Introduction
Nursing theories provide useful information concerning the definitions of nursing and the practice itself, principles that form the foundation for nursing, and also the goals and functions of nursing. Theories can be constructed to make a conceptual model which assists nurses in the assessment, planning, and implementation of patient care by providing a framework for which the nurses work in.
It is this framework that provides uniformity in the nursing profession. It does this by systemizing the nurses’ actions by guiding them on what to ask, observe, focus, and so on. These theories also provide an outline for the development of new information concerning the profession and the validation of the current information.
Theories in the nursing profession help to:
- Describe existing elements in a discipline
- Explain the relationship between two properties or components and the functioning of the profession
- Predict how components of a phenomenon related to each other
- Describe the nursing therapeutics and the result of interventions
Nursing theories are in four levels. These are:-
- The metatheory which is very abstract and difficult to test
- The grand theory consists of a conceptual framework that defines the practice
- Middle range theory is a moderate abstract with limited variables
- The practice theory outlines the nursing practice.
Theories come in four types. These are needs, interaction, outcome, and humanistic.
Various major nursing theorists have come up with theories to streamline the nursing profession. The first theorist who defined the role of nurses was Florence Nightingale who developed her theory during the Crimean War period.
In 1959 Ray MA developed the theory of bureaucratic caring for the nursing practice. Her theory intends to explain caring decisions in terms of politics, economy, technology, and law. It also explains caring in terms of ethics and spirituality. This theory will focus more broadly on the management and caring views. The application of this theory will lead to a transformation of the health care organization.
Watson J and Ray M.A say that
Caring science encompasses a humanitarian, human science orientation to the human caring process, phenomena, and experiences.
Tranpessmal caring acknowledges the unity of life and connections that move in centric circles of caring from individuals to others.
Nurses need to provide quality health care within a framework of human caring with the economic resources available. Ray M.A (1995) says that the right model used should be comprised of ‘bottom line’ solutions and human caring solutions. Looking for only one particular solution is bound to affect the health of the caregivers and the clients. It can also affect the well-being of health care organizations.
In the event of an illness especially a major one, people tend to turn to spirituality for healing and to ease their pain. At this time spirituality plays a very major role in the provision of inner strength to help the sufferer to bear with the discomfort they are experiencing.
It is through spirituality that patients can acquire a new attitude towards life and health. This attitude helps them to appreciate life through love and faith. It is mostly through suffering that one develops a desire for spirituality.
Ray (1994) recommends the use of love in caring for a patient. The incorporation of love in the giving of care creates a suitable environment for the physical and emotional healing of an ill person. This inclusion of spirituality in health care can transform nursing care and provide a way of producing optimal patient outcomes. A nurse caring for a patient provides her touch and presence. This creates a spiritual connection between two people. Spiritualism is required in the nursing practice for directing and fulfillment. It entails hope, trust, knowledge, and comparison. Nurturing and the intimacy included in caring express the values of spirituality. Nurses must constantly use love and kindness in the delivery of their services.
Ethics in the provision of care focuses on the ability of the nurse to make important ethical decisions. According to Ray, ‘reasoned moral choices’ enable us to choose how, when, where, what, and who we care for. Caregivers must employ a code of ethics in their profession.
This can be achieved by employing loving relationships. Love gives reason to care. This love should be unusual and non-judgmental. To embrace this love is to embrace the belief in a higher power.
This code of ethics should include moral judgments on how the caregiver ought to treat the patients.
Nurses enface many ethical dilemmas in their practice and often need the advice to make good decisions that involve patient care.
There is a delicate relationship that exists between nursing and ethics. This means that the quality of nursing where ethics are not applied is usually substantial.
Ethics in caring involve applying principles theories and ethical practice issues. It also involves moral reasoning. A nurse should be able to think and make decisions independently and understand why a particular stance was chosen. They need to keep in mind that the life of the patient is in their hands and consequently the decision they make is very important to the health of the patient.
Dr. Madiline Leininger’s transcultural nursing theory
This theory is based on humanistic discipline and defines caring within the context of culture. Dr. Leininger argues that competent care in the cultural aspect can only be achieved when cultural care values are understood. To augment the provision of quality health care, transcultural nurses are encouraged to be conversant with two or more cultures. Knowledge of various cultures will involve learning the beliefs of values and practices of a particular culture.
Leininger holds that since the quality of life is culturally constituted and patterned a transcultural nursing perspective should be adapted to aid the advancement of the practice and profession.
She discovered that culturally based care factors influenced the human expressions related to health, illness or wellbeing, death, and disability.
According to Leininger, Transcultural nursing goes beyond local regional, and national views to that of worldwide nursing on the global view of nursing.
The need for transcultural nursing theory and practice in all areas of health care became more evident with the changing demographics of countries worldwide.
The development of Dr. Leininger’s theory has led to the discovery of similarities and differences in clients from different cultures. This theory helps nurses to accommodate, maintain or repattern the cultural views and practices of the patient. This leads to the provision of high-quality health care that embraces diverse cultures. Misdiagnoses, poor treatment, staff frustration, and harmful care are some of the issues that arise from ignorance about the patient’s culture.
Leininger has presented the sunrise model with different dimensions of her transcultural theory. It depicts different dimensions of the theory which are closely related. Among the dimensions depicted in this model are political and legal factors, economic factors, and technological factors. Leininger states that these dimensions influence the care patterns and practices which are responsible for the holistic well being.
References
Ray MA. The theory of bureaucratic caring for nursing practice in the organizational culture. Nursing admin quarterly 1989 Volume 13 (2):31-42.
Watson J and Ray MA (1988) The Ethics of care and the Ethics of cure. New dimensions of human caring theory Nursing Science Quarterly.
Ray MA The Edge of chaos: Caring and the Bottom line Nursing Management 1995 Volume 26(9); 48-55.
Raholm MB (2007) Wearing the fabric of spirituality as experienced by patients who have undergone a coronary Bypass surgery. Journal of holistic nursing Volume 20(1) 31-47.