THEORY WK 10

1. Relationship of Theory and Practice

Theory is considered both a process and a product. As a process, theory has numerous activities and includes four interacting phases: analyzing concepts, constructing relationships, testing relationships, and validating relationships. These phases are all implemented in practice. As a product, theory provides a set of concepts and relationships that may be combined to describe, explain, predict, and prescribe phenomena of interest. This information is then used to guide nursing practice. In a practice discipline such as nursing, theory and practice are inseparable. Indeed, development and application of theory associated with research-based practice has been seen as fundamental to the development of the profession and autonomous nursing practice.

Theory provides nurses with a perspective to view client situations and a way to organize data in daily care. Theory allows nurses to focus on important information while setting aside less important, or irrelevant, information. It may assist in directing analysis and interpretation of the relationships among data and in predicting outcomes necessary to plan care. Further, a theoretical perspective allows the nurse to plan and implement care purposefully and proactively, thereby being more efficient with better control over the outcome of the care. Nurses need to use theoretical perspectives to help understand which information is important, how the information is related, what can be predicted by relationships, and what interventions are needed to deal with special relationships.

For example, a nurse working in pediatrics should understand the theoretical principles of immunity and disease prevention when explaining the importance of immunization to a new mother. If the mother expresses concerns about a potential complication of the vaccine, the nurse should gather additional information from the mother to understand her specific concerns. On learning that the mother had read recent reports that the MMR might cause autism, the nurse must be able to articulate the rationale behind immunization and to direct the mother to sources of information about vaccine safety and potential complications, including the most recent and relevant research data. Such information will allow the mother to make an informed decision about the care of her infant. 

2. Theory-Based Nursing Practice

Theory-based nursing practice is the "application of various models, theories, and principles from nursing science and the biological, behavioral, medical, and sociocultural disciplines to clinical nursing practice" (Kenney, 2002, p. 275-285). Nursing practice is complex, and theory informs the practitioner about and good practice. In nursing, practice without theory becomes rote performance of activities based on common sense and following orders.

Theory offers the practitioner a basis for making informed decisions that are based on deliberation and practical judgment. With increasing clinical experience, nurses are able to combine theoretical and clinical knowledge with critical thinking skills to make better clinical decisions and improve practice. Like all practice disciplines, nursing uses a special combination of theory and practice in which theory guides practice and the practice grounds theory. Nurses rely on theoretical understanding along with experience to improve practice. As Cody stated, "one learns to practice nursing by studying nursing theories, and one learns to practice nursing very well by studying nursing theories very intensely" (Cody,2003, p. 225-231).

It is sometimes difficult to decide where, when, and how to apply theory in nursing practice. This may be particularly true for nursing students and novice nurses. The application of theory in practice requires an understanding of concepts and principles associated with the needs of a particular client, group of clients, or community. In addition, the application of theory in practice requires recognition of when and how to utilize these concepts and principles when planning and implementing nursing care. Chinn and Kramer suggested criteria for determining when theory should be applied to practice.

3. Evidence-Based Practice

Over the past several years, the concept of evidence-based practice (EBP) has appeared with increasing frequency in nursing literature. EBP is similar to research-based practice and has been called an approach to problem solving in clinical practice that conscientiously uses the current "best" evidence in the care of patients. EBP involves identifying a clinical problem, searching the literature, critically evaluating the research findings, and determining the appropriate interventions.

In medicine, EBP has been defined as the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients. It is an approach to health care practice in which the clinician is aware of the evidence that relates to clinical practice and the strength of that evidence.

In nursing, EBP generally includes careful review of research findings according to guidelines that nurse scholars have used to measure the value of a study or group of studies. Evidence-based nursing de-emphasizes ritual, isolated, and unsystematic clinical experiences, ungrounded opinions, and tradition as a basis for practice, and stresses the use of research findings.

An example of EBP was published by the Centers for Disease Control and Prevention and applied to nursing. The guidelines for prevention of surgical site infection were synthesized from the findings of almost 500 research studies. That information and theoretical rationale were used as the basis for categorizing a number of practice recommendations. The result was a comprehensive, well-documented directive that has become the standard for operating rooms.

4. Application of Mid-Range Theories

Articles showing how mid-range nursing theories have been applied in nursing practice can readily be found in nursing literature. For example, Martinez used Orem’s  self-care deficit theory to develop a plan of care for an elderly woman who needed an ileostomy. The author described how Orem’s theory was utilized to assess the woman’s self-care agency and therapeutic self-care demands, and determined that her self-care demands exceeded her self-care agency. The goal was to increase her self-care agency to adequately and effectively meet her self-care demands.

Another example is the mid-range  comfort theory, which was used to direct nursing practice in a post anesthesia care unit (PACU). These nurses described how  comfort theory directed more holistic care through employment of "comfort care interventions." These interventions were grouped as standard comfort interventions (vital signs, patient assessment, medication administration), coaching interventions (emotional support, education), and "comfort food for the soul" (therapeutic touch, music therapy, personal connection). Wilson and Kolcaba (2004) concluded that these measures enhanced comfort in PACU patients.

Chinn, Kramer & Sitzman, Chapters 3, 4, 10, 11 

· Abu-Baker, N.N., AbuAlrub, S., Obeidat, R.F., & Assmairan, K. (2021). Evidence-based practice beliefs and implementations: A cross-sectional study among undergraduate nursing students.  BMC Nursing, 20(13).  https://doi.org/10.1186/s12912-020-00522-x

· Lai, J., Brettle, A., Zhang, Y., Zhou, C., Li, C., Fu, J., & Wu, Y. (2022). Barriers to implementing evidence-based nursing practice from the hospitals’ point of view in China: A regional cross-sectional study.  Nurse Education Today, p.  116, N.PAG.  https://doi-org.wilkes.idm.oclc.org/10.1016/j.nedt.2022.105436

· Younas, A., & Quennell, S. (2019). Usefulness of nursing theory‐guided practice: An integrative review.  Scandinavian Journal of Caring Sciences, 33(3), 540-555.  https://doi.org/10.1111/scs.12670