Nursing Theories
Theory plays an integral role in the development of a set of ideas that
provide a purposeful and organized view of a phenomenon. Many scientific
disciplines utilize theory to provide a framework that details and defines that
discipline’s field. Nursing is one of those disciplines and theory has
developed over many years to explain and shape the field as well as define
our scope of practice. Nursing theories range from grand theories, which are
the most complex and broadest in scope, to middle range theories, which are
a middle ground between grand nursing models and more practice-specific
theories (McEwen & Wills, 2019). The science and discipline of nursing has
many specialties that utilize many different grand and middle range theories
to provide a framework to how that specialty should practice.
Forensic Nursing and its Theoretical Foundations
I currently practice as a sexual assault nurse examiner (SANE)-certified
forensic nurse. Forensic nursing is a new and evolving nursing science that
has developed due to the needs of a world in crisis (Lynch, 2006). This
specialty that applies forensic science and nursing was first recognized as an
official specialty by the American Nurses Association (ANA) in 1995. Forensic
nursing has specific considerations for meeting the “biological,
psychological, social, spiritual, and now legal dimensions of patient care in a
humanitarian, holistic, and pragmatic orientation” (Lynch, 2006, p. 10).
Constructing a theoretical framework for forensic nursing derives from
several preestablished nursing theories such as Paterson and Zderad, Chinn
and Kramer, Conway and Hardy, Leininger, Giger and Davidhizar, and
Benner. I will be discussing the grand nursing theory of Chinn and Kramer
and the middle range theory of Leininger and their application to the
specialty of forensic nursing.
Chinn and Kramer: Patterns of Knowing Theory
The initial four patterns of knowing were identified by Barbara Carper
as empirics, esthetics, personal knowledge, and ethics (McEwen & Wills,
2019). These four fundamental patterns for nursing knowledge describe the
science of nursing, the art of nursing, one’s own personal knowledge in
nursing, and moral knowledge in nursing. These patterns represent the
complex phenomenon of knowing that nurses use when caring for their
patients (Carper, 1978). More recently, Peggy Chinn and Maeona Kramer
added a fifth pattern: emancipatory knowing. This new addition addresses
the issue of equality, justice, and transformation in all areas of practice. With
the application of Chinn and Kramer’s fifth pattern of emancipatory knowing,
the patterns of knowing’s application to nursing care is strengthened by
giving nurses the knowledge to advocate for social justice in health
disparities and inequity. By applying and understanding the patterns of
knowing, one becomes more aware of the complexity and diversity of
nursing knowledge, thus being able to expand upon and practice appropriate
nursing care. Some weaknesses of this theory include the necessity of each
pattern of knowing to achieve substantive nursing care; if one were to
develop a pattern of knowledge separately, it would lead to some patterns
being applied. For example, if one were to only apply some of the patterns, it
may lead to one providing care that is more geared towards personal
knowing thus providing unethical and nontherapeutic care.
Leininger: Culture Care Theory
The importance of considering the impact of culture on health and
healing was addressed by Madeleine Leininger; she was also a leading
proponent that nursing is synonymous with caring (McEwen & Wills, 2019).
Major concepts of the culture care theory include culture which refers to the
learned and shared values and beliefs of an individual that helps to guide
their thinking, actions, and ways of living, culture care which refers to the
influence that culture has on helping the person improve their health or deal
with illness, and culture care differences and similarities which help to
describe the differences and similarities between how one’s culture should
be applied to their care. This theory provides several strengths such as
providing a holistic view of how the role of culture pertains to healthcare, and
that the theory provides a great foundation in understanding today’s ever-
growing, multicultural population and how to provide culturally competent
care. Some weaknesses of this theory include the application of this theory
as nurses who are often inclined to focus only on the ethnonursing
methodology or only the principles of transcultural nursing when culturally
congruent care requires all components (Alligood, 2014).
Application of Theories to Forensic Nursing
Forensic nursing care is multidimensional and encompasses a
sensitivity to differences among culturally diverse populations. By utilizing
these theories as part of the theoretical framework of forensic nursing,
forensic nurses can ensure appropriate care is given to victims of violence. It
is integral that forensic nurses practice culturally competent care. The
victims of violence that forensic nurses care for are human beings that are
made up of various dimensions that involve culture and spirituality. Forensic
nurses utilize the patterns of knowing in their practice as it helps to
articulate the value of nursing theory and how it guides practice while also
referencing the patterns of knowing which are essential to nursing (Valentine,
2014). Cultural care and interventions are essential components of forensic
nursing and the culture care theory addresses the importance of providing
culturally competent and respectful care (Valentine, 2014). To treat others
with respect and kindness is a basic tenet of Christianity. The Golden Rule
states to treat others as you would want to be treated. These tenets and
rules are described in the Bible, “For the entire law is fulfilled in keeping this
one command: “Love your neighbor as yourself” (New Living Translation
Bible, 1996/2015, Galatians 5:14). Very simply put, it is my duty as a forensic
nurse to ensure my patients are treated how I would want to be treated if I
were in their position as these victims are having the worst days of their
lives.
References
Alligood, M. R. (2014). Nursing theory: Utilization and application (5th ed.).
Elsevier Mosby. http://stikespanritahusada.ac.id/wp-
content/uploads/2017/04/Nursing-Theory-Utilization-Application-2014-CD.pdf
Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances
in Nursing Science, 1(1).
https://journals.lww.com/advancesinnursingscience/citation/1978/10000/fund
amental_patterns_of_knowing_in_nursing.4.aspx
Lynch, V. A. & Duval, J. B. (2006). Forensic nursing science. (2nd ed.). (p. 10).
Elsevier Health Sciences. https://nursekey.com/2-concepts-and-theory-of-
forensic-nursing-science/
McEwen, M. & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.).
Wolters Kluwer.
New Living Translation Bible. (2015). Tyndale House Publishers.
https://www.bible.com/bible/116/GEN.1.NLT (Original work published 1996)
Valentine, J. L. (2014). Why we do what we do: A theoretical evaluation of the
integrated practice model for forensic nursing science. Journal of Forensic
Nursing, 10(3). https://oce-ovid-com.ezproxy.liberty.edu/article/01263942-
201407000-00002/HTML
Valerie,
Watson’s Human Caring Theory is applicable to many nursing specialties.
While the theory has continued to evolve and guide our discipline of nursing,
it has faced challenges in finding ways to integrate the theory into nursing
practice (Wei & Watson, 2019). The theory provides a holistic perspective
and has been widely used to guide nursing education, practice and research.
Many positives to the theory include how universal the principles of human
caring are and that the theory itself is continually advanced. The theory’s
basis of human-to-human caring allows for positive patient and nurse
outcomes when the core values of the Human Caring Theory are applied in
practice. As a forensic nurse, we are required to provide holistic care that is
no-strings attached. Application of caring to my patients who are victims
helps to restore a sense of their worth and integrity of self which aligns with
Watson’s ontological assumption of oneness and wholeness. Watson also
noted that caring is a transpersonal experience which is when two persons
(nurse and victim) come together in the moment of patient care; forensic
nurses often connect with their patients in the moments of trauma and
distress which necessitates the need for nurses to create the caring
moments that facilitate healing. I also feel that Leininger’s Transcultural
nursing theory applies to many nursing specialties. I applied Leininger’s
middle ground theory to forensic nursing as this theory provides a holistic
view of how the role of culture pertains to healthcare, and how the theory
provides a great foundation in understanding today’s ever-growing,
multicultural population and how to provide culturally competent care. As
forensic nurses, and nurses in general, we provide care to a growing
population that encompasses many cultures. It’s important to continue to
provide holistic, culturally-sensitive care that aligns with the basic tenet of
Christianity which is to treat others with respect. A Christian viewpoint also
sees us as one in the body of Christ. The Bible states, “From one man he
created all the nations throughout the whole earth” (New Living Translation
Bible, 1996/2015, Acts 17:26). To practice culturally-competent care is to
respectfully “see” our brothers and sisters without minimizing or devaluing
individual differences.
Thank you for your post!
New Living Translation Bible. (2015). Tyndale House Publishers.
https://www.bible.com/bible/116/GEN.1.NLT (Original work published 1996)
Wei, H., & Watson, J. (2019). Healthcare interprofessional team members’
perspectives on human caring: A directed content analysis study.
International Journal of Nursing Sciences, 6(1).
https://www.sciencedirect.com/science/article/pii/S2352013218305210
Ashley,
Orem’s grand theory of Self-Care Deficit Nursing Theory is a theory that has
stood the test of time. The theory is comprised of three nested theories:
theories of self-care, self-care deficit, and nursing systems (McEwen & Wills,
2019). Orem’s theory has managed to change over time to accommodate
the concept of the individual and of the nursing system. The theory
emphasizes that human beings are a summative entity that needs to adapt
with their environment to meet life goals (Younas, 2017). This is especially
evident and can be applied to the patients, or victims, that I care for as a
forensic nurse. Victims of violence suffer both physically and emotionally. The
impact their environment, aka their abuser, has on their person is
detrimental to their self-care. It is my nursing duty to provide them with
nursing care that gives them the opportunity to correct their environment to
better their basic human needs for survival.
Kolcaba’s Theory of Comfort is one that addresses a human’s basic need for
relief, ease, or transcendence by providing comfort measures to reduce
negative tensions and engage positive tensions (McEwen & Wills, 2019). By
providing comfort, the nurse can promote health-seeking behaviors. This is
especially beneficial and can be applied to my role as a forensic nurse.
Victims that seek medical care are often reluctant and come from a hostile
environment that would cause negative tensions. By providing my patients
with comfort through my nursing care as well as providing a comfortable
environment, I am giving them the chance to attain enhanced comfort. By
attaining enhanced comfort, my patients are able to have better health-
related outcomes. Longing for comfort is a basic human need that can be
found in the Christ by Christians. Victims who are Christian can rely on
knowing Psalms 23:4, “4Even when I walk through the darkest valley, I will
not be afraid, for you are close beside me. Your rod and your staff protect
and comfort me” (New Living Translation Bible, 1996/2015, Psalms 23:4).
Thank you for your post!
McEwen, M. & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.).
Wolters Kluwer.
New Living Translation Bible. (2015). Tyndale House Publishers.
https://www.bible.com/bible/116/GEN.1.NLT (Original work published 1996)
Younas, A. (2017). A foundational analysis of Dorothea Orem’s Self-Care
Theory and evaluation of its significance for nursing practice and research.
Creative Nursing, 23(1). https://www.proquest.com/docview/1878391074?
parentSessionId=G%2BUr1m4czfu7IDvEGrcR0mBKAd4kdJLb8qRI65j9AmM
%3D&pq-origsite=summon&accountid=12085
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