Nursing Theories and Nursing Practice
·-• •• Fourth Edition
Nursing Theories and Nursing Practice
Nursing Theories & Nursing Practice Fourth Edition
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Nursing Theories & Nursing Practice Fourth Edition
Marlaine C. Smith, PhD, RN, AHN-BC, FAAN
Marilyn E. Parker, PhD, RN, FAAN
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Library of Congress Cataloging-in-Publication Data
Nursing theories and nursing practice. Nursing theories & nursing practice / [edited by] Marlaine C. Smith, Marilyn E. Parker. — Fourth edition.
p. ; cm. Preceded by Nursing theories and nursing practice / [edited by] Marilyn E. Parker, Marlaine C. Smith.
3rd ed. c2010. Includes bibliographical references and index. ISBN 978-0-8036-3312-4 (alk. paper) I. Smith, Marlaine C. (Marlaine Cappelli), editor. II. Parker, Marilyn E., editor. III. Title. [DNLM: 1. Nursing Theory—Biography. 2. Nurses—Biography. WY 86] RT84.5 610.7301—dc23
2014047296
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Preface to the Fourth Edition
v
This book offers the perspective that nursing is a professional discipline with a body of knowl- edge that guides its practice. Nursing theories are an important part of this body of knowl- edge, and regardless of complexity or abstrac- tion, they reflect phenomena central to the discipline, and should be used by nurses to frame their thinking, action, and being in the world. As guides, nursing theories are practical in nature and facilitate communication with those we serve as well as with colleagues, stu- dents, and others practicing in health-related services. We hope this book illuminates for the readers the interrelationship between nursing theories and nursing practice, and that this un- derstanding will transform practice to improve the health and quality of life of people who are recipients of nursing care.
This very special book is intended to honor the work of nursing theorists and nurses who use these theories in their day-to-day practice. Our foremost nursing theorists have written for this book, or their theories have been de- scribed by nurses who have comprehensive knowledge of the theorists’ ideas and who have a deep respect for the theorists as people, nurses, and scholars. To the extent possible, contributing authors have been selected by theorists to write about their work. Three middle-range theories have been added to this edition of the book, bringing the total number of middle-range theories to twelve. Obviously, it was not possible to include all existing middle-range theories in this volume; how- ever, the expansion of this section illustrates the recent growth in middle-range theory de- velopment in nursing. Two chapters from the third edition, including Levine’s conservation
theory and Paterson & Zderad’s humanistic nursing have been moved to supplementary on- line resources at http://davisplus.fadavis.com.
This book is intended to help nursing stu- dents in undergraduate, masters, and doctoral nursing programs explore and appreciate nurs- ing theories and their use in nursing practice and scholarship. In addition, and in response to calls from practicing nurses, this book is in- tended for use by those who desire to enrich their practice by the study of nursing theories and related illustrations of nursing practice. The contributing authors describe theory de- velopment processes and perspectives on the theories, giving us a variety of views for the twenty-first century and beyond. Each chapter of the book includes descriptions of a theory, its applications in both research and practice, and an example that reflects how the theory can guide practice. We anticipate that this overview of the theory and its applications will lead to deeper exploration of the theory, lead- ing students to consult published works by the theorists and those working closely with the theory in practice or research.
There are six sections in the book. The first provides an overview of nursing theory and a focus for thinking about evaluating and choos- ing a nursing theory for use in practice. For this edition, the evolution of nursing theory was added to Chapter 1. Section II introduces the work of early nursing scholars whose ideas provided a foundation for more formal theory development. The nursing conceptual models and grand theories are clustered into three parts in Sections III, IV, and V. Section III contains those theories classified within the interactive-integrative paradigm, and those in
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the unitary-transformative paradigm are in- cluded in Section IV. Grand theories that are focused on the phenomena of care or caring appear in Section V. The final section contains a selection of middle-range theories.
An outline at the beginning of each chapter provides a map for the contents. Major points are highlighted in each chapter. Since this book focuses on the relationship of nursing theory to nursing practice, we invited the authors to share a practice exemplar. You will notice that some practice exemplars were writ- ten by someone other than the chapter author. In this edition the authors also provided content about research based on the theory. Because of page limitations you can find additional chapter content online at http:// davisplus.fadavis.com. While every attempt was made to follow a standard format for each of the chapters throughout the book, some of the chapters vary from this format; for exam- ple, some authors chose not to include practice exemplars.
The book’s website features materials that will enrich the teaching and learning of these nursing theories. Materials that will be helpful for teaching and learning about nursing theo- ries are included as online resources. For exam- ple, there are case studies, learning activities, and PowerPoint presentations included on both the instructor and student websites. Other online resources include additional content, more extensive bibliographies and longer biog- raphies of the theorists. Dr. Shirley Gordon and a group of doctoral students from Florida Atlantic University developed these ancillary materials for the third edition. For this edition, the ancillary materials for students and faculty were updated by Diane Gullett, a PhD candi- date at Florida Atlantic University. She devel- oped all materials for the new chapters as well as updating ancillary materials for chapters that appeared in the third edition. We are so grate- ful to Diane and Shirley for their creativity and leadership and to the other doctoral students for their thoughtful contributions to this project .
We hope that this book provides a useful overview of the latest theoretical advances of many of nursing’s finest scholars. We are grateful for their contributions to this book. As
editors we’ve found that continuing to learn about and share what we love nurtures our growth as scholars, reignites our passion and commitment, and offers both fun and frustra- tion along the way. We continue to be grateful for the enthusiasm for this book shared by many nursing theorists and contributing authors and by scholars in practice and research who bring theories to life. For us, it has been a joy to renew friendships with col- leagues who have contributed to past editions and to find new friends and colleagues whose theories enriched this edition.
Nursing Theories and Nursing Practice, now in the fourth edition, has roots in a series of nursing theory conferences held in South Florida, beginning in 1989 and ending when efforts to cope with the aftermath of Hurricane Andrew interrupted the energy and resources needed for planning and offering the Fifth South Florida Nursing Theory Conference. Many of the theorists in this book addressed audiences of mostly practicing nurses at these conferences. Two books stimulated by those conferences and published by the National League for Nursing are Nursing Theories in Practice (1990) and Patterns of Nursing Theories in Practice (1993).
For me (Marilyn), even deeper roots of this book are found early in my nursing career, when I seriously considered leaving nursing for the study of pharmacy. In my fatigue and frus- tration, mixed with youthful hope and desire for more education, I could not answer the question “What is nursing?” and could not dis- tinguish the work of nursing from other tasks I did every day. Why should I continue this work? Why should I seek degrees in a field that I could not define? After reflecting on these questions and using them to examine my nursing, I could find no one who would con- sider the questions with me. I remember being asked, “Why would you ask that question? You are a nurse; you must surely know what nurs- ing is.” Such responses, along with a drive for serious consideration of my questions, led me to the library. I clearly remember reading se – veral descriptions of nursing that, I thought, could just as well have been about social work or physical therapy. I then found nursing
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defined and explained in a book about educa- tion of nurses written by Dorothea Orem. During the weeks that followed, as I did my work of nursing in the hospital, I explored Orem’s ideas about why people need nursing, nursing’s purposes, and what nurses do. I found a fit between her ideas, as I understood them, with my practice, and I learned that I could go even further to explain and design nursing according to these ways of thinking about nursing. I discovered that nursing shared some knowledge and practices with other serv- ices, such as pharmacy and medicine, and I began to distinguish nursing from these related fields of practice. I decided to stay in nursing and made plans to study and work with Dorothea Orem. In addition to learning about nursing theory and its meaning in all we do, I learned from Dorothea that nursing is a unique discipline of knowledge and professional prac- tice. In many ways, my earliest questions about nursing have guided my subsequent study and work. Most of what I have done in nursing has been a continuation of my initial experience of the interrelations of all aspects of nursing scholarship, including the scholarship that is nursing practice. Over the years, I have been privileged to work with many nursing scholars, some of whom are featured in this book. My love for nursing and my respect for our discipline and practice have deepened, and knowing now that these values are so often shared is a singular joy.
Marlaine’s interest in nursing theory had similar origins to Marilyn’s. As a nurse pursu- ing an interdisciplinary master’s degree in pub- lic health, I (Marlaine) recognized that while all the other public health disciplines had some unique perspective to share, public health nursing seemed to lack a clear identity. In search of the identity of nursing I pursued a second master’s in nursing. At that time nurs- ing theory was beginning to garner attention, and I learned about it from my teachers and mentors Sr. Rosemary Donley, Rosemarie Parse, and Mary Jane Smith. This discovery was the answer I was seeking, and it both expanded and focused my thinking about nursing. The question of “What is nursing?” was answered for me by these theories and I couldn’t get
enough! It led to my decision to pursue my PhD in Nursing at New York University where I studied with Martha Rogers. During this same time I taught at Duquesne University with Rosemarie Parse and learned more about Man-Living-Health, which is now humanbe- coming. I conducted several studies based on Rogers’ conceptual system and Parse’s theory. At theory conferences I was fortunate to dialogue with Virginia Henderson, Hildegard Peplau, Imogene King, and Madeleine Leininger. In 1988 I accepted a faculty posi- tion at the University of Colorado when Jean Watson was Dean. The School of Nursing was guided by a caring philosophy and framework and I embraced caring as a central focus of the discipline of nursing. As a unitary scholar, I studied Newman’s theory of health as expand- ing consciousness and was intrigued by it, so for my sabbatical I decided to study it further as well as learn more about the unitary appre- ciative inquiry process that Richard Cowling was developing.
We both have been fortunate to hold faculty appointments in universities where nursing the- ory has been valued, and we are fortunate today to hold positions at the Christine E. Lynn Col- lege of Nursing at Florida Atlantic University, where faculty and students ground their teach- ing scholarship and practice on caring theories, including nursing as caring, developed by Dean Anne Boykin and a previous faculty member at the College, Savina Schoenhofer. Many faculty colleagues and students continue to help us study nursing and have contributed to this book in ways we would never have adequate words to acknowledge. We are grateful to our knowl- edgeable colleagues who reviewed and offered helpful suggestions for chapters of this book, and we sincerely thank those who contributed to the book as chapter authors. It is also our good fortune that many nursing theorists and other nursing scholars live in or visit our lovely state of Florida. Since the first edition of this book was published, we have lost many nursing theorists. Their work continues through those refining, modifying, testing, and expanding the theories. The discipline of nursing is expanding as research and practice advances existing theories and as new theories emerge. This is especially
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important at a time when nursing theory can provide what is missing and needed most in health care today.
All four editions of this book have been nur- tured by Joanne DaCunha, an expert nurse and editor for F. A. Davis Company, who has shep- herded this project and others because of her love of nursing. Near the end of this project Joanne retired, and Susan Rhyner, our new ed- itor, led us to the finish line. We are both grate- ful for their wisdom, kindness, patience and understanding of nursing. We give special thanks to Echo Gerhart, who served as our con- tact and coordinator for this project. Marilyn thanks her husband, Terry Worden, for his abiding love and for always being willing to help,
and her niece, Cherie Parker, who represents many nurses who love nursing practice and scholarship and thus inspire the work of this book. Marlaine acknowledges her husband Brian and her children, Kirsten, Alicia, and Brady, and their spouses, Jonathan Vankin and Tori Rutherford, for their love and understand- ing. She honors her parents, Deno and Rose Cappelli, for instilling in her the love of learning, the value of hard work, and the importance of caring for others, and dedicates this book to her granddaughter Iyla and the new little one who is scheduled to arrive as this book is released.
Marilyn E. Parker, Marlaine C. Smith, Olathe, Kansas Boca Raton, Florida
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Nursing Theorists
ix
Elizabeth Ann Manhart Barrett, PhD, RN, FAAN Professor Emerita Hunter College City University of New York New York, New York Charlotte D. Barry, PhD, RN, NCSN, FAAN Professor of Nursing Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida Anne Boykin, PhD, RN* Dean and Professor Emerita Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida Barbara Montgomery Dossey, PhD, RN, AHN-BC, FAAN,
HWNC-BC Co-Director, International Nurse Coach
Association Core Faculty, Integrative Nurse Coach
Certificate Program Miami, Florida Joanne R. Duffy, PhD, RN, FAAN Endowed Professor of Research and
Evidence-based Practice and Director of the PhD Program
West Virginia University Morgantown, West Virginia Helen L. Erickson* Professor Emerita University of Texas at Austin Austin, Texas Lydia Hall†
Virginia Henderson†
Dorothy Johnson†
Imogene King†
Katharine Kolcaba, PhD, RN Associate Professor Emeritus Adjunct The University of Akron Akron, Ohio Madeleine M. Leininger†
Patricia Liehr, PhD, RN Professor Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida Rozzano C. Locsin, PhD, RN Professor Emeritus Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida Afaf I. Meleis, PhD, DrPS(hon), FAAN Professor of Nursing and Sociology University of Pennsylvania Philadelphia, Pennsylvania Betty Neuman, PhD, RN, PLC, FAAN Beverly, Ohio Margaret Newman, RN, PhD, FAAN Professor Emerita University of Minnesota College of Nursing Saint Paul, Minnesota Dorothea E. Orem†
Ida Jean Orlando (Pelletier)†
Marilyn E. Parker, PhD, RN, FAAN Professor Emerita Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida
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Rosemarie Rizzo Parse, PhD, FAAN Distinguished Professor Emeritus Marcella Niehoff School of Nursing Loyola University Chicago Chicago, Illinois Hildegard Peplau†
Marilyn Anne Ray, PhD, RN, CTN Professor Emerita Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida Pamela G. Reed, PhD, RN, FAAN Professor University of Arizona Tucson, Arizona Martha E. Rogers†
Sister Callista Roy, PhD, RN, FAAN Professor and Nurse Theorist William F. Connell School of Nursing Boston College Chestnut Hill, Massachusetts Savina O. Schoenhofer, PhD, RN Professor of Nursing University of Mississippi Oxford, Mississippi Marlaine C. Smith, PhD, RN, AHN-BC, FAAN Dean and Helen K. Persson Eminent Scholar Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida
Mary Jane Smith, PhD, RN Professor West Virginia University Morgantown, West Virginia Mary Ann Swain, PhD Professor and Director, Doctoral Program Decker School of Nursing Binghamton University Binghamton, New York Kristen M. Swanson, PhD, RN, FAAN Dean Seattle University Seattle, Washington Evelyn Tomlin*
Joyce Travelbee†
Meredith Troutman-Jordan, PhD, RN Associate Professor University of North Carolina Chapel Hill, North Carolina Jean Watson, PhD, RN, AHN-BC, FAAN Distinguished Professor Emeritus University of Colorado at Denver—Anschutz
Campus Aurora, Colorado Ernestine Wiedenbach†
x Nursing Theorists
*Retired †Deceased
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Contributors
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Patricia Deal Aylward, MSN, RN, CNS Assistant Professor Santa Fe Community College Gainesville, Florida
Howard Karl Butcher, PhD, RN, PMHCNS-BC Associate Professor University of Iowa Iowa City, Iowa
Lynne M. Hektor Dunphy, PhD, APRN-BC Associate Dean for Practice and Community
Engagement Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida
Laureen M. Fleck, PhD, FNP-BC, FAANP Associate Faculty Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida
Maureen A. Frey, PhD, RN*
Shirley C. Gordon, PhD, RN Professor and Assistant Dean Graduate Practice
Programs Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida
*Retired.
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xii Contributors
Diane Lee Gullett, RN, MSN, MPH Doctoral Candidate Christine E. Lynn College of NursingFlorida
Atlantic University Boca Raton, Florida
Donna L. Hartweg, PhD, RN Professor Emerita and Former Director Illinois Wesleyan University Bloomington, Illinois
Bonnie Holaday, PhD, RN, FAAN Professor Clemson University Clemson, South Carolina
Beth M. King, PhD, RN, PMHCNS-BC Assistant Professor and RN-BSN Coordinator Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida
Lois White Lowry, DNSc, RN* Professor Emerita East Tennessee State University Johnson City, Tennessee
Violet M. Malinski, PhD, MA, RN Associate Professor College of New Rochelle New Rochelle, New York
Mary B. Killeen, PhD, RN, NEA-BC Consultant Evidence Based Practice Nurse Consultants,
LLC Howell, Michigan
Ann R. Peden, RN, CNS, DSN Professor and Chair Capital University Columbus, Ohio
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Contributors xiii
Margaret Dexheimer Pharris, PhD, RN, CNE, FAAN Associate Dean for Nursing St. Catherine University St. Paul, Minnesota
Maude Rittman, PhD, RN Associate Chief of Nursing Service for Research Gainesville Veteran’s Administration
Medical Center Gainesville, Florida
Christina L. Sieloff, PhD, RN Associate Professor Montana State University Billings, Montana
Jacqueline Staal, MSN, ARNP, FNP-BC PhD Candidate Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida
Marian C. Turkel, PhD, RN, NEA-BC, FAAN Director of Professional Nursing Practice Holy Cross Medical Center Fort Lauderdale, Florida
Pamela Senesac, PhD, SM, RN Assistant Professor University of Massachusetts Shrewsbury, Massachusetts
Hiba Wehbe-Alamah, PhD, RN, FNP-BC, CTN-A Associate Professor University of Michigan-Flint Flint, Michigan
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xiv Contributors
Terri Kaye Woodward, MSN, RN, CNS, AHN-BC, HTCP Founder Cocreative Wellness Denver, Colorado
Kelly White, RN, PhD, FNP-BC Assistant Professor South University West Palm Beach, Florida
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Reviewers
xv
Ferrona Beason, PhD, ARNP Assistant Professor in Nursing Barry University – Division of Nursing Miami Shores, Florida Abimbola Farinde, PharmD, MS Clinical Pharmacist Specialist Clear Lake Regional Medical Center Webster, Texas Lori S. Lauver, PhD, RN, CPN, CNE Associate Professor Jefferson School of Nursing Thomas Jefferson University Philadelphia, Pennsylvania Elisheva Lightstone, BScN, MSc Professor Department of Nursing Seneca College King City, Ontario, Canada
Carol L. Moore, PhD, APRN, CNS Assistant Professor of Nursing, Coordinator,
Graduate Nursing Studies Fort Hays State University Hays, Kansas Kathleen Spadaro, PhD, PMHCNS, RN MSN Program Co-coordinator & Assistant
Professor of Nursing Chatham University Pittsburgh, Pennsylvania
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Contents
xvii
Section I An Introduction to Nursing Theory, 1
Chapter 1 Nursing Theory and the Discipline of Nursing, 3 Marlaine C. Smith and Marilyn E. Parker
Chapter 2 A Guide for the Study of Nursing Theories for Practice, 19 Marilyn E. Parker and Marlaine C. Smith
Chapter 3 Choosing, Evaluating, and Implementing Nursing Theories for Practice, 23
Marilyn E. Parker and Marlaine C. Smith
Section II Conceptual Influences on the Evolution of Nursing Theory, 35
Chapter 4 Florence Nightingale’s Legacy of Caring and Its Applications, 37 Lynne M. Hektor Dunphy
Chapter 5 Early Conceptualizations About Nursing, 55 Shirley C. Gordon
Chapter 6 Nurse-Patient Relationship Theories, 67 Ann R. Peden, Jacqueline Staal, Maude Rittman, and Diane Lee Gullett
Section III Conceptual Models/Grand Theories in the Integrative- Interactive Paradigm, 87
Chapter 7 Dorothy Johnson’s Behavioral System Model and Its Applications, 89
Bonnie Holaday
Chapter 8 Dorothea Orem’s Self-Care Deficit Nursing Theory, 105 Donna L. Hartweg
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Chapter 9 Imogene King’s Theory of Goal Attainment, 133 Christina L. Sieloff and Maureen A. Frey
Chapter 10 Sister Callista Roy’s Adaptation Model, 153 Pamela Sensac and Sister Callista Roy
Chapter 11 Betty Neuman’s Systems Model, 165 Lois White Lowry and Patricia Deal Aylward
Chapter 12 Helen Erickson, Evelyn Tomlin, and Mary Ann Swain’s Theory of Modeling and Role Modeling, 185
Helen L. Erickson
Chapter 13 Barbara Dossey’s Theory of Integral Nursing, 207 Barbara Montgomery Dossey
Section IV Conceptual Models and Grand Theories in the Unitary–Transformative Paradigm, 235
Chapter 14 Martha E. Rogers Science of Unitary Human Beings, 237 Howard Karl Butcher and Violet M. Malinski
Chapter 15 Rosemarie Rizzo Parse’s Humanbecoming Paradigm, 263 Rosemarie Rizzo Parse
Chapter 16 Margaret Newman’s Theory of Health as Expanding Consciousness, 279
Margaret Dexheimer Pharris
Section V Grand Theories about Care or Caring, 301
Chapter 17 Madeleine Leininger’s Theory of Culture Care Diversity and Universality, 303
Hiba Wehbe-Alamah
Chapter 18 Jean Watson’s Theory of Human Caring, 321 Jean Watson
Chapter 19 Theory of Nursing as Caring, 341 Anne Boykin and Savina O. Schoenhofer
Section VI Middle-Range Theories, 357
Chapter 20 Transitions Theory, 361 Afaf I. Meleis
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Chapter 21 Katharine Kolcaba’s Comfort Theory, 381 Katharine Kolcaba
Chapter 22 Joanne Duffy’s Quality-Caring Model©, 393 Joanne R. Duffy
Chapter 23 Pamela Reed’s Theory of Self-Transcendence, 411 Pamela G. Reed
Chapter 24 Patricia Liehr and Mary Jane Smith’s Story Theory, 421 Patricia Liehr and Mary Jane Smith
Chapter 25 The Community Nursing Practice Model, 435 Marilyn E. Parker, Charlotte D. Barry. and Beth M. King
Chapter 26 Rozzano Locsin’s Technological Competency as Caring in Nursing, 449
Rozzano C. Locsin
Chapter 27 Marilyn Anne Ray’s Theory of Bureaucratic Caring, 461 Marilyn Anne Ray and Marian C. Turkel
Chapter 28 Troutman-Jordan’s Theory of Successful Aging, 483 Meredith Troutman-Jordan
Chapter 29 Barrett’s Theory of Power as Knowing Participation in Change, 495
Elizabeth Ann Manhart Barrett
Chapter 30 Marlaine Smith’s Theory of Unitary Caring, 509 Marlaine C. Smith
Chapter 31 Kristen Swanson’s Theory of Caring, 521 Kristen M. Swanson
