns of health. The theory guides nurses in their practice to focus on the quality of life of their patients.

Martha E. Rogers

She received a diploma in 1936 from the Knoxville General Hospital School of Nursing then graduated one year later with a degree in public health nursing at the George Peabody College in Nashville, Tennessee. She got her M.A. In public health nursing from Teachers College of Columbia University in 1945, MPH in 1952 and Sc.D. In 1954 from Johns Hopkins School of Public Health.

Nursing is both art and science in that it is unique and like all other sciences, it lies in the phenomenon which is at the center of its focus. The purpose of nurses is to promote the well-being and health of patients.

Nurses need to focus on the patient's wholeness and should seek to find an interaction between the person and their environment to strengthen the integrity and coherence of the person. Nurses also coordinate the human field with the rhythm of the environment and direct and redirect the interaction patterns between the patient and the environment in order to promote the maximum health potential.

Her theory helps nurses to see the effect of the environment on the patient and learn to use it to manipulate and enhance the healing process.

Margaret Newman

She has a Bachelor's degree from the University of Tennessee received in 1962 and a Master's received in 1964 from the University of California. She also has a Doctorate degree from the New York University received in 1971.

She stated that nursing is the process of understanding the power and using it to develop higher levels of consciousness to help the disease process.

Nursing is the process by which a person provides care to another in the human health experience. It is a partnership between the nurse and the client where both exercise and grow by having higher levels of consciousness.

The theory helps nurses to redefine nursing and to understand that the pattern of providing care is essential to the disease process.

Reflection

The grand theories of nursing attempt to put together the nursing concepts to provide definitions and assumptions that explain the phenomena in the nursing practice in a systematic manner. All of the four grand theories described in the table above provide their own definitions and assumptions to explain the nursing practice. In order to show my personal reflection on the theories, it is important to first look at each of the grand theories to analyze their concepts, assumptions, definitions and purpose.

Florence Nightingale's Legacy of Caring Theory

Florence Nightingale's Legacy of Caring Theory focuses on the nursing practice with the patient being the major concept. The theory provides the relationship between the patient and the environment which is necessary to ensure the patient is provided with the most appropriate nursing care that leads to their healing. The theory describes five key assumptions that are necessary to provide the patient with the healthful house. These are pure air, pure water, efficient drainage, cleanliness and light Selanders, 2010()

The theory that was put forth by Florence Nightingale describes the person as the advocate for all. She advocated for the patient and defined them as people who deserved care in a civilized manner regardless of their stage of life. She also poised that the social contact for the patients was extremely important for the healing process. Florence Nightingale defined the environment as the foundation of patient care. In her writings, Florence Nightingale put forth that the environment was fundamental to patient care. Items such as nutrition, noise, personal cleanliness and room cleanliness were extremely essential and influenced patient care Selanders, 2010()

Florence Nightingale defined health as more than the mere absence of disease. She stated that health was the state of a person being well and also having the ability to use every power that they have well. She defined nursing as an art rather than a science. She bore the belief that nurses were required to observe the patients and to report any changes noted to the physicians assigned in a manner that was timely and ensured accuracy. The nurses were also required to think critically about the changes in the patient and what aspects of care they could change to prevent those changes. She also believed that the nurses were required to show loyalty to the physicians but are not servile Selanders, 2010()

Martha Roger's Science of Unitary Human Beings

Marta Roger's theory provides a wide body of knowledge about the field of nursing. It provides the way to view the unitary nature of human being. Human beings are viewed as integral with the universe meaning that the unitary human being and the environment in which they live are one and not dichotomous. Her theory states that nursing focuses on people and that the manifestations that emerge from the mutual environment and unitary human being process. Any changes in the pattern and relationship between the human being and the environment are propagated by waves that emerge as observable events. Nurses need to identify the pattern and the changes in the pattern in order to understand the human experience. According to her theory, the basic concepts in nursing are the environment, the unitary human being and homeodynamic principles Rogers, 1989()

Martha Rogers also provides definitions. The person is the unitary human being and is irreducible, indivisible and identified by a pattern and characteristics that manifest to the whole person and which are unpredictable. The environment is defined as an irreducible energy field that is pan dimensional and integral with the human field. It is also identified by pattern. Health is defined as an expression of the life process and there are particular characteristics and behavior that emerge out of the mutual interaction of the environmental and human fields. Nursing is viewed as a body of organized knowledge specific to nursing and is arrived at through research and logical analysis. Nursing is an art and is a creative use of science and knowledge for the improvement of the human being Tomey & Alligood, 1998()

Margaret Newman's health as expanding consciousness theory

This theory is built upon Roger's theory of unitary human beings. The theory defines health as an expanding consciousness that is stimulated by concern for those people for whom health as the absence of disability or disease is impossible. The theory has five major assumptions. The first is that health encompasses all conditions which are described as illness or in medical terms as pathology. The second assumption is that these pathological conditions are a manifestation of the pattern of the individual. The third assumption is that the pattern of the individual which eventually manifests as pathology is essential and exists prior to any functional or structural changes. The fourth assumption is that the removal of the pathology does not change the pattern of the individual. The fifth assumption is that the person becoming ill is the only way in which the pattern manifests itself and that is the person's health. The last assumption is that health is an expansion of consciousness Newman, 1979()

Margaret Newman describes health as fusion of one state of being with its direct opposite which results in health. Nursing is described as caring for the human health experience. It is a partnership between the patient and the nurse where they both grow their levels of consciousness. The person is a unitary being that cannot be divided and is inseparable from the larger unitary field. Lastly, the environment is a universe of open systems Newman, 1979()

Most congruent theorists

My personal philosophy of nursing is patient care as the central purpose of the nurses. Florence Nightingale's theory of legacy of caring is developed to give information regarding individuals and families and it encompasses the community, hospitals and nurses. It is widely used by educators, hospital administrators and researchers and it has served as the basis of many nursing programs. The reason for this is that it is congruent with nursing standards and is a revolutionary theory and gives vital guidelines to be followed by nurses in today's practice. The theory is most congruent with my personal philosophy of patient care since it dwells much on the value of the environment to promoting good healing and reducing the incidence of nosocomial infections. The theory emphasizes on nursing practice being centered on the patient and it emphasizes on proper utilization of nursing methods to ensure the highest standards of care are delivered to the patient thus accomplishing the goal of providing quality care to the patients.