Nursing Theories and

Using Evidence to
Guide Practice
Nursing 285
Expertise in Registered Nursing Practice: Nursing
Knowledge
Dr. Cydnee Seneviratne
Adapted from Catherine Fox MN, RN, CON(C)

Image credit: Colourbox

 Lesson Objectives
By the end of this lesson, you will be able to:
• Define the term “nursing knowledge.”
• Describe the evolution of nursing knowledge
through understanding nursing theories.
• Understand the importance of utilizing
evidence to guide clinical decision-making.
• Recognize the difference between evidence-
based and evidence-informed practice.
• Begin to understand how to critically
evaluate the quality of different types and
sources of evidence.
 What is nursing knowledge?

• Unique knowledge base that is essential to nursing

practice and nursing science.
• Wide range of theoretical and practical knowledge used in
nursing.
• Nursing knowledge is organized and communicated by
using concepts, models, frameworks, and theories.
Philosophy in Nursing

Ontology

Epistemolog
Ethics
y
 Important Terms
Concept
Philosophy

Paradigm
Conceptual
Framework

Assumptions

Conceptual
Model
Theory
Why are Nursing Theories Important?
 Metaparadigm of Nursing

Person or Environme
Nursing Health
client nt
Levels of Nursing Theory

Nursing Metaparadigm

Abstrac
Grand Theories t

Middle-Range Theories

Practice-Level Theories
Specifi
c
Components of a Theory
Concepts
Phenomenon Abstract
Inferential
Concrete
Nursing
Theory
Definitions
Theoretical Relational Statements
Operational

Assumptions
 Classification and Examples of
Theories
Term Description Examples
Nursing Beliefs and values that define a way of Nightingale,
Philosophy thinking. Abstract and sets forth the meaning Watson, Ray,
of nursing phenomena through analysis, and Benner
reasoning, and logical presentation.
Conceptual Comprehensive nursing theories that are Levine,
Frameworks regarded by some as pioneers in nursing. Rogers, Roy,
These theories address the nursing King, and Ore
metaparadigm and explain the relationship
between them.
Grand Are works derived from nursing philosophies, Levine,
Nursing conceptual models, and other grand theories Rogers, Orem,
Theories that are generally not as specific as middle- and King
range theories.
 Nursing Theories: Summary
• Nurses use a wide range of theoretical and practical knowledge
in their work.
• The study of philosophy in nursing enables nurses to further
their understanding of the values, beliefs, assumptions, and
knowledge that constitutes the discipline.
• Nursing theories are the basis of nursing practice and help
guide evidence-based research.
• Nursing metaparadigm: there are four major concepts that are
frequently interrelated and fundamental to nursing theory
(person, environment, health, and nursing).
• Three major categories of nursing theories are based on their
level of abstraction: grand theory, middle-range theory, and
practice-level theory.
• A nursing theory contains concepts, definitions, relational
statements, and assumptions that explain a phenomenon.
Using Evidence to Guide
Practice
Critical Thinking, Decision Making, and
Evidence-Based Practice
How does it all connect?

Best Research
Evidence

Clinical Decision
Making
Client Values
Clinical
and
Expertise
Preferences
 Evidence-Based Practice
Evidence-based nursing
is an integration of the Best
best evidence available, Research
nursing expertise, and Evidence
the values and Evidence-Based
preferences of the Practice
individuals, families and
Clinical Client
communities who are expertise Values
served.
 Evidence-Informed Nursing Practice
What is the difference between evidence-based
practice and evidence-informed practice?
• Evidence-informed practice is broader and Best Research Evidence

includes additional resources to formulate

clinical decisions.
• It describes the “ongoing process that Other
available
Evidence-informed Client
resources practice preferences
incorporates evidence from research, clinical
expertise, client preferences, and other available
resources to make nursing decisions about
clients” (Canadian Nurses Association, 2010). Clinical expertise
Evidence Hierarchy
Levels of Evidence
Clinical Practice
Guidelines
 Translating Research into Practice
Type Description
Systematic Reviews A systematic review is a detailed, systematic and transparent
. means of gathering, appraising and synthesising evidence to answer
a well-defined question.

Meta-Analysis A meta-analysis is a statistical procedure for combining numerical

data from multiple separate studies.

Evidence-Based or Evidence-based guidelines or clinical practice guidelines are available to

help guide clinical practice. A large amount of evidence is collected into a
Clinical Practice manageable and usable format. They are usually based on systematic
Guideline reviews and give recommendations for practice based on the latest and best
medical evidence available.

Nursing Best Practice Guidelines (RNAO) (Polit & Beck, 2016)

Cochrane Collaboration
 Quality of Evidence
Evaluation Criteria for Evidence for Clinical Questions
Level Definition
I Evidence comes from a systematic review of all relevant RCTs or from
clinical practice guidelines that are based on such a review.
II Evidence comes from at least one well-designed RCT.
III Evidence comes from well-designed case-controlled that are not
randomized.
IV Evidence comes from well-designed case-controlled and cohort studies.

V Evidence comes from a number of descriptive or qualitative studies.

VI Evidence comes from a single descriptive or qualitative study.

VII Evidence comes from the opinion of authorities and/or reports of expert
committees.

(Ackley et al., 2007; Melnyk & Fineout-Overholt, 2010; Polit & Beck, 2016)
 Evaluating Resources
Questions to help critically evaluate a source

1. Author: Who is the author and/or publisher?

2. Audience: Who is the author speaking to?
3. Review process: Has the source been peer
reviewed by scholars in the field for accuracy
and credibility?
4. Currency: How up-to-date is the resource?
5. Perspective: What is the purpose of the
article?
 Evaluating Research Articles
Step-by-Step Suggestions

Step One: Read the abstract.

Step Two: If the abstract is applicable, skip to the end of the article.
Step Three: If what you have scanned to this point is applicable, read
the entire article.
Step Four: After reading the article, ask yourself these questions:

(Rosalinda, 2020)
 Databases and Search Tools
Commonly used databases:
• CINAHL
• Medline
• PubMed
• Cochrane Library

Reminder: Library support for Nursing:

Term 3 Library Resources
Using Evidence to Guide Practice:
Summary

New evidence comes into play every single day as technology changes,
research evolves, and patients present with new and unique
disease processes.

Evidence-informed practice describes the ongoing process that

incorporates evidence from research, clinical expertise, client preferences,
and other available resources to make nursing decisions about clients.
 References
Ackley, B. J., Swan, B. A., Ladwig, G., & Tucker, S. (2008). Evidence-based nursing care guidelines: Medical-surgical
interventions. (p. 7). Mosby Elsevier.
Allingood, M. & Tomey, A. (2010) Nursing theorists and their work (7th ed.). Mosby.
Allingood, M. (2010). Nursing theory: Utilization and application (4th ed.). Mosby.
McIntyre, M. & McDonald, C. (2018). Nursing philosophies, theories, concepts, frameworks, and models. In B. Kozier, G.
Erb, A. Berman, S.J. Snyder, G. Frandsen, G.M. Buck, L. Ferguson, L. Yiu, & L.L. Stamler (Eds.), Fundamentals of Canadian
nursing: Concepts, process, and practice (4th ed.; pp. 51-65). Pearson.
Canadian Nurses Association. (2010). Evidence-informed decision-making and nursing practice.
https://www.cna-aiic.ca/-/media/nurseone/page-content/pdf-en/evidence-informed-decision-making-and-nursing-practice.pdfC
anadian
Melnyk B. M., & Fineout-Overholt, E. (2010). Evidence-based practice in nursing & healthcare: A guide to best practice (2nd
ed.). Lippincott Williams & Wilkins.
Polit, D. G., & Beck, C. T. (2016). Nursing research: Generating and assessing evidence for nursing practice (10th ed.).
Wolters Kluwer.
Rosalinda, A.L. (2020). Critical thinking, clinical reasoning, and clinical judgment: A practical approach (7 th ed.). Elsevier.
Wilkinson, J. (2012). Nursing process and critical thinking. (5 th ed.). Pearson.