A model to guide development and application of multiple nursing theories

A Framework for Combining Theoretical Conceptual Practice Models in Occupational Therapy Practice

Background. Occupational therapists find it difficult to use theoretical conceptual practice models to guide practice because no single model can address all of a client's occupational performance issues. Purpose. This paper presents a proposed framework for combining conceptual practice models to guide both collaborative assessment and intervention planning to address clients' occupational performance issues. The framework was designed as a tool not only to help therapists use theoretical models more easily, but also to help them better defend their intervention decisions. Key Issues. The framework provides a systematic method of combining a variety of theoretical conceptual practice models to address a client's issues more comprehensively thereby making theory appealing to therapists. Implications. The framework may be useful in helping occupational therapists combine multiple theoretical models to address clients' occupational performance issues and in defending their clinical decisions effectively.

Application of the Dental Hygiene Human Needs Conceptual Model and the Oral Health-Related Quality of Life Model to the dental hygiene curriculum in Japan

This paper reports the incorporation of the Dental Hygiene Human Needs Conceptual Model (DHHN) and the Oral Health-Related Quality of Life Model (OHRQL) into a dental hygiene curriculum in Japan. A simulated patient practice was offered to 67 dental hygiene students. In the practice activity, all students were introduced to the use of an OHRQL assessment tool. A DHHN assessment tool was utilized additionally only by the experimental student group. The statistical analysis of the post-practice survey showed that the OHRQL instrument was more helpful in assessment and problem identification than the DHHN instrument. By contrast, text-based analysis of dental hygiene diagnostic statements showed that the experimental group identified more domains of patients' human needs deficits than the control group. This suggested the possibility that the DHHN model helped them to see patients from broader perspectives. However, it was difficult for students to design care plans attending to the domains of the models. Also, in considerations to the cultural issues, the validity and equivalence of the Japanese versions of both models should be further investigated. Within the limitation of the present study, the results suggested that incorporation of the combination of the DHHN and OHRQL models can be useful in a dental hygiene curriculum, as each tool helps students expand the perspective from which they view client. Further improvements in learning strategies should facilitate the effective utilization of these models.

The meaning of models of nursing to practising nurses

BACKGROUND

It is contended that models of nursing have lost the momentum and challenge that they promised the profession. Their use, value and purpose have been seriously questioned and new perspectives on their use and implementation in practice, education and research are required. In addition, limited evidence exists on the implementation of models into clinical areas.

AIM

To explore the meaning of models of nursing to practising nurses.

METHODS

Serial interviews with qualified nurses who were undertaking an educational programme or module that explored and examined models of nursing.

FINDINGS

The outcome reveals that the use of the terms, models of nursing or nursing model, are limited and confusing as the terms can encompass a range of meanings. It is suggested that a three-model typology exists that clarifies more fully the present position of nursing models. The three models are Theoretical Model, Mental Model and Surrogate Model.

LIMITATIONS

The focus on data collection through serial interviews with qualified practitioners could have been broadened to include a range of data sources such as teachers and clinical areas, which could have enriched the phenomenon of models of nursing.

CONCLUSIONS

There is a greater need to understand nursing models within the framework of the three-model typology and to reconsider their introduction and use in this context.

The Roper, Logan and Tierney (1996) model: perceptions and operationalization of the model in psychiatric nursing within a health board in Ireland

This study aimed to determine whether the Roper, Logan & Tierney model was an appropriate model for planning nursing care for clients who are mentally ill. Data were collected from two sources in one Health Board region in Ireland. A care plan audit was used to evaluate the extent to which the Roper, Logan & Tierney model was used to assess, plan and evaluate nursing care in nursing documentation. Qualitative interviews with nurses explored their experiences of using the model and their perceptions of the model's usefulness and appropriateness for planning care. Both data sets were complementary, the qualitative data often providing contextual information which helped put the findings into perspective. It was found that there was little evidence that the Roper, Logan and Tierney model guided care planning and that goals and nursing interventions were frequently not explicitly documented. Interviews with nurses indicated that they lacked educational preparation for using the model and found the model constraining and physically orientated. The appropriateness of the Roper, Logan and Tierney model for planning care for clients who are mentally ill is questioned. It is suggested that nurses need to be adequately prepared if they are to use a model appropriately. Consideration should be given when selecting a model as to its 'fit' with the needs of the client group and the ward team philosophy.

An exploratory study of the alternative theoretical frameworks of student nurses

Alternative theoretical frameworks are the tacit assumptions and logical structures of practical action. Student nurses have alternative theories in which ethical and technical knowledge are combined to form high-level heuristics which assist with understanding and responding to client problems. The alternative theories of student nurses can be observed to guide care giving and therefore the theory-practice gap may not be as wide as is often assumed. The values and beliefs about nursing held by student nurses are broadly similar to those advocated for the profession as a whole.

Thoughts on the discipline of nursing as we approach the year 2000

A discipline is 'characterized by a unique perspective, a distinct way of viewing all phenomena, which ultimately defines the limits and nature of its inquiry' (Donaldson & Crowley 1978). Further, Chinn & Jacobs (1987) define discipline as a 'branch of instruction; a body of knowledge and of systematizing that knowledge within an area of concern or domain of inquiry'. The position taken in this paper is that nursing, as it approaches the year 2000, is an evolving discipline that is 'dedicated to the advancement of knowledge which contributes to the pursuit of excellence of care' (AARN 1985). The writer agrees with Jennings' (1987) position that theory gives definition to nursing's body of knowledge, and direction to research and practice. This paper addresses some of the issues and concerns related to the development of nursing knowledge which serves as a cornerstone for the discipline. It goes on to consider briefly a few tasks that face nursing as it approaches the year 2000.

Health care and the quality of life: a review

The increasing requirement for evaluation of health care, either for purposes of quality assurance or deciding resource distribution issues, has brought into question a number of ideas concerning the aims of the health care enterprise. This article suggests that the ultimate aim is to improve the quality of life, and examines the feasibility of adopting this as an evaluation criterion. Difficulties concerning the concept and definition of the quality of life are outlined, and a plea made for the adoption of the broadest possible therapeutic aims. Social indicators and subjective evaluations are considered in turn as measures of the quality of life, and their inadequacies and strengths exposed. Relationships between the measures are discussed, and their uses outlined. It is finally suggested that nurses should participate in the formulation of quality of life concepts and evaluations which reflect the values which underpin their own practice.