Introduction
Nursing is a fundamentally unique discipline, as illustrated by the various nursing theories that have emerged over the years. These knowledge-based theories are organized into grand, middle, and practice nursing theories. They are crucial to nursing practice as they form part of the foundational knowledge of nursing care and enable nursing professionals to understand and explain what they do and how they respond to patients’ care needs (Quinn & McDonough, 2019).
Understanding the rationale behind their actions is important because the nurse can then build evidence to justify their actions when caring for patients. Despite nursing theories emerging in the 19th century, they remain relevant today, mainly due to a focus and shift to evidence-based nursing practice (Xu et al., 2022). This research paper will critically analyze the three categories of nursing used in research articles in their attempt to advance nursing practice.
Background
Grand nursing theories deal with broad and abstract nursing concepts. They provide a general framework regarding people and health and originate from a nurse’s own experience caring for patients. Examples of grand nursing theories include Ida Jean Orlando-Pelletier’s deliberative nursing process theory and Watson’s caring theory, among many others (Smith & Gullett, 2020).
Middle-range nursing theories focus on specific nursing areas rather than broad and abstract concepts (Younas & Quennell, 2019). They originate from research, similar disciplines, or nursing practice. Middle-range nursing theories include the theory of comfort and the theory of maternal role attainment, among others (Friberg, 2020).
Finally, practice nursing theories offer more specificity by focusing on a defined population of patients at specific times (Mudd et al., 2020). The practice-level theories have a greater impact on a patient than all the other categories of nursing theories. Practice-level nursing theories include self-care deficit theory, Casey’s nursing model, cultural care theory, environmental theory, and patient-centered approach to nursing.
Grand Nursing Theory in Research: Orlando’s Deliberative Nursing Process Theory
A descriptive research article titled “Communication with Infertile Women Who Failed Treatment: An Examination of Orlando according to Interaction Theory” focuses on nursing care for a woman whose infertility treatment has failed (Kirmizigul et al., 2022, p. 1). It uses Orlando’s deliberative nursing process theory, also known as an interactive theory, to recommend how a nurse should handle such a patient.
The authors note that nursing is based on human and mutual interaction (Kirmizigul et al., 2022). Consequently, because the people receiving care are human, it is important to master interpersonal relations to be able to offer the necessary care to patients. Positive interaction with patients is also key in improving their health conditions, with many healthcare professionals who maintain healthy conversations and interactions with patients having been credited with faster recovery of their patients. In this regard, the authors assert that this theory is essential to practitioners in their interaction with patients whose fertility treatment fails to yield the expected results.
Orlando’s deliberative nursing process theory stresses the reciprocity of the relationship between a patient and a nursing professional due to a realization that what nurses engage in and say affects both the patients and the nurse. It is thus imperative that a patient’s needs are established and met on time through a deliberative process between the patient and the nurse.
Consequently, the model put forward by Orlando revolves around five interrelated concepts: assessment, diagnosis, planning, implementation, and evaluation (Friberg, 2020). A nurse’s obligations and duties in an interactive model presented by Orland are to organize the principle while a patient’s responsibility is presenting a problematic situation. In such conditions, an engaging and deep interaction between the nursing profession and the patients results in a proper diagnosis of the underlying health conditions and recommendations of a plan to manage the symptoms and treat the disease.
The authors in the article believe that the mutual interaction advocated by Orlando’s deliberative nursing process theory offers lessons on how to handle a patient whose fertility treatment has failed. Grand nursing theories such as this one offer general descriptions and abstract ideas on how to tackle a nursing problem.
Middle-Range Nursing Theories in Research: Theory of Comfort
In a descriptive article titled “Comfort, well-being, and Quality of Life: Discussion of the Differences and Similarities among the Concepts,” the authors focus on establishing the differences and similarities between comfort, well-being, and quality of life as applied in nursing practice. They argue that a distinction is always unclear and that the lack of definitions for these terms could lead to redundancies, knowledge aspersions, and gaps (Pinto et al., 2017). While some people may view comfort, well-being, and quality of life as interchangeable, the authors argue that they are distinct concepts from the point of view of nursing care. In particular, they point out that the theory of comfort is very specific on what comfort means to a patient, which makes the quality of care and well-being related but completely different concepts in nursing practice.
The theory of comfort regards patients to be individuals, institutions, and organizations in need of nursing care. Consequently, it is the job of a nursing professional to manipulate the environment around a patient to ensure their comfort. According to this theory, a patient’s recovery is dependent on the optimal performance of the environment around them, especially as it relates to groups, family, and the (Friberg, 2020).
Thus, under the comfort nursing theory, nursing is regarded as the process of finding out the comfort needs of a patient, implementing different care needs, and evaluating the implemented care plans to ensure that the patient’s comfort needs are optimized. The assessment should be intentional, objective, and sometimes subjective. For example, assessing how a patient’s wound is healing is objective, while assessing if they are comfortable is a subjective undertaking.
Thus, by drawing on the comfort theory, the authors are able to distinguish between comfort, well-being, and quality of life. These concepts are essential to the proper nursing care of a patient. Therefore, an understanding of comfort, well-being, and quality of life in a nursing professional improves the care they provide to patients and their recovery process. Middle-range theories, such as the theory of comfort, are important in nursing practice because they focus on specific areas, unlike grand nursing, which is abstract.
Conclusion
Nursing theories fall into three categories, with grand nursing theories dealing with abstract concepts in nursing practice. Middle-range nursing theories address specific issues related to nursing practice and patient care. The nursing practice theories are more specific and concern the care of a patient more than the other two categories of nursing theories. Despite most of these theories originating in the 19th century, their relevance and importance to a nursing professional are continually growing as nursing practice shifts to evidence-based practice. Further research that expands the meaning and application of nursing theories adds to the general nursing knowledge, leading to the expansion of nursing as a distinct field of knowledge in the healthcare industry.
References
Friberg, E. E. (2020). Conceptual foundations: The bridge to professional nursing practice. Elsevier.
Kirmizigul, E., Baran, E., & Sahin, S. (2022). Communication with infertile women who failed treatment: “An examination of Orlando according to interaction theory.” Journal of Social and Analytical Health, 2(2). Web.
Mudd, A., Feo, R., Conroy, T., & Kitson, A. (2020). Where and how does fundamental care fit within seminal nursing theories: A narrative review and synthesis of key nursing concepts. Journal of Clinical Nursing. Web.
Pinto, S., Fumincelli, L., Mazzo, A., Caldeira, S., & Martins, J. C. (2017). Comfort, well-being, and quality of life: Discussion of the differences and similarities among the concepts. Porto Biomedical Journal, 2(1), 6–12. Web.
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Smith, M. C., & Gullett, D. L. (2020). Nursing theories and nursing practice. F.A. Davis.
Xu, L., Yu, X., & Wang, X. (2022). Nursing theory and practice. UK Scientific Publishing.
Younas, A., & Quennell, S. (2019). Usefulness of nursing theory‐guided practice: An integrative review. Scandinavian Journal of Caring Sciences, 33(3), 540–555. Web.
