Nursing theory gathers specific information regarding aspects of nursing and utilizes these findings to communicate and describe nursing phenomena. Theories provide a framework for nursing practice and processes. Grand nursing theories are broadest in scope and provide generalizations regarding nursing situations. Grand nursing theories consist of four schools of thought. Nursing theorists bring a unique definition, approach, and focus to these specific schools of thought. The first school of thought includes theories that reflect an image of nursing as meeting the needs of patients (Meleis, 2012).
When a patient is unable to meet their individual needs it is the responsibility of the nurse to provide what is necessary in assisting the patient towards independence. Virginia Henderson was a needs theorist who categorized human needs into 14 components: breathing normally, eating and drinking adequately, eliminate body wastes, move and maintain desirable postures, sleep and rest, select suitable clothes, maintain homeostasis, personal hygiene, protect the integument, avoid environmental dangers and injury to others, communicate with others, worship according to faith, participate in recreation, learn and discover, and work in such a way there is a sense of accomplishment (www.
Henderson defined nursing as assisting with these activities to help the individual achieve independence. A person’s ability to successfully perform activities of daily living is imperative to healing. Nurses can assist patients achieve this by identifying knowledge deficits and providing the person with knowledge to help restore wholeness. The next school of thought is interaction. These theories were conceived by those who viewed nursing “…as an interaction process with a focus on the development of a relationship between patients and nurses” (Meleis, 2012). Interaction theorists focus on illness as an experience and nurses must implement therapeutic processes to care for the patient. Imogene King was an interaction theorist that defined nursing as “…a process of action, reaction, and interaction whereby nurse and client share information about their perceptions of the nursing situation and agree on goals” (Meleis, 2012).
King’s theory stated that the goal of nursing is to help individuals maintain their health and share meaningful interactions to achieve their goals (Meleis, 2012). The interaction school of thought is imperative because it empowers the patient to be an active and equal participant in their own health care. The third school of thought is outcomes. These theorists strived to restore stability and bring balance to the patient and their environment (Meleis, 2012). Myra Levine was an outcomes theorist the believed that nursing is a conservation of integrities and energy (Meleis, 2012). Levine also defined nursing as patient advocacy and individualizing patient needs with compassion and commitment (Meleis, 2012). These theorists believe that effective coping mechanisms can help the patient live harmoniously.
The fourth and final school of thought is caring/becoming. These theories evolved from interaction theories but they are more expansive. “The process of care is defined as a process of becoming for both clients and nurses; however, transformation is only possible if each is open to it” (Meleis, 2012). Jean Watson believed the goal of nursing to be mental and spiritual growth for human beings, (nurses and clients), and finding meaning in experiences (Meleis, 2012). The caring theory focuses more on the nurse/patient relationship compared to the interaction theory. The grand theory school of thought that is most congruent with my nursing practice is the outcomes theory.
I believe that every patient responds to health issues differently. I assess what they need, what their deficits are, and how I can enable their coping mechanisms. I work at a busy trauma center and we have emergency surgeries frequently. Many of these are suction dilatation and curettages. Each woman handles this differently. So I sense and assess what they need to have the best outcome possible. Some want to leave right away, some want to stay a while, some want to see their family and some don’t. It might not be the norm to keep one of these patients for three hours, but I will keep them until they are ready to leave. I believe in patient advocacy on an individualized basis. Please refer to Table 1. Grand Theorist Information for theorist comparison.
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