APPLICATION OF THEORY INTO NURSING PRACTICE

Nurses have traditionally based nursing practice on their experiences or the way they
were taught. These methods are not necessarily based on scientific practice. Practice that
is based on theories makes it possible to derive a rationale for nursing action. Therefore,
practice must be based on a sound theoretical background. As the science of the nursing
develops, nurses will be able to accurately understand and explain the past events, and
predict the future events. Practice based on science will support the image of nursing as a
discipline.

Concept: Chinn and Jacobs define a concept as “a complex mental formulation of an

object, property or event, that is derived from individual perception and experience
(1983, page 200). The concepts are the basic components of theory.

Concepts are said to be “empirical, inferential or abstract depending on their ability to be

observed in the real world” (George, 1990, page 2). For example, empirical concepts
refer to what we can observe directly in the real world, the pen, knife, patients bed;
whereas the inferential concepts refer to those indirectly observed as pain, and abstract
concepts are ideas that are difficult to observe either directly or indirectly, such as stress,
state of health.

Model : Models are pictorial or diagrammatically representation of a proposition where

propositions are explained as the statements that explain relationship between the
concepts.

E.g Agent-host environment model, where the agent, host and environments are the
concepts and the triad drawn between these three concepts depicts the model of Agent-
host-environment indicating relationships between these three concepts.

Theory: The word theory is derived from Greek work theoria meaning a “vision”.
Therefore, development of theory is viewed as rational and intellectual process leading to
the discovery of truth. Further, the theories are composed of – concepts, models and
propositions and based on assumptions.

Definitions of Nursing Theory:

“Nursing theory is a set of concept, depositions and propositions that project a systematic
view of phenomena by designating specific interrelationship among concepts for purpose
of describing, explaining, predicting and/or controlling phenomena” (Chinn and Jacob
1983).

Basic Elements of Nursing Theories

Four most significant concepts that describe any nursing theories are
1) The Human or individual,
2) Society/Environment,
3) Health and
4) Nursing actions.

Characteristics of Nursing Theories (George, 1990, p8-9)

1) Theories can interrelate concepts in such a way as to create a different way of looking
at a particular phenomenon.
2) It must be logical in nature.
3) It forms the bases for hypotheses that can be tested.
4) Theories contribute to and assist in increasing the general body of knowledge within
the discipline through the research that validates the concepts.
5) Theories can be used by practitioners to guide and improve their practice.
6) Theories must be consistent with other validated theories, laws and principles.
7) Theories should be simple, yet generalizable.

LEVELS OF THEORY
One method for classification of theories in nursing based on scope is; Meta theory,
grand theory, middle range theory and practice theory.

Meta theory
It refers to theory about theory, focused on generating knowledge and theory
development. Meta theory is very abstract and may not be easily tested; main purposes
are identifying kind of theory needed, developing and analyzing methods for creating
nursing theory and proposing criteria for evaluating theory.

Grand theory / Macro theory

Most complex and broadest in scope, not amenable to testing, provide foundation for a
mid-range theory.

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Middle range theory
Moderately abstract, have a limited number of variables, which are testable in a direct
manner. Have strong relationship with research and practice. Provide basis for generating
testable hypotheses relating to particular nursing phenomena.

Practice / Situation Specific / Micro / Prescriptive theory

Least complex, more specific, narrow in scope, contains few concepts for practice,
limited to specific population.

Nursing theories have also been classified based on type or purpose of theory.
These are:
Factor Isolating theories (Descriptive theories)
Factor relating theories (explanatory theories)
Situation relating theories (predictive theories)
Situation producing theories (prescriptive theories)

Factor isolating theories are those which describe, observe and name concepts,
properties and dimensions.

Factor relating theories are those that relate concepts to one another describe inter-
relationships among concepts or propositions and specify the associations.

Situation relating theories are achieved when the conditions under which concepts are
related are stated and the relational statements are able to describe future outcomes
consistently.

Situation producing theories are those that prescribe activities necessary to reach
defined goals.

Importance of Theories in Nursing

Use of theory offers structure and organization to nursing knowledge and provides a
systematic means of collecting data to describe, explain and predict nursing practice.

 Theory provides nurse with a sound basis to describe, explain and predict factors
that influence nursing care.
 In nursing, caring is the core of nursing practice. As a profession, we need to
develop theoretical knowledge based on research findings to form the foundation
of nursing practice. Therefore, development and validation of nursing theory will
help in strengthening nursing practice.
 Nursing theory is a source of professional autonomy and power.
 It guides nursing education, research and practice and differentiates nursing
practice from other disciplines.

Nursing theory and practice

Theory is considered to be both a process and a product. As a process, theory has
numerous activities.

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 - Analyzing concepts
- Constructing relationships
- Testing relationships
- Validating relationships
- Implementing into practice

As a product theory provides a set of

- Concepts and relationships that may be combined to
 describe
 explain
 predict and
 prescribe phenomenon of interest

This information is then used to guide nursing practice (Kenney 2002)

Relationship between theory and practice

 Practice is the basis for nursing theory development and nursing theory must be
validated in practice.
 Theory is rooted in practice and refined by research, and it should be reapplied in
practice.
 The primary uses of theory are to provide insights about nursing practice
situations and to guide research.
 Research validates, refutes and modifies theory as well as generates new theory.
Theory then guides practice.
 Nurses gain wisdom from their practice experiences and formulate theories that
were generates from their experiences.
 Theory provides nurses with the framework and the goals for assessment
diagnosis and intervention.
 Theory is a tool that renders practice more efficient and more effective and helps
in identifying outcomes.

Uses of application of theory into practice

In a practice discipline such as nursing, theory and practice are inseparable.
 Development and application of theory affiliated with research based practice has
been seen as fundamental to the development of the profession and autonomous
nursing practice. E.g. Dale 1994.
 A nurse who knows theories and principles of the anatomy of soft tissues and the
related physiologic concept of pressure.
 This knowledge allows the nurse to recognize how a pressure sore can develop.
Armed with this knowledge, the nurse can take steps to prevent it.
 Professional autonomy and accountability are supported by theory use in practice.
 Being able to practice by using scientific principles allows nurses the opportunity
to accurately predict patterns of responses that are consequences of care
 Articulation of actions, goals and consequences of actions empowers nurses and
enhances their accountability.

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  Being able to predict consequences increase nurses control of nursing practice and
therefore increase nurses’ autonomy. Fuller (1978) stated – the autonomy of a
profession rests more firmly on the uniqueness of its knowledge.
 A theoretical perspective allows the nurse to plan and implement care
purposefully and proactively and when nurses practice purposefully and
systematically they are more efficient have better control over the outcome of
care, and are better able to communicate that care with others. Thus nurses need
to use theoretical perspectives to help understand which data are important, how
data re related, what can be predicted by relationships and what interventions are
needed to deal with special relationships.

Ways in which theory influences nursing practice

1. Identifies recipients / clients of nursing care.
2. Describes settings and situations in which practice should occur.
3. Defines which data to collect and how to classify the data.
4. Outlines actual and potential problems to be considered.
5. Aids in understanding, analyzing and interpreting health situations.
6. Guides formulation of nursing diagnosis.
7. Describes, explains and sometimes predicts client’s responses.
8. Clarifies objectives and establishes expected outcome.
9. Specifies actions or interventions to be provided.
10. Sets standards for practice.
11. Differentiates nursing practice from practice of other health disciplines.
12. Promotes responsibility and accountability for nursing care.
13. Identifies areas for research.

Theory based nursing practice

It is the application of various models, theories and principles from nursing science and
the biological, behavioral, medical and socio-cultural disciplines to clinical nursing
practice Kenney, 2002
 With increasing clinical experience nurses are able to combine theoretical and
clinical knowledge with critical thinking skills to make better clinical decisions
and thereby improve practice.
 Nursing, like all practice disciplines, uses a special combination of theory and
practice in which theory guides practice and the practice grounds theory.
 Nurses rely heavily on theoretical understanding, and practice will be improved
not just by experience, but by an understanding of theory.
 Theory is needed to explain the ends and means of nursing practice and the nurse
who uses theory based practice will be able to describe, explain, predict and
control nursing events and initiate preventive actions.

Grounds

THEORY PRACTICE

Guides

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Guidelines for application of theory in nursing practice
The application of theory in practice requires an understanding of concepts and principles
associates with the needs of a particular client, group of clients or community and a
recognition of when and how to use these concepts and principles when planning and
implementing nursing care.
Chinn and Kramer (2004) suggested criteria for determining when theory should be
applied in practice.
1. Are theory goals and practice goals congruent?
2. Is the contest of the theory congruent with the practice situation?
3. Is there similarity between theory variables and practice variables?
4. Are explanations of the theory sufficient to be used as a basis for nursing action?
5. Does research evidence support the theory?
6. How can the theory influence nursing practice and the nursing unit?

Nurses role in implementing theory in practice

- To improve the practice of nursing, nurses need to search the literature, critically
appraise research findings, and synthesize empirical and contextually relevant
theoretical information to be applied in practice.
- Nurses must continually question their practice and seek to find better
alternatives.
- Nurse should be aware that theory and research provide the basis for practice.

Application of Theories in Nursing Practice

Nursing as a practice discipline, must concern itself with the development of theory that
will assist the nurse in using relevant knowledge to guide her actions. It is through
nursing theory that this level of knowledge and the depth of understanding can be
increased so that the quality of care will be enhanced.

All of the theorists are concerned with nursing as a discipline that assists man to reach his
optimal health state, but differ in their descriptions as to how this is achieved.
While King spoke of meeting man’s basic needs, Peplau saw the nurse’s interpersonal
relationship. The nurse according to Orem, seeks to influence man’s development in
achieving an optimal level of self-care, where as Roy viewed nursing as promoting man’s
adaptive abilities.

DESCRIPTION OF SELECTED THEORIES

Nursing includes caring; what is caring for one person may be perceived differently by
another person. Since 1960s the nursing theorists have attempted to develop theories that
are unique to nursing.
Interpersonal Theory
Dr. Hildegard Peplau is a dynamic nursing leader whose ideas and beliefs shaped
psychiatric nursing. It was the first systematic, theoretical framework developed for
psychiatric nursing. Her work represents a milestone in the conceptualization of the
psychotherapeutic role of the nurse in the context of the interpersonal relationship.

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She defined nursing as a “significant, therapeutic process”. She believed that the nurse
patient relationship was characterized by four overlapping and interlocking phases:

1. Orientation,
2. Identification,
3. Exploitation and
4. Resolution.

Interpersonal nursing roles have been identified by Peplau; these include the following:
1) Stranger: The role assumed by both nurse and patient when they first meet.
2) Resource person: Provider of health information to a patient who has assumed the
consumer role.
3) Teacher: Refers to one who imparts knowledge with the purpose of assuring the
patient as learner to grow and learn from his/her experience with the health care system.
4) Leader refers to person who carries out the process of initiation and maintains group
goals through interaction.
5) Surrogate refers to one who takes the place of another while assuming roles that have
been assigned by the patient, based on his/her significant past relationships.
6) Counsellor is the person who aids another in recognizing, facing, accepting, resolving
problems that are interfering effectively by helping the patient integrate the facts and
feelings associated with a living episode of illness into his total life experiences.

For example, Peplau described nursing roles relative to the patient’s needs and ability to
function. The unconditional mother-surrogate role related to the actually ill phased and
implied that the nurse would act in maternal nurturing way. When the patient began to
feel better, the nurse would assume a role characterized by some continuation of mother
surrogate functions with the addition of counseling, leadership and resource person’s
activities.

Peplau’s theory application in Nursing Process

Mr.A, 27 years came to the hospital with the following problems, headache, leg pain,
tiredness, loss of appetite, sleep disturbance, suicidal ideations and worthlessness
feelings, diagnosed moderate depression.
Orientation phase – Nursing assessment and diagnosis
Identification phase – Planning and goal setting
Exploitation phase – Implementation
Resolution phase – Evaluation

Application of Peplau Interpersonal Model

Dimensions /states/ patient’s needs - Headache, leg pain, tiredness, sleep and appetite
disturbances, poor coping abilities
Goal : Learning and growing of patient and nurse
Methods: orientation phase- establishing trust and rapport
Identification phase- identifying patient’s problems and resources. Explore
relevant stressors

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 Exploitation phase – facilitate behavioral change, promote patient’s
development of insight into problem, provide opportunities for
independent functioning
Resolution phase – review progress of therapy, fixing next appointment,
giving hope
Principle : in above phases nurse uses interpersonal relationship principles for patient self
growth

Roy’s Adaptation Model Theory

Sr. Calista Roy believes people interact with the environmental stimuli to which they
respond and adapt.

The adaptation mechanisms are regulator and cognator. Adaptation maintains integrity.
The nurse is to help the person adapt by managing the environment. Roy’s theory focuses
on the concept of adaptation of man.

There are five elements in her model.

1. The person refers to the recipient of nursing care – individual, family or community.
2. The goal nursing is defined as the promotion of adaptive, responses that positively
affect health.
3. Nursing activities are the nursing actions that promote adaptive responses in situations
of health and illness.
4. Health: Roy defines health as “a state and process of being and becoming an
integrated and whole person” (Roy, 1984, p.38)
5. The Environment: Roy defines “environment as all conditions, circumstances, and
influences surrounding and affecting the development and behavior of persons and
groups” (Roy, 1984, p.39)

Her concepts of nursing person, health and environment are all interrelated to this central
concept. The person continuously scans the environment for stimuli so he can respond
and ultimately adapt to it. Nursing has a unique goal to assist the person in his adaptation
effort by managing the environment. The result is an attainment of an optimum level of
wellness. As an open living system person receives inputs or stimuli from both the
external environment and the self (i.e. internal environment).

The focal stimuli is the person’s internal or external world that immediately confront the
person;

The contextual stimuli refer to the person’s internal and external world that influence the
situation and are observable, measurable or subjectively reported by the person and does
not include the focal stimuli;

The residual stimulus includes the characteristics of the individual that are relevant to
the situation but are difficult to measure objectively. (George (1990, pp. 382, 385, 389).

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According to Roy adaptation occurs when the person responds positively to
environmental changes. This adaptive response promotes the integrity of the person,
which leads to good health. Ineffective responses to stimuli lead to disruption of the
integrity of the person.

There are two interrelated subsystems in Roy’s model. The primary functional or control
processes subsystem consists of the regulator and the cognator. Roy explains coping
mechanisms as the control process of the person as an adaptive system. She further
explains that some of the coping mechanisms are inherited or genetic, e.g. WBC in the
body defense system. Some of the mechanisms are learned such as patient
himself/herself taking an insulin injection. She further describes cognators and
regulators as coping mechanisms of a person. Regulators are subsystem and include
chemical, neural, endocrine transmitters and autonomic responses whereas cognator
mechanism relates to higher brain functions of perception, learning, judgement, etc. The
secondary effectors subsystem consists of four adaptive modes: physiological function,
self-concept, role function and interdependence. Roy views regulator and cognator as
methods of coping.

Perception of the person links the regulator with the cognator. Perception is a process of
cognator. The responses following perception are feedback into both the cognator and the
regulator. The four adaptive modes of the second subsystem in Roy’s model provide
former manifestations of cognator and regulator activity. Responses to stimuli are carried
out through these four modes. The purpose of modes is to achieve physiological,
psychological and social integrity.

Roy’s theory application in Nursing Process

First level assessment

1. Physiologic and physical mode
- Oxygen
- Nutrition
- Elimination
- Activity and rest
- Fluid and electrolytes
- Neurological function

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 - Endocrine function

2. Self concept mode

- Self-esteem

3. Role performance mode

4. Interdependence mode
- Interaction with others

Second level assessment

Focal stimulus: Suicidal ideations and present symptoms
Contextual stimuli: Financial problems, failure in examination etc.
Residual stimuli : Family history of depression, less coping ability

Nursing care plan

Assessment of behavior Assessment of stimuli Nursing diagnosis

Impaired activity in Focal stimuli due to Impaired physical mobility
physical and physiological depressive disorder his related to decreased energy
mode physical and physiological level, and alterations in
functions are altered. E.g. neuro transmitters
decreased sleep and
appetite, less energy to
work

Goal Intervention Evaluation

Patient will attain maximum Prepare daily activity chart.
physical mobility and Positive reinforcement for
adaptation to physiological even a small improvement
functions to increase the frequency of
the desired activity
Able to follow daily activity
chart ,
Self motivated in doing
minor activities

Orem’s Self Care Deficit Theory

Dorothea Orem described her work as a general theory of nursing comprising three
“articulating” or interrelated theories;
1. Theory of Self-Care,
2. Theory of Self-Care Deficit and
3. Theory of Nursing Systems.

The specific name for Orem’s general theory of nursing is Self-Care Deficit Theory of
Nursing. She chose the name ‘deficit’ as it describes and explains a relationship between
abilities of individuals to care for themselves and the self-care needs or demands of the
individual, their children or the adults for whom they care. The notion of ‘deficit’ does

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not refer to a specific type of limitation, but to the relationship between the capabilities of
the individual and the need for action.

Self Care: Self care refers to the practice of “activities that individuals initiate and
perform on their own behalf in maintaining life, health and well being” (Orem, 1985,
p.84).

Self Care Agency: This refers to the “ability for engaging in self care” by the client.

Self Care Requisites: Self care requisites or requirements can be classified as

(1) Universal (associated with life process, such as air, water)
(2) Developmental (e.g. adjusting to body changes, adjusting to loss of significant other),
and
(3) Health deviation (e.g. conditions due to illness, injury or disease) (Orem, 1985, p.90-
91).

Therapeutic Self care Demand: TSD refers to “totality of self care actions to be
performed to meet the self care requisites by using valid methods and related actions”
(Orem, 1985, p.88).

Self Care Deficit: Self care deficit is determined by the differences between self care
needs and self care capabilities, that is when the needs are more than the abilities of the
patient to perform self care activities.

Nursing System Action: Nursing is required when there is self care deficit, that is, the
care abilities are less than those required for meeting the self care demand (Orem, 1985,
p.35).

Orem has described three systems, these are:

1) Wholly compensatory system (e.g. when individual is unable to perform any form of
deliberate action, such as in coma).

2) Partially compensatory system (e.g. when both nurse and patient perform care because
of patients self care limitations as in the second post operative day after surgery).

3) Supportive-educative system (e.g. when the client is able to perform or can learn to
perform required measures for therapeutic self care as an antenatal mother, requiring
information on nutritious diet.)

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She used these six concepts to express the three constituent theories of the general theory
of nursing.
The concept of self-care, self-care agency, therapeutic self care demand and self care
deficit are related to the patient or the person in need of nursing while the concepts of
nursing agency and nursing system are related to the nursing and their actions.

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Data collection according to Orem’s theory of self care deficit
1. Universal self-care requisites: Air, water, food, elimination, activity, social
interaction, prevention of hazards
2. Developmental self-care requisites: Maintenance of developmental environment,
e.g. able to perform activities of daily living, able to feed etc.
3. Health deviation self care requisites: Adherence to medical regimen, awareness
of potential problems associated with the regimen, adjustment to lifestyle etc.

Applying the orem’s theory of self-care deficit, a nursing care plan

Therapeutic self care demand: deficient area: food

Adequacy of self care agency: inadequate
Nursing diagnosis
Inability to maintain the ideal nutrition related to inadequate intake and knowledge deficit
Outcomes and plan
 Improved nutrition
 Maintenance of a balanced diet

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b. Nursing Goals and objectives
Goal: to achieve optimal levels of nutrition.
Objectives: Mrs. X will:  
state the importance of maintaining a balanced diet.  
List the food items rich in protein that are available in the locality.
c. Design of the nursing system:
Supportive educative
d. Method of helping:
 Guidance
 Support
 Teaching
 Providing developmental environment
Implementation
Mutually planned and identified the objectives and the patient were made to understand
about the required changes in the behavior to have the requisites met.
Evaluation
 Mrs. X understood the importance of maintaining an optimum nutrition.  
 She told that she will select the protein rich diet for her food. 
 She listed the foods that are rich in protein and that are locally available.  
 The self care deficit in terms of food will be decreased with the initiation of the
nutritional intake.
 The supportive educative system was useful for Mrs. X

Psychoanalytical Model
Psychoanalytical model has been derived from the work of Sigmund Freud and his
followers.
Basic assumptions of psychoanalytical model are:
 All human behavior is caused and thus is capable of explanation. Human
behavior, however insignificant or obscure, does not occur randomly or by
chance. Rather, all human behavior is determined by prior life events.
 All human behavior from birth to old age is driven by an energy called the libido.
The goal of the libido is the reduction of tension through the attainment of
pleasure. The libido is closely associated with physiological or instinctual drives
(For example, hunger, thirst, elimination and sex). Release of these drives results
in the reduction of tension and experience of pleasure. Hence, the pleasure
principle becomes operative when pleasure seeking behaviors are used.
 The personality of the human being can be understood by way of three major
hypothetical structures, viz. id, ego and superego. Id represents the most primitive
structure of the human personality. It houses the physiological drives. Human
behavior originating from the id is impulsive, pleasure-oriented, and disconnected
from reality.
 The ego represents that part of the human personality, which is in closest contact
with reality. Unlike the id, ego is capable of postponing pleasure until an
appropriate time, place or object is available. Unlike the superego, the ego is not
driven to blind conformity with rules and regulations. Rather, the ego acting as

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 mediator between the id and superego, gives rise to a much more mature and
adaptive behavior.
 The superego is the personality structure containing the values, legal and moral
regulations and social expectations that thwart free expression of pleasure-seeking
behaviors. The superego thus functions to oppose the id.
 Understandably, humans occasionally experience anxiety when confronted with
situations that challenge the tenuous balance between the id and the superego. At
these times, the ego uses defense mechanisms that include repression, denial,
regression, rationalization, reaction formation, undoing, projection, displacement,
sublimation, isolation, and fixation.
 The human personality functions on three levels of awareness: conscious,
preconscious and unconscious. Consciousness refers to the perception, thoughts
and feelings existing in a person’s immediate awareness. Preconscious content on
the other hand, is not immediately accessible to awareness. Unlike conscious and
preconscious, content in the unconscious remain inaccessible for the most part.
 The unconscious affects all the three personality structures—id, ego and the
superego. Although the id’s content resides totally in the unconscious, the
superego and the ego have aspects in all the three levels of consciousness. The
ego maintains contact with reality, the id and the superego.
 Human personality development unfolds through five innate psychosexual stages
—oral, anal, phallic, latent and genital. Although these stages extend throughout
the lifespan, the first 6 years of life determine the individual’s long-term
personality characteristics.

Psychoanalytical Process
Psychoanalysis, described by Freud, makes use of free association and dream analysis to
affect reconstruction of personality. Free association refers to the verbalization of
thoughts as they occur, without any conscious screening. Analysis of the patient’s dreams
helps to gain additional insight into his problem and the resistances. Thus dreams
symbolically communicate areas of intrapsychic conflict. The therapist then attempts to
assist the patient to recognize his intrapsychic conflicts through the use of interpretation.

The patient is an active participant, freely revealing all thoughts exactly as they occur and
describing all dreams. By termination of therapy, the patient is able to conduct his life
according to an accurate assessment of external reality and is also able to relate to others
uninhibited by neurotic conflicts.

Behavioral Model
Prominent theorists of behavioral theory include Ivan Pavlov, John Watson, BF Skinner,
etc.
Basic assumptions of behavioral model are:
•All behavior is learnt (adaptive and mal-adaptive).
•All behavior occurs in response to a stimulus.
•Human beings are passive organisms that can be conditioned or shaped to do anything if
correct responses are rewarded or reinforced.

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•Maladaptive behavior can be unlearnt and replaced by adaptive behavior if the person
receives exposure to specific stimuli and reinforcement for the desired adaptive behavior.
•Deviations from behavioral norms occur when undesirable behavior has been reinforced.
This behavior is modified through application of learning theory.

Therapeutic Approaches
• Systematic desensitization
• Token reinforcement
• Shaping
• Chaining
• Prompting
• Flooding
• Aversion therapy
• Assertiveness and social skills training

Fundamental Assumptions of cognitive model

Cognitive model is based on the premise that the way a person perceives an event, rather
than the event itself, determines its relevance and the emotional response to it.

- Therapeutic change can be effected through an alteration of idiosyncratic,

dysfunctional modes of thinking, leading to cognitive change.
- These therapies are based on the belief that patients are the architects of their own
misfortune and have control over their thoughts and actions.
- They do not help the patient only to overcome the problem for which he or she is
seeking help, they also help the patient learn something about the process of
therapy and develop therapeutic skills applicable to other problems.
- Cognitive therapy aims at altering the cognitions for effecting a change in
behavior.
- It implies that all psychiatric disorders have some amount of cognition
impairment and an improvement in this enhances the patient’s recovery.

Techniques of cognitive therapy

There are four main groups of cognitive techniques. They are the following:
 Techniques for stopping intrusive cognitions
 Techniques to counterbalance faulty cognitions
 Techniques for altering cognitions
 Techniques to resolve problems directly
Evidence-based practice
 EBP is similar to research based practice. It involves identifying a clinical
problem, searching the literature, critically evaluation the research evidence and
determining appropriate interventions 9Upton, 1999)
 EPB refers to the integration of individual clinical expertise with the best
available external clinical evidence from systematic research.

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Characteristics of EBP
 It is a problem-based approach.
 Brings together the best available evidence and current practice by combining
research with tacit knowledge and theory.
 Facilitates the application of research findings by incorporating first and second
hand knowledge into practice.

Relationship among theory, research and practice

In applied disciplines such as nursing, practice is based on the theories that are validated
through research. Thus, theory, research and practice affect each other in a reciprocal,
cyclical and interactive way.

RESEARCH PRACTICE

THEORY

Relationship between theory and research

Research validates and modifies theory. In nursing theories stimulate nurse scientists to
explore significant problems in the field of nursing. In doing so, the potential for the
development of nursing knowledge increases. Theories can be used to formulate a set of
generalizations to explain relationships among variables. When empirically tested, the
results of research can be used to verify, modify disprove or support a theoretical
proposition.

Relationship between theory and practice

Theory guides practice, one of the primary uses of theory is to contribute insights about
nursing practice situations through provision of goals for assessment, diagnosis and
intervention.
Likewise, through practice, nursing theory is shaped and guidelines for practice evolve.
Theory renders practice more efficient and more effective, and the ultimate benefit of
theory application in nursing is the improvement in client care - Meleis 2005.

Relationship between research and practice

Research is the key to the development of a discipline, Middle range and practice theories
may be tested in practice through clinical research. If individual practitioners are to
develop expertise, they must participate in research.
There is a need to encourage nurses to test and refine theories and models to develop their
own personal models of practice.

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