Nursing Theories: Foundations, Models, and Practice

Grand Nursing Theory and Roy's Adaptation Model

Nursing can be described as a science and practice that enlarges adaptive capabilities and improves the transformation of an individual and the environment. This profession focuses on promoting health, improving the quality of life, and facilitating dying with dignity. The nursing profession has certain theoretical foundations that govern nurses in promoting adaptation for individuals and groups. These theoretical foundations include theories, theory integration, reflection, research and practice, and assimilation.

Several grand nursing theories were developed by various theorists, including the Science of Unitary Human Beings by Martha Rogers, Sister Callista Roy's Adaptation Model, and the Systems Model by Betty Neuman. Sister Callista Roy's Adaptation Model is based on the consideration of the human being as an open system. Roy argues that the system reacts to environmental stimuli via cognator and regulator coping techniques for individuals. On the other hand, stabilizer and innovator control mechanisms are the means by which the system responds to environmental stimuli for groups (George, 2009).

Sister Callista Roy developed this grand nursing theory while she was a graduate student. The major factor that prompted her to develop this theory was a challenge she received to build a conceptual nursing model from Dorothy Johnson during a seminar. During this process, she examined Harry Helson's adaptation theory and incorporated concepts from Seyle and Lazarus. The development of the Adaptation Model was also influenced by her 17-year work with the faculty at St. Mary's College in Los Angeles, where it became the framework for a nursing-based integrated curriculum.

One of the central values and beliefs established by Roy is that nursing focuses on transforming stimuli or fostering adaptive procedures to produce adaptive behaviors. In essence, nursing practice focuses on promoting adaptation for individuals and groups throughout the four adaptive modes in order to improve health, enhance quality of life, and contribute to dying with dignity ("The Roy Adaptation Model," 2013). Additionally, this model presents the individual as a holistic adaptive system that constantly interacts with both internal and external environments. Since nursing focuses on promoting successful adaptation, the major responsibility of the human system is to maintain integrity when faced with environmental stimuli.

Roy's Adaptation Model is adequate and useful for nursing education because it incorporates the four metaparadigm concepts. Its use in nursing education is evident in its integration as a framework for a nursing-based curriculum. The person metaparadigm is included in the model through its definition of the human system, while environment is included through consideration of environmental stimuli. The model also defines health and states the major goal of nursing practice in relation to individuals and groups. Furthermore, this model is particularly useful in nursing practice because it enables the nurse to follow the six stages in the nursing process (Masters, 2011).

The Institute of Medicine (IOM) recently published a report on the future of health care in the United States. One of the major concepts highlighted in the report is the critical role nurses will have in that future with regard to promoting safe, quality care and coverage for every patient in the health care system ("IOM Recommendations," 2011). The basis for these recommendations includes the need for nurses to practice to the full extent of their education and training, and the need for an improved education system to facilitate seamless academic progression. Additional factors include the need for improved data collection and information infrastructure, and fostering partnerships between nurses and other health care professionals.

Nursing Theory and the Future of Nursing

Since nursing theory has traditionally played an important role in nursing practice, it will be crucial in supporting IOM recommendations for the future of nursing. However, the role of nursing theory in the future of the profession will require further theoretical development, which will be fueled by the evolving needs of the population. Further theoretical development in the nursing field will also be characterized by attempts to meet patient needs from an interdisciplinary and integrative perspective (Meleis, 1995, p. 112). In order to support IOM recommendations, the nursing profession will increasingly be based on phenomenon-driven theories.

Nursing theory can support the future of nursing by focusing on three major areas that form the basis of IOM recommendations: education, research, and practice. In education, nursing theory should offer a general emphasis for designing curriculum and directing curricular decision-making. In research, nursing theory should provide the basis for producing knowledge and new ideas, facilitate the identification of knowledge gaps, and provide a systematic framework for identifying study questions, interpreting findings, and ratifying nursing interventions ("Application of Theory in Nursing Process," 2012). In practice, nursing theory should govern the assessment and intervention of nursing care, develop means to evaluate quality of care, and provide a framework for data collection.

One of the major middle-range theories is Watson's Theory of Human Caring, which focuses on how nurses provide care to patients and the translation of that caring into improved health plans that promote patients' well-being. Jean Watson asserts that people enter the nursing profession because of the opportunity it provides to care about individuals. Based on Watson's Philosophy and Science of Caring, nursing practice is founded on caring and promotes improved health as compared to mere medical cure. Therefore, caring promotes growth, since a caring environment accepts an individual as he or she is and works toward enabling that individual to become better ("Jean Watson — Nursing Theorist," 2011). Watson's development of the theory and philosophy is attributed to her rich history and background in the nursing field, which can be traced to her graduation from Lewis Gale School of Nursing in 1961. She holds a Bachelor's Degree in Nursing, a Master's Degree in Psychiatric and Mental Health Nursing, and a Doctorate Degree in Educational Psychology and Counseling.

A useful model case for applying Watson's theory is in the delivery of care to older adults in order to promote successful aging. For instance, consider a 59-year-old patient admitted to a hospital for acute abdominal pain caused by excessive drinking. The patient requests pain medications more often than other patients suffering from the same condition, and in addition to requiring a higher level of analgesia, receives a greater morphine dose due to conflicts with the physician.

Middle Range Theories and Watson's Theory of Human Caring

The current measures and views of successful aging originate from the medical model and primarily focus on behavioral determinants of health (McCarthy, 2011, p. 22). However, successful aging requires a combination of biomedical and psychosocial perspectives, which can be achieved through caring. Watson's Theory of Caring can be used in this scenario to address the patient's biophysical, psychophysical, and psychosocial needs. This can be achieved through attentiveness, responsibility, competence, and responsiveness — that is, recognizing the patient's need, determining the scope and extent of care required, developing effective intervention strategies, and evaluating whether the patient's caring needs are met (Lachman, 2012, p. 114).

In an advanced nursing role, the application of the theory would follow the same general procedure as the scientific process: assessment of the problem, development of a nursing care plan, implementation of the developed plan, and evaluation of results. Notably, the assessment of the problem may involve formulating a hypothesis, while the evaluation of results may contribute to the formulation of a subsequent hypothesis. The strength of Watson's theory is that it helps develop a generalized framework for practice that is applicable to various patients and situations. However, the theory is less useful in situations that require a more structured approach to patient care.

While middle-range theories are quite different from grand nursing theories, grand nursing theories provide the basis for some middle-range theories, such as the Self-Care Deficit theory. Compared to grand theories, middle-range theories are more constrained, though not as narrow as situation-specific practice theories. In the past few years, these theories have attracted considerable scientific interest because of their high levels of construction (Andershed & Olsson, 2009, p. 598). Nevertheless, there remains a need to continue examining and promoting the use of middle-range theories in nursing research and practice.

One major reason for ongoing evaluation and promotion of middle-range theories is their high explanatory value in understanding varying phenomena and their ease of application in practice. By assessing these theories, researchers not only examine their relevance but also develop measurement tools and practical models. This process enables assessment of the effectiveness of these theories and clarifies how they can guide nursing research and practice.

Secondly, these theories provide valuable management frameworks for facts being evaluated by interdisciplinary teams. There is a strong need to continue using middle-range theories in research and practice because they benefit nurses and professionals from other disciplines in formulating common phenomena (Smith & Liehr, 2008). The use of these theories in research and practice elevates nurses' work through theory-guided practice. Thirdly, examining middle-range theories should be promoted because their application to individual health behaviors has not been thoroughly assessed in several instances (McDonald, Graham & Grimshaw, 2004, p. 32). Such evaluation will help in developing a complete scientific rationale for nursing intervention to enhance quality of care.