Fundamentals of Nursing Models, Theories, and Practice discusses the theory-practice gap in detail in many chapters. As you’ve read throughout the course, there is ongoing discussion about the connection between theory and practice, and the application in day-to-day nursing activities. This assignment is designed to illustrate that although there may be a gap, other factors play an important role in decision-making and each aspect of theory, research, and practice experience are integral to well-rounded patient care.Click the Paper tab for a link to Fundamentals of Nursing Models, Theories, and Practice and review Figure 1.4 Correlation: education, science and practice.Think of a scenario in which theory, research, and practice interact to create good patient outcomes.Create a visual representation of the theory-practice relationship or gap by replacing the text in the Theory-Practice Gap diagram template. Write a minimum of 525- to 700-word narrative explanation of your visual representation following the diagram.Describe the chosen theory, research, and practice guideline or standard.Explain the relationship between the three and discuss the role each plays in quality patient care in the scenario.Explain any gaps, such as a lack of research, no practice standard, or no useable theory.Determine the best course of action for making decisions in the absence of one aspect.Include documentation of the practice guideline or standard, and your corresponding research, evidence, or literature example.Cite your research and practice guidelines in-text and on the references page at the end of the template.
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Week 5: Theory Practice Gap
Fundamentals of Nursing Models, Theories, and Practice discusses the theory-practice gap in detail
in many chapters. As you’ve read throughout the course, there is ongoing discussion about the
connection between theory and practice, and the application in day-to-day nursing activities. This
assignment is designed to illustrate that although there may be a gap, other factors play an
important role in decision-making and each aspect of theory, research, and practice experience are
integral to well-rounded patient care.
Click the Paper tab for a link to Fundamentals of Nursing Models, Theories, and Practice and
review Figure 1.4 Correlation: education, science and practice.
Think of a scenario in which theory, research, and practice interact to create good patient outcomes.
Create a visual representation of the theory-practice relationship or gap by replacing the text in the
Theory-Practice Gap diagram template.
Write a minimum of 525- to 700-word narrative explanation of your visual representation following
the diagram.
•
•
•
•
Describe the chosen theory, research, and practice guideline or standard.
Explain the relationship between the three and discuss the role each plays in quality patient
care in the scenario.
Explain any gaps, such as a lack of research, no practice standard, or no useable theory.
Determine the best course of action for making decisions in the absence of one aspect.
Include documentation of the practice guideline or standard, and your corresponding research,
evidence, or literature example.
Cite your research and practice guidelines in-text and on the references page at the end of the
template.
Click the Assignment Files tab to submit your completed assignment template, practice guidelines,
and research documentation.
Content: 14points possible
Points possible
Completed an appropriate visual representation
3
Described the chosen theory, research, and practice
guideline or standard
3
Points earned
Content: 14points possible
Points possible
Explained the relationship between the three and
discuss the role each plays in quality patient care in the
scenario.
3
Explained any gaps, such as a lack of research, no
practice standard, or no useable theory
3
Determined the best course of action for making
decisions in the absence of one aspect.
Format:4 points possible
2
Points possible
All formats need an introduction and conclusion.
Papers need to be formatted using APA
Cited a research and practice guidelines in APA format
1
Followed a structure that is clear and concise;
submission is free of grammar and syntax errors
1
Points earned/possible /18
Comments:
Points earned
Points earned
NSG/416
Theory–Practice Gap
The book discusses the theory-practice gap in detail in many chapters. As you’ve read throughout the
course, there is ongoing discussion about the connection between theory and practice and the application
in day-to-day nursing activities. This assignment is designed to illustrate that although there may be a
gap, other factors play an important role in decision making and each aspect of theory, research, and
practice experience are integral to well-rounded patient care.
Return to the classroom to review Figure 1.4 from Fundamentals of Nursing Models, Theories, and
Practice.
Think of a scenario in which theory, research, and practice interact to create a good patient outcomes.
Create a visual representation of your theory-practice relationship or gap using the diagram below by
replacing the text in each box below to illustrate your scenario.
Note: Use names, citiations, or brief explanations only. The narrative summary should include desciptions
and more detailed discussion about each concept in the scenario.
Theory
Research
Science
Nursing Practice
Here, write a 525- to 700-word narrative explanation of your visual representation in APA format. Your
explanation should:
•
•
•
•
Describe the chosen theory, research, and practice guideline or standard
Explain the relationship between the three and discuss the role each aspect plays in quality patient
care in the scenario
Explain any gaps (a lack of research, no practice standard, or no useable theory)
Determine the best course of action for making decisions in the absence of one aspect
Cite your research and practice guidelines in-text and in the references section of this document.
1 The case for nursing theory
Fundamentals of Nursing Models, Theories and Practice, Second Edition. Hugh P.
McKenna, Majda Pajnkihar and Fiona A. Murphy. © 2014 John Wiley & Sons, Ltd.
Published 2014 by John Wiley & Sons, Ltd. Companion
website: www.wileyfundamentalseries.com/nursingmodels
Outline of content
This chapter covers the following: the case for theory; the argument that all intentional and
rational actions, including nursing actions, by definition must have an underlying theory; an
initial definition of theory; how theory and practice become integrated in nursing praxis.
Learning outcomes
At the end of this chapter you should be able to:
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1. Understand what nursing theory is
2. Define theory
3. Understand the construction/development of a theory
4. Discuss the relationship between nursing theory and science
5. Evaluate the relationship between nursing theory and practice
6. Know the limitations of the nursing theory
7. Understand the importance of nursing theory for contemporary nursing
Introduction
Before nursing students and registered nurses recognise the content and function of theory, they
often ask themselves question such as the following. What are nursing theories? Why study
them? What has this got to do with nursing? How can something that is divorced from action,
that is by definition abstract and conjectural, be of value to something like nursing, which is one
of the most practical of activities?
This book will help to answer these questions. Theories exist everywhere in society. There are
numerous theories of the family, of the internal combustion engine, of how cancer cells multiply,
of changes in the weather. There are even lots of theories as to who killed President John F.
Kennedy or Marilyn Monroe. The world is full of theories, some tested as accurate, some
untested and some speculative. It is no surprise, then, that there are theories of nursing. But what
do theories do? In essence, they are simply used to describe, explain or predict phenomena
(see Reflective Exercise 1.1). This will be explored in detail later.
Reflective Exercise 1.1: Theory
Write down or discuss with other people two different theories for one of the following:
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• the break-up of the Beatles
• the assassination of John F. Kennedy
• global warming
• newborn babies smiling when spoken to
Consider if there is the basis of truth in any of these theories.
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Now, none of the theories that you outlined for any of the topics in Reflective Exercise 1.1 may
be true. In fact, they may be erroneous or downright preposterous. The point is that we all use
theories to explain what goes on in our lives or in the world. But if you wanted to, you could
probably test or find out whether your theories are true. Later on in this chapter we will outline
what theories are made of and how they are formed.
In many ways, theories are like maps. Maps are used to give us directions or to help us find our
way in a complicated landscape or terrain. Maps often make simple what is a very complex
picture. At their best, nursing theories also give us directions as to how to best care for patients.
But why have we got so many nursing theories (over 50 at last count)? If you take any large city,
there are many maps. For instance, in London, there are street maps, underground maps,
electricity supply maps, Ordinance Survey maps and so on. Consider the London Underground
map or the Moscow or Paris Metro maps – they are simple and easy to follow but they do not
look anything like the complex reality of the underground networks they represent. In other
words, they make a complex system understandable.
Similarly, nursing is highly complex and we need different theories to help us understand what is
going on. A theory that can be used in emergency care may not be much use in mental health
care, and a theory that can be used to help nurses in a busy surgical ward may be of little use in
community care.
Nursing theories can provide frameworks for practice and in many clinical settings they have
been used in the assessment of patients’ needs. For instance, in the UK one of the most popular
nursing theories was designed by three nurses who worked at Edinburgh University – Nancy
Roper, Winifred Logan and Alison Tierney. They based their theory on the work of an American
nurse called Virginia Henderson. Her theory outlined how nurses should be focused on
encouraging patients to be independent in certain activities of daily living (ADLs) such as
sleeping, eating, mobilising etc. Roper et al. took this a step further by identifying 12 ADLs.
They stressed that it was the nurses’ role to prevent people having problems with these ADLs. If
this could not be achieved then nurses should help the patients to be independent in the ADLs. If
this was not possible then nurses should give the patient and/or the patient’s family the
knowledge and skills to cope with their dependence on the ADLs. Many clinical nurses used the
ADL theory to assess patients. They simply see how independent the patient is for each ADL and
then focus their care on those for which the patient is dependent.
Therefore, theory can help us to carry out an individual patient’s care and can contribute to better
observation and recognition of specific patient needs, be they biological, social or psychological.
Nursing theories are often derived from practice. In other words, nursing theorists have
constructed their theories based on what they have experienced when working with patients and
their families. Understanding the basic elements of a theory and its role, as well as taking a
critical view of it, can help to develop a body of knowledge that nurses need for everyday work.
In this book we want to highlight the need for and use of nursing theory and its function. We will
try to convince you of the importance of nursing theories to the nursing profession, to nursing
education and especially to practice. This first chapter will introduce you to new words and ideas
and it will take some concentration to understand the terminology. You may decide to read it in
small doses, rather than all of it in one sitting. However, once you have mastered this first
chapter, the rest of the book will be relatively easy to understand and, believe it or not,
enjoyable. Several aspects of nursing theory are discussed in later chapters, and when reading
those, dipping back into this first chapter will be helpful. Have a look at Reflective Exercise 1.2.
Reflective Exercise 1.2: Terminology
When you get involved in a new subject, you often have to learn new words to understand the
topic. If you are a nursing student, you have had to learn many new anatomical or psychological
words and phrases. Also, think of all the new words you would have to learn to take on any of
the following hobbies:
• photography
• astronomy
• music
• gardening
See how many more you can think of. People accept learning new terms as part of understanding
something in which they have an interest. The same is true in nursing theory.
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The necessity and meaning of theory
Some people argue that in the real world of practice most nurses are not concerned with theories
and that they are of interest only to nursing academics. However, our position is that there is no
such thing as nursing without theory, because there is no such thing as atheoretical nursing.
Nursing is theory in action and every nursing act finds its basis in some theory. For instance, if a
nurse is talking to a patient, she may be using communication theory. At its simplest, a
communication theory would include a speaker, a listener, a message and understanding between
the speaker and the listener. Similarly, if she is putting a dressing on a patient, she may be using
a theory of asepsis from the field of microbiology. Nurses may not always have a named theory
in mind or they may even reject the notion that they are using a theory at all. Yet nurses do what
they do for a reason and where there is a reason or purpose in mind, there is, more often than
not, a theory.
When providing care to a patient, we are doing something in a purposeful manner. While doing
it, we are seeking to understand, to uncover meaning, to determine how we should act on the
basis of our understanding. This process describes theorising or theory construction. In this
sense, theory is not some rarefied academic pursuit, but something that every nurse employs
many times a day.
From the moment we start to think about something intentionally, we are constructing a theory.
When we speak of construction, we are referring to how something is built or how the parts are
put together to form a whole structure. Frequently we are referring to a building that has been
constructed, such as a house or a bridge. When we bring thoughts together to form some
understanding, we are also constructing. In this instance we are producing a mental building that
has about it a sense of wholeness, which can be explained and shared with others through
language.
This draws attention to another significant aspect of this process: when we think, we do so in
language. A set of symbols that label the mental images are constructed, made up of our thoughts
and the connections we make between them. In daily life too, people use different words and
symbols to express meaning. In the same way, all theorists constructing their own theory use
their own language and symbols to express and describe the theory. For example, an American
nurse theorist, Jean Watson (1979), developed a theory that differentiates nursing from medicine,
and advocates a moral stance on caring and nursing as a service driven by specific value systems
regarding human caring. According to this theory, the purpose of nursing is to preserve the
dignity of clients.
Similarly, another American theorist, Dorothy Orem (1991) began to see that most people are
self-caring, e.g. they feed themselves, they get themselves out of bed and they wash themselves.
This is a normal way of living for most of the population. Orem saw that self-caring is very
important for the preservation of dignity and independence. How would you feel if someone
started feeding you or helping you to walk when you could do these things very well yourself?
Her theory focused on encouraging patients and helping them towards as much self-caring as
possible (Pajnkihar 2003).
Therefore, theory involves thinking (describing) and seeking meanings and connections
(explaining), and often leads to actions (predicting). Such knowledge included in different
nursing theories can help not only to describe and explain what is significant about patient care,
but also to assist with the prediction of what would work with different patients’ problems
(Pajnkihar 2003). As we outlined earlier, there are many nursing theories to help us describe,
explain or predict caring practices. However, we need to be selective in the use of theories and
this will be dealt with in a later chapter. We can, of course, adopt, adapt or develop our own
theories, but many of the existing ones have been researched and found to be useful guides for
practice and so might be more useful than simply constructing our own. But as with the map
analogy discussed earlier, we need to consider them as guides that inform our actions
(Meleis 1997, 2007). It has been said that there is nothing as practical as a good theory, so
theories only have value if they can be applied in practice.
Theory defined
The issue of what theory actually is will be returned to frequently in this and subsequent
chapters. There are almost as many definitions of theory as there are nursing theories. Various
definitions are offered here with the intention of showing differences in describing and defining
what a nursing theory is.
To best understand the various definitions of theory, it would be useful to describe the bits that
make up a theory – the working parts of a theory. We have already alluded to some of these. For
instance, theories describe, explain or predict phenomena. The singular of phenomena is
phenomenon. But what, you may ask, are phenomena? Put simply, phenomena are things we
witness through our senses. So a patient falling is a phenomenon, a dog barking is a phenomenon
and a wet floor is a phenomenon. Kennedy’s assassination was a phenomenon and wound
healing is a phenomenon (see Reflective Exercise 1.3).
Reflective Exercise 1.3: Phenomena
Consider your average day in class or at work. Identify five phenomena that you have seen,
heard, smelled, touched or tasted.
As you have read, theories seek to explain, describe or predict these phenomena.
When we put a name to a phenomenon, it becomes a concept. To take the examples discussed
earlier of a patient falling, a dog barking, a wet floor and an assassination are all concepts. They
tend to encapsulate what the phenomenon is. If we can define the concepts, they help clarify our
view of the phenomena. So, concepts are the building blocks of a theory (see Reflective
Exercise 1.4).
Reflective Exercise 1.4: Concepts
See if you can put a label or name to the five phenomena you identified in Reflective Exercise
1.3. If you can provide a name such that any other person hearing it would know what the
phenomenon is then so much the better. Try to define each of the concepts in one sentence.
When two or more concepts are linked, this is called a proposition. The obvious proposition from
one of the concepts introduced earlier would be the link between a wet floor and a patient falling.
So a proposition would be that the patient fell because of the wet floor. This would be termed a
causal proposition. There are different types of propositions and, as you will see in the following,
they can be seen as the cement or mortar that binds the concepts (bricks) together to form the
structure (a theory) (see Reflective Exercise 1.5).
Reflective Exercise 1.5: Proposition
Consider the names (concepts) you gave to your five phenomena in Reflective Exercise 1.4.
Think of other possible concepts they could be linked to. For example, let’s say one of your
phenomena was seeing a car crash on your way to work or to class. The name you put on this to
make it a concept was ‘road traffic accident’. Anyone seeing this concept would know what the
phenomenon was. What other concepts in the situation could be linked to this concept? Let’s say
that the traffic lights were not working at that junction or the road was wet and slippery. These
are also phenomena and can be expressed as concepts. When you form linkages or relationships
between different phenomena, you are developing propositions.
Another term that you will find when you study nursing theory is assumption. An assumption is
something that you accept as true even though it has not been tested. For instance, I think readers
can assume that people are composed of biological, psychological and social dimensions. If you
take the example of the car crash, you may assume that the driver did not want to crash (see Key
Concepts 1.1).
Key Concepts 1.1
Phenomenon: something that you experience through your senses
Concept: a name given to a phenomenon
Proposition: a statement that links concepts together different types of relationships
Assumption: something that you take for granted even though it has not been proved or tested
From these exercises you will hopefully be able to understand some of the definitions that exist
to explain nursing theory. For example, Dickoff an …
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