Comparison of Nursing Theories

Nursing is a knowledge-based profession that relies on continued learning and experience in the practical environment. Since the 19th century, the growth in the field of nursing theories and conceptual models have developed. The world is changing but most of the fundamental issues that enhance the nursing care delivery. According to Fawcett (2010), nursing theories and conceptual models are the starting point for nursing practice. Fawcett believed that nurses must improve their knowledge and use of the conceptual-theoretic-empirical systems to enhance their knowledge and experience in their service delivery. Most scholars echo these sentiments although some critics argue that the generalized and environmental issues in different theories make nursing theories inapplicable. Nursing theories defined as

a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationship among concepts to describe, explaining, predicting and prescribing. (Meleis, 2007)

The definition is broad hence the classification of nursing theory into two major categories of grand theory and middle-range theory.

Grand Theory provides a conceptual framework by which the fundamental concepts and principles of nursing are identified. The generalized nature of grand theory makes it essential in providing comprehensive guidance and view for nursing practice, but its framework makes it impossible to test (Meleis, 2007). Theories of the grand theory focus on broad issues thus involve many assumptions but use acceptable methods to determine the cause and strategies to improve nursing practices.

In addition. Middle-Range Theories, are exact and analyses a specific situation with a limited number of variables (Meleis, 2007). The narrow scope of these theories makes them testable and help demonstrate the reality of different problems in the field of nursing and other aspects of life. The right prescription of the theories towards a right problem makes it perfect for empirical and evidence-based experiments.

The difference in scope of the theories with the grand theory too broad and having too many variables and assumptions making it untestable and the middle-range theory focusing on a specific problem and its testability are the main differences of the theories. However, the theories tend to borrow ideas and assumptions from each other which makes them have some similarities. Therefore, this paper uses Virginia Henderson’s Need Theory and Diane Lauver’s Theory of Care-Seeking Behavior in the comparison of grand theory and middle-range theory respectively.

The vast scope of grand theories is evident in Henderson’s Need Theory since it is based on her definition of nursing. She defines nursing as,

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. (Henderson, 1966)

Based on this definition, she formulated her concept based on individual care and portrayed the roles of the nurse to assist the patient recover, maintain health or have a peaceful death. These roles depict that interaction of the nurse of critical in the success or failure of patient recovery. Henderson identified fourteen components with the first nine indicating physiological aspects, the tenth and fourteenth having psychological facets, the twelfth and thirteenth possessing sociological orientations whereas the eleventh component deals with spiritual and moral aspects (Crossan & Robb, 1998). Although Henderson places the patient at the center of care, the theory targets the roles of nurses to ensure quick recovery and progress of the patient even after hospitalization. The extensive range of roles defined in the study seems untestable for instance spirituality.

Unlike Henderson’s approach that tends to focus on the roles of nurses, Lauver theory of care-seeking behavior explores the reasons people tend to ignore or not take part in health promotional programs such as the mammography screening that would help in treatment of breast cancer in the early stages (Worawong, Borden, Cooper, Pérez & Lauver, 2018). The theory portrays that clinical and socio-demographical factors tend to influence the participation of people in such health programs (Lauver, 1992). These factors tend to influence the psychosocial constructs such as habits, affects, norms, and beliefs. For instance, women in the low-income economic class are less likely to engage in such programs as they fear that knowing and having no money to finance the cancer problem would result in depression (Lawal, Murphy, Hogg & Nightingale, 2017). Therefore, these women tend to ignore such programs.

The brief description of the two theories is evident that middle-range theories are testable due to focusing on a particular issue, unlike the grand theories that approach a problem with no specific target hence the generalization that makes them difficult to test.

Background

Virginia Henderson’s Needs Theory 

Henderson working in the hospitals for many years was able to acknowledge that the nurses played a crucial role in the recovery of a patient. Based on the earlier description of nursing practice demonstrated that the nurses' roles and care for the patients were different from the cure that physicians provided to the patients. The care and cure may be different but were dependent. The theory is classified in grand theory due to its broad aspects in demonstrating nursing practice, but unlike most grand theories, it can be used in practice or real-world scenarios. Her aspects are still useful in the modern clinical perspective due to the focus on the importance of care that increased nurses and patient interrelationship in the bid to help patients become independent. The theory employs fourteen points of client assistance (McEwen & Wills, 2007). The theory has been instrumental in shaping the dynamics of the nursing which would become instrumental in nursing practice. Even in this complicated modern nursing that utilizes evidence-based strategies in understanding medical interventions, the concepts and understanding of the roles of nursing practice are still applicable as discussed later in the paper.

Diane Lauver’s Theory of Care-Seeking Behavior 

Health behavioral theories (HBT) tend to analyze factors that influence human to engage in healthy behaviors or seek medication. These theories have been in use to understand the reasons and barriers that contribute to people willing to participate in healthy behaviors since 1970 (Lauver, 1992). However, each theory is different and practical and evidence-based clinical trials. Lauver’s theory of care-seeking behavior being a middle-range theory was formulated to determine the factors that influence the women engaging in mammography screening tests. The approach has since then been used in health promotional programs. Lauver’s approach gained many claims due to the ability to differ from other behavioral theories such as the psychological issues since they are influenced by the other internal and external factors in individual care-seeking behaviors (Lauver, 1992). The theory limits its reliance on the beliefs and norms that have been central in the Triadic theory that was instrumental in its formulation.

Philosophical Underpinning

Henderson’s theory is identified as a philosophy since it is a grand theory that developed and described nursing phenomena differently from the previous definitions. The philosophical underpinnings theory matured from Henderson’s experiences as a psychiatrist, pediatric, medical-surgical and home nursing practitioner. The experiences and integration with patients and colleagues led to understanding the concepts of nursing in a different perception hence the development of the fourteen points of care. The points are namely:

Breathe normally, eat and drink adequately, eliminate body waste, move and maintain postures, provide for sleep and rest, wear suitable clothing, maintain body temperature, keep the body clean and well groomed. Other points are; avoid dangers in the environment, communicate, worship according to one’s faith, feel good about work accomplishment, participate in recreation, and learn, discover, or satisfy the curiosity that leads to health. (McEwen & Wills, 2007)

According to McEwen and Wills (2007), these fourteen points of care can be divided into seven values or philosophies that are interpersonal, health, human being, adaptation, goal attainment, care, and environment. These philosophies enable the theory to align with the metaparadigm used in nursing which includes patient, health, nurse and environment.

Lauver’s theory is a framework used to determine the factors that influence care-seeking behaviors. Therefore, it does not change the scope of nursing. However, the framework variation from past health-behavioral theories demonstrates a change in dimension and tactics of understanding a given population healthcare access behaviors although it cannot fit as philosophical underpinnings. The framework begins by understanding the clinical and socio-democratic factors which impact the psychosocial influences. Lauver depicted affects, norms, beliefs, and habits to influence the psychosocial aspects of care-seeking behaviors. She defined affects as the anxiety about mammography and the results, norms as the professional recommendation, beliefs as the benefits and risks, whereas habits are based on individual behaviors and lifestyles (Lauver, 1992). The combination of the clinical and socio-demographic factors and psychosocial are further facilitated or hindered by the environmental factors such as economic status to form the care-seeking behavior of the individual. The essence that Henderson’s theory has a philosophic underpinning that lacks in Lauver’s theory is another significant difference between the theories.

Significant Assumptions, Concepts, and Relationships

Henderson’s theory assumed that the fourteen points of care were essential in enhancing the interrelationship of the patient and nurse. The definition and the fourteen points demonstrate that nurses should appreciate their significant roles in enabling the patient recovery or peaceful death, therefore, in the bid to enhance the independence of the patients, they must interact not only with the patient but also with the family of the patient (Fawcett, 2010). The theory understood that by using the theory in any given scenario, the nursing practice would improve and boost patient-oriented practices.

Lauver’s theory, on the other hand, focused on determining the factors that influence care-seeking behaviors of mammography screening programs. The study using the framework discussed earlier understands that many factors can influence or reduce the participation of the women in such programs. Lauver believed that by understanding these factors, it would be possible to improve the levels of participation by changing the dynamics of promoting the programs. The also depicts the value of nurses in facilitating or inhibiting mammography screening participation (Lawal, Murphy, Hogg, & Nightingale, 2017). Therefore, it is evident that the interaction of nurses and patients are vital for the success of each theory. Although the assumptions and concepts of the theories differ, both theories focused on the patient as the center of attention with all factors aiming to make their lives better.

Clinical Applications

Henderson’s approach has been instrumental in shaping the roles of the nurses and has helped towards patient-oriented healthcare provisions. The focus by most healthcare providers to empower patients, families, and communities, enhance responsive and competency among health practitioners, improving the healthcare organizations and enabling humanitarian and supportive healthcare systems are enhanced by the doctrines popularized in Henderson’s theory. Most scholars argue that grand theory is untestable, but Henderson’s fourteen points have been used to gauge the provision of healthcare that is used to enhance the focus of these values and scopes. However, the testability of these factors is limited due to their descriptive nature although few studies have succeeded in providing quantitative data from the fourteen points (Barnett, 2006). The limited preference of using this theory in quantitative research demonstrates the difficulty in testing these factors.

The theory of care-seeking behavior was framed to determine the influence of participating in mammography screening programs. Therefore, the framework is set to provide both qualitative and quantitative analysis (Lawal, Murphy, Hogg, & Nightingale, 2017). The approach have been used to monitor and educate healthcare sector and practitioners on the most suitable promotion styles and methods to ensure participation of different people in health promotion programs.

Comparison of the use of both Theories in Nursing Practice

Virginia Henderson’s theory has been instrumental in defining the roles of the nursing practitioners. The theory through the fourteen points are used by organizations, and nursing practice education makes it easier to implement and change the scope and service delivery in a patient-centered healthcare setting. Lauver’s approach, on the other hand, focused on determining the factors of engaging in mammography screening programs. Cancer is one of the leading causes of fatalities, employing the theory enhances the formulation of health promotion programs, and in recent periods, the theory has been used to determine the access of healthcare for people with HIV/AIDs (Lawal, Murphy, Hogg, & Nightingale, 2017). The complexity of the determining factors that influence low turn-out or participation of women in the low economic individuals from accessing free mammography has been addressed by this theory to portray that other external facilitating factors can hinder the care-seeking behaviors.

Specific Examples of Application of the Theories in a Specific Clinic Setting

The full-service hospital has been facing an increase in patients leading to work overload for the nurses. The work overload has resulted in complains from the patients and their families which has also led to the decline in motivation among the nurses. By using the definition and concepts proposed by Henderson’s theory depicts that the interaction with the patients would reduce the complaining from the patients and families. The concepts demonstrate that nurses would make it their responsibility to interact with the family and patients which would ensure that they can explain the situation and convince them that they are working to ensure independence or recovery of the patients. In such a scenario the patients and families would understand and appreciate the inputs of the nurses thus reduce complains and motivate the nurses in the long-run.

The clinic can also reduce the fear of undertaking mammography and other tests that have been hindered by beliefs such as using the churches and media to influence Hispanic to endorse current medication and seek chronic ailment such as diabetes tests.

Parsimony

The law of parsimony argues that a theory should establish the simplest possible explanation for a phenomenon. The simplicity enables understanding and application of the theory with the real world. Both theories are simple and can be used, but only Lauver’s theory of care-seeking behavior is readily applicable in the quantitative studies.

Conclusion

The paper succeeded in demonstrating the differences and similarities of grand and middle-range theories. By using Virginia Henderson’s needs theory and Diane Lauver’s theory of care-seeking behavior, it was evident that both theories employed a patient-centered strategy whereby the actions of nursing practices would improve the lives of the public or patients. However, Henderson’s approach was more abstractive whereas Lauver’s theory focused on gaining the solutions of the mammography screening participation. The narrow scope of Lauver’s theory that enables evidence-based studies is different from the wide dimension used by Henderson. In conclusion, it is evident that grand theory focus on problems or situations that affects the entire nursing practice whereas the middle-range theory is problem-based thus affects only a few problems in the nursing practice.

References

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Crossan, F., & Robb, A. (1998). Role of the nurse: introducing theories and concepts.  British Journal Of Nursing ,  7 (10), 608-612.

Fawcett, J., (2010). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (2 nd ed.). Philadelphia: F. A. Davis.

Henderson V (1966). The Nature of Nursing: A Definition and its Implication for Practice, Research, and Education. Macmillan, New York.

Lauver, D. (1992). A Theory of Care-seeking Behavior.  Image: The Journal Of Nursing Scholarship ,  24 (4), 281-288.

Lawal, O., Murphy, F., Hogg, P., & Nightingale, J. (2017). Health Behavioural Theories and Their Application to Women's Participation in Mammography Screening.  Journal Of Medical Imaging And Radiation Sciences ,  48 (2), 122-127.

McEwen, M. & Wills, E.M. (2007). Theoretical basis for nursing, 2nd edition . Philadelphia: Lippincott.

Meleis, A. I., (2007). Theoretical nursing : Development and Progress (4 th ed.). Philadelphia, PA: Lippincott.

Worawong, C., Borden, M., Cooper, K., Pérez, O., & Lauver, D. (2018). Evaluation of a Person-Centered, Theory-Based Intervention to Promote Health Behaviors.  Nursing Research ,  67 (1), 6-15.