You are on page 1of 12

Application of Theory in Nursing Process

This page was last updated on January 28, 2012


Theories are a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory & predictive in nature.

Theories are composed of concepts, definitions, models, propositions & are based on assumptions. They are derived through two principal methods; deductive reasoning and inductive reasoning.

pengenalan Teori adalah satu set konsep saling berkait dan yang memberi gambaran yang sistematik fenomena (fakta yang dapat dilihat atau peristiwa) yang penjelasan & ramalan bersifat. Teori terdiri daripada konsep, definisi, model, usul & berdasarkan andaian. Mereka yang diperolehi melalui dua kaedah utama; penaakulan deduktif dan penaakulan induktif.


to assess the patient condition by the various methods explained by the nursing theory to identify the needs of the patient to demonstrate an effective communication and interaction with the patient. to select a theory for the application according to the need of the patient to apply the theory to solve the identified problems of the patient to evaluate the extent to which the process was fruitful.


Nursing theory is an organized and systematic articulation of a set of statements related to questions in the discipline of nursing. "A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing."

C h a r a c t e r i s t i c s o f a U s e f u l T h e o r y [Robert T. Croyle (2005)] A useful theory makes assumptions about a behavior, health problem, target population, or environment that are:

Logical Consistent with everyday observations Similar to those used in previous successful programs and Supported by past research in the same area or related ideas.

Importance of nursing theories

Nursing theory aims to describe, predict and explain the phenomenon of nursing It should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future. Theory is important because it helps us to decide what we know and what we need to know

It helps to distinguish what should form the basis of practice by explicitly describing nursing. The benefits of having a defined body of theory in nursing include better patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education

The main exponent of nursing caring cannot be measured, it is vital to have the theory to analyze and explain what nurses do As medicine tries to make a move towards adopting a more multidisciplinary approach to health care, nursing continues to strive to establish a unique body of knowledge

This can be seen as an attempt by the nursing profession to maintain its professional boundaries

teori Kejururawatan bertujuan untuk menerangkan, meramal dan menerangkan fenomena kejururawatan Ia harus menyediakan asas-asas amalan kejururawatan, membantu untuk menjana pengetahuan lanjut dan nyatakan di mana kejururawatan arah harus membangunkan pada masa akan datang. Teori adalah penting kerana ia membantu kita untuk memutuskan apa yang kita tahu dan apa yang kita perlu tahu Ia membantu untuk membezakan apa yang patut dijadikan asas amalan dengan jelas menggambarkan kejururawatan. Manfaat yang mempunyai badan yang ditakrifkan teori dalam bidang kejururawatan termasuk penjagaan pesakit yang lebih baik, peningkatan status profesional untuk jururawat, komunikasi yang lebih baik antara jururawat dan panduan

bagi penyelidikan dan pendidikan utama pelopor kejururawatan - penyayang - tidak boleh diukur, ia adalah penting untuk mempunyai teori bagi menganalisis dan menjelaskan apa yang jururawat melakukan Sebagai ubat cuba untuk membuat satu langkah ke arah mengguna pakai pendekatan yang lebih daripada pelbagai bidang untuk penjagaan kesihatan, kejururawatan terus berusaha untuk menubuhkan suatu badan pengetahuan yang unik Ini boleh dilihat sebagai percubaan oleh profesion kejururawatan untuk mengekalkan sempadan profesional
Evolution of Nursing Theories & Application

The history of professional nursing begins with Florence nightingale. Later in last century nursing began with a strong emphasis on practice. Following that came the curriculum era which addressed the questions about what the nursing students should study in order to achieve the required standard of nursing.

As more and more nurses began to pursue higher degrees in nursing, there emerged the research era. Later graduate education and masters education was given much importance. The development of the theory era was a natural outgrowth of the research era. With an increased number of researches it became obvious that the research without theory produced isolated information; however research and theory produced the nursing sciences.

Within the contemporary phase there is an emphasis on theory use and theory based nursing practice and lead to the continued development of the theories.

Sejarah profesional kejururawatan bermula dengan Florence bulbul. Kemudian dalam abad yang lalu kejururawatan bermula dengan penekanan yang kuat terhadap praktik. Berikutan itu datang era kurikulum yang dialamatkan soalan tentang apa yang pelajar kejururawatan perlu belajar untuk mencapai standard yang diperlukan kejururawatan. Seperti yang lebih dan lebih ramai jururawat mula mengejar ijazah kejururawatan yang lebih tinggi, muncul era penyelidikan. Pendidikan Kemudian siswazah dan pendidikan sarjana telah diberi kepentingan yang banyak.

pembangunan era teori adalah bungkul semulajadi era penyelidikan. Dengan bilangan meningkat daripada penyelidikan ia menjadi jelas bahawa penyelidikan tanpa teori yang dihasilkan maklumat terpencil; Walau bagaimanapun penyelidikan dan teori yang dihasilkan sains kejururawatan. Dalam fasa kontemporari terdapat satu penekanan terhadap penggunaan teori dan amalan kejururawatan berasaskan teori dan membawa kepada pembangunan yang berterusan daripada teori.
Characteristics of theories Theories are

Interrelating concepts in such a way as to create a different way of looking at a particular phenomenon. Logical in nature. Generalizable. Bases for hypotheses that can be tested. Increasing the general body of knowledge within the discipline through the research implemented to validate them. Used by the practitioners to guide and improve their practice. Consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated.

Purposes of theory in practice

Assist nurses to describe, explain, and predict everyday experiences. Serve to guide assessment, intervention, and evaluation of nursing care. Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation.

Help to establish criteria to measure the quality of nursing care Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed and words defined.

Enhance autonomy (independence and self-governance) of nursing by defining its own independent functions.


Assist nurses to describe, explain, and predict everyday experiences. Serve to guide assessment, interventions, and evaluation of nursing


Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation.

Help to describe criteria to measure the quality of nursing care. Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed and words are defined. Enhance autonomy (independence and self-governance) of nursing through defining its own independent functions.

In Education:

Provide a general focus for curriculum design Guide curricular decision making.

In Research:


Offer a framework for generating knowledge and new ideas. Assist in discovering knowledge gaps in the specific field of study. Offer a systematic approach to identify questions for study; select variables, interpret findings, and validate nursing interventions. Approaches to developing nursing theory Borrowing conceptual frameworks from other disciplines. Inductively looking at nursing practice to discover theories/concepts to explain phenomena. Deductively looking for the compatibility of a general nursing theory with nursing practice. Questions from practicing Nurse about using Nursing theory

Does this theory reflect nursing practice as I know it? Will it support what I believe to be excellent nursing practice? Can this theory be considered in relation to a wide range of nursing situation? Personal Interests, Abilities and Experiences What will it be like to think about nursing theory in nursing practice? Will my work with nursing theory be worth the effort?


If theory is expected to benefit practice, it must be developed cooperatively with people who practice nursing. People who do research and develop theories think differently about theory when they perceive the reality of practice.

Theories do not provide the same type of procedural guidelines for practice as do situation- specific principles and procedures or rules. Procedural rules or principles help to standardize nursing practice and can also be useful in achieving minimum goals of quality of care. Theory is ought to improve the nursing practice. One of the most common ways theory has been organized in practice is in the nursing process of analyzing assessment data.

References 1. Alligood M R, Tomey A M. Nursing Theory: Utilization &Application .3rd ed. Missouri: Elsevier Mosby Publications; 2002. 2. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002 3. George JB .Nursing Theories: The Base for Professional Nursing Practice .5th ed. New Jersey :Prentice Hall;2002. 4. Croyle RT. Theory at a Glance: Application to Health Promotion and Health Behavior (Second Edition). U.S. Department of Health and Human Services, National Institutes of Health, 2005. Available at

CONTAGION - A Harvard University Library Open Collection Program o Notable People -Florence Nightingale o International Statistical Congress, Second Section: Sanitary Statistics. o Notes on Nursing: What It Is, and What It Is Not. o Notes on Nursing for the Labouring Classes. o Notes on HospitalsRural Hygiene o How People May Live and Not Die in India


Entrez Medscape The Cochrane Review Free Pubmed Nursing articles National Electronic Library For Health


eMedicine The Merck Manual Free Books The Virtual Hospital

Nursing Links

Wikipedia on Nursing Wikipedia free encyclopedia on Nursing Process Mathematics and biology: the interface Nursing Theory Page Free supplement Journal issues at Nursing Center Questions Archives : Nurse Minerva Historical and Cultural Development of Nursing Global Nursing Shortages Conducting Research on the Internet Nursing Procedures Continuing Education Archives Continuing Education Web Site Links International Nursing issues Nursing Protocols and Procedures Nursing Humor Online CNE Directory Nursing Theories Nursing: A Global View Medical Library Search index The Open Directory Project Internet Resources The ICN Code of Ethics for Nurses Medical Encyclopedia Index Immunization The Virtual Autopsy Stress Management Communicable Diseases Surgical Procedures Interactive Tool on Patient Teaching Aids

Indian Nursing

Indian Nursing Council Trained Nurses Association of India Nursing in India The International Council of Nurses

Patient Information

Medical Dictionary Patient.UK Patient Textbooks :VH UpToDate Patient Information Patient Handouts: Merck Medicus

Other Resources

FindArticles Encyclopedia of Psychology PsychCrawler Browse Psychiatry Journals IndMed: A Bibliographic Database of

Indian Biomedical Journals

Treatment Guidelines

Treatment guidelines from Cipla

Empowerment is a word we hear a lot in today's health service and one that has become a central tenet of health policy (Department of Health, 1997). According to Malin and Teasdale (1991), empowerment means the freedom to choose where and when one has treatment and also implies that patients should retain autonomy and responsibility for decision-making during their treatment. Empowerment is described by Gibson (1991) as a composite of three factors: attributes that relate to the client; attributes that relate to the nurse; and those that relate to the client and nurse. While the government's emphasis on patient involvement is commendable, its actual policies (such as targets to reduce diseases) still encourage compliance and central control. To empower patients, there needs to be less rigid central control. An example is the 'expert patient' initiative suggested in Saving Lives: Our Healthier Nation (DoH, 1999). The report says that as people are living longer, an increasing number will suffer from chronic illness. The expert patient programme is designed for people with chronic diseases who can actively participate in managing their own care. However, to enable the expert patient to become a reality, practitioners, patients and politicians will need to reach a consensus on the concept of empowerment. Initiatives which encourage active participation in self-management are also seen as having the potential to reduce demand on NHS resources. However, health professionals have expressed concerns that it could actually lead to more 'demanding' patients and an increase in the use of resources (Wilson, 2001). At an individual level, even when patients do participate in their health care, they are often met with barriers from professionals, what Wilson (2001) calls 'punitive gatekeeping'. The question that initiatives such as this raise is whether the reality is about saving resources or facilitating a real shift in power. Although the expert patient initiative does focus on the rights and responsibilities of those with chronic illness, should there not be a corresponding strategy that challenges professionals' assumptions and actions towards those with chronic illness? Arguably, access to the most appropriate services, such as NHS Direct, NHS Direct online and digital TV, are significant features in enabling people to take more control of their own care and a more active part in shaping service provision. Yet where does this leave clients who do not have access to such information and are not in a position to 'argue their corner'? While empowerment suggests a move to reduce such inequality, the disadvantage of poverty and the reluctance of the current government to tackle it continues to be a barrier (Hoskins, 2001).

The philosophy of empowerment is laudable, but without recognising the underlying complexities that need to be addressed, encouraging patient self-reliance can turn into a mere cost-cutting exercise (Chavasse, 1992) Empowerment also has implications for the relationship between nurse and patient. Nurses wishing to empower clients must understand the complexity of this approach because failure to do so could result in the nurse not recognising the need for an individual approach which takes into account patients' differing circumstances. This could result in patients being overloaded with information, creating unnecessary anxiety, rather than the nurse using his/her skills to assess and address individual needs.
Pemerkasaan pula ialah satu perkataan yang kita dengar banyak dalam perkhidmatan kesihatan hari ini dan yang telah menjadi tunggak utama dasar kesihatan (Jabatan Kesihatan, 1997). Menurut Malin dan Teasdale (1991), memperkasakan bermakna kebebasan untuk memilih di mana dan apabila seseorang mempunyai rawatan dan juga membayangkan bahawa pesakit perlu mengekalkan autonomi dan tanggungjawab untuk membuat keputusan semasa rawatan mereka.

Memperkasakan digambarkan oleh Gibson (1991) sebagai komposit tiga faktor: sifat-sifat yang berkaitan dengan pelanggan; sifat-sifat yang berkaitan dengan jururawat; dan orangorang yang berkaitan kepada pelanggan dan jururawat.

Manakala penekanan kerajaan mengenai penglibatan pesakit adalah, dasar sebenar (seperti sasaran untuk mengurangkan penyakit) masih menggalakkan pematuhan dan kawalan pusat. Untuk memberi kuasa kepada pesakit, perlu ada kawalan pusat yang kurang tegar.

Satu contoh adalah inisiatif 'pesakit pakar' yang dicadangkan dalam Kehidupan Penjimatan: Bangsa Kita Sihat (Doh, 1999). Laporan itu menyatakan bahawa sebagai orang yang hidup lebih lama, peningkatan jumlah akan mengalami penyakit kronik. Program pakar pesakit direka bagi orang-orang yang mempunyai penyakit kronik yang boleh mengambil bahagian secara aktif dalam menguruskan penjagaan mereka sendiri. Walau bagaimanapun, untuk membolehkan pesakit pakar untuk menjadi kenyataan, pengamal, pesakit dan ahli politik perlu untuk mencapai kata sepakat mengenai konsep penurunan kuasa.

Inisiatif yang menggalakkan penyertaan aktif dalam pengurusan diri juga dilihat sebagai mempunyai potensi untuk mengurangkan permintaan ke atas sumber-sumber NHS. Walau bagaimanapun, profesional kesihatan telah menyatakan kebimbangan bahawa ia sebenarnya boleh membawa kepada lebih 'menuntut' pesakit dan peningkatan dalam penggunaan sumber (Wilson, 2001).

Di peringkat individu, walaupun pesakit mengambil bahagian dalam penjagaan kesihatan mereka, mereka sering bertemu dengan halangan daripada profesional, apa Wilson (2001)

memanggil 'gatekeeping hukuman'.

Soalan bahawa inisiatif seperti kenaikan ini adalah sama ada realiti menyelamatkan sumber air atau memudahkan peralihan kuasa yang sebenar dalam. Walaupun inisiatif pakar pesakit tidak memberi tumpuan kepada hak dan tanggungjawab mereka yang mempunyai penyakit kronik, di sana tidak perlu menjadi satu strategi yang sama yang mencabar andaian dan tindakan profesional ke arah mereka yang mempunyai penyakit kronik?

Boleh dikatakan, akses kepada perkhidmatan yang paling sesuai, seperti NHS Direct, NHS Direct talian dan digital TV, adalah ciri-ciri penting bagi membolehkan orang ramai untuk mengambil lebih banyak kawalan penjagaan mereka sendiri dan bahagian yang lebih aktif dalam membentuk penyediaan perkhidmatan. Namun jika tidak ini meninggalkan pelanggan yang tidak mempunyai akses kepada maklumat itu dan tidak dalam kedudukan untuk 'berhujah sudut mereka? Manakala pemerkasaan mencadangkan satu langkah untuk mengurangkan ketidaksamaan itu, kelemahan kemiskinan dan keengganan kerajaan semasa untuk menangani ia terus menjadi penghalang (Hoskins, 2001).

Falsafah memperkasakan adalah patut dipuji, tetapi tanpa menyedari kerumitan asas yang perlu ditangani, menggalakkan pesakit berdikari boleh bertukar menjadi satu latihan sematamata pengurangan kos (Chavasse, 1992)

Memperkasakan juga mempunyai implikasi hubungan antara jururawat dan pesakit. Jururawat yang ingin memberi pelanggan mesti memahami kerumitan pendekatan ini kerana kegagalan berbuat demikian boleh menyebabkan jururawat tidak mengiktiraf keperluan untuk pendekatan individu yang mengambil kira keadaan pesakit akaun yang berbeza. Ini boleh mengakibatkan pesakit yang terlalu banyak maklumat, mewujudkan kebimbangan yang tidak perlu, bukannya jururawat yang menggunakan / kemahiran beliau untuk menilai dan menangani keperluan individu. ----------------------------------------------------------------------------------------------------------------------------------1

J Adv Nurs. 1992 May;17(5):609-18.

Empowerment in nursing education: concept analysis and application to philosophy, learning and instruction.
Hawks JH. Empowerment in nursing education: concept analysis and application to philosophy, learning and instruction. J Adv Nurs. 1992 May;17(5):609-18. PubMed PMID: 1602078.

Hawks JH. Widener University , Chester, Pennsylvania ( edited from US National Health of Medicine National Institute Of Health)

Widener University, Chester, Pennsylvania.

The Walker & Avant strategy is used to complete a concept analysis of empowerment. Empowerment is defined as the interpersonal process of providing the proper tools, resources and environment to build, develop and increase the ability and effectiveness of others to set and reach goals for individual and social ends. Empowerment occurs between two or more people: the person who empowers and the person(s) who is (are) empowered. The MurrellArmstrong Empowerment matrix, with six categories of empowering behaviours, provides the theoretical framework. References from organizational, nursing, educational and sociological literature provide support for the defining attributes, antecedents and consequences of empowerment. A conceptual map depicts these relationships and demonstration cases serve to make the ideas more apparent. The concept of empowerment is applied to philosophy, learning and instruction. Pragmatism reflects the ideas presented on empowerment because both embrace individual and social goals, the student is active in the learning process, learning is lifelong, and the appropriate environment, tools and resources for learning must be present. Kolb's experimental learning model corresponds with empowerment and pragmatism. The works of Dewey, Lewin, Piaget, Rogers and Freire are used as the basis for the model. Kolb describes learning as a four-step process that includes concrete experience, reflective observation, abstract conceptualization and active experimentation. Transformative instruction is based on Freire's critical pedagogy, Belenky et al.'s connected teaching, Schn's reflection-in-action, and activities that allow students to complete the experimental learning cycle. Several strategies that promote transformative instruction are discussed.
Strategi Walker & Avant digunakan untuk melengkapkan analisis konsep penurunan kuasa. Memperkasakan ditakrifkan sebagai proses yang interpersonal menyediakan alat, sumber dan persekitaran untuk membina, membangun dan meningkatkan keupayaan dan keberkesanan orang lain untuk menetapkan dan mencapai matlamat untuk hujung individu dan sosial. Memperkasakan berlaku antara dua atau lebih orang: orang yang memberi dan orang yang (s) yang ialah kuasa. Murrell-Armstrong Pemberdayaan matriks, dengan enam kategori tingkah laku memperkasa, menyediakan rangka kerja teori. Rujukan dari organisasi, kejururawatan, sastera, pendidikan dan sosiologi memberikan sokongan untuk ciri-ciri yang menentukan, latar belakang dan akibat penurunan kuasa. Peta konsep menggambarkan

hubungan ini dan kes-kes demonstrasi berkhidmat untuk membuat idea-idea yang lebih jelas. Konsep penurunan kuasa yang dikenakan kepada falsafah, pembelajaran dan pengajaran. Pragmatisme mencerminkan idea-idea yang dibentangkan pada pemerkasaan, kerana kedua-dua pelukan matlamat individu dan sosial, pelajar aktif dalam proses pembelajaran, pembelajaran sepanjang hayat, dan persekitaran yang sesuai, peralatan dan sumber untuk pembelajaran mestilah hadir. Model pembelajaran Kolb eksperimen sepadan dengan memperkasakan dan pragmatisme. Kerja-kerja Dewey, Lewin, Piaget, Rogers dan Freire digunakan sebagai asas untuk model. Kolb menerangkan pembelajaran sebagai satu proses empat langkah yang termasuk pengalaman konkrit, pemerhatian reflektif, konsep abstrak dan eksperimentasi aktif. Arahan yang transformatif adalah berdasarkan pedagogi kritikal Freire, pengajaran Belenky et al. 'S yang berkaitan, Schn pemikiran dalam tindakan, dan aktiviti-aktiviti yang membolehkan pelajar untuk melengkapkan kitaran pembelajaran eksperimen. Beberapa strategi yang menggalakkan arahan transformasi dibincangkan.