Introduction
Nursing is the profession that changes many lives, improves the quality of a human life, and promotes the development of personal and professional skills. Nursing is also a discipline that should be organized in accordance with some principles and rules. Therefore, it is important to identify and understand nursing theories and their possible impact on health care and society.
The analysis of nursing theories implies the necessity to discuss the roles of nurses, explain their impact on healthcare services, and investigate major concepts that could help nurses to succeed in their work. In this project, three theories will be discussed in regards to advanced nursing practice. The theories developed by Virginia Henderson (nursing needs), Martha Rogers (unitary human beings), and Kurt Lewin (change importance) are chosen for the analysis.
All of them touch upon different aspects of nursing practice and help to create a picture of how an advanced nurse should work, what to expect from nursing, and when it is necessary to take the steps and promote changes crucial for nurses and patients. Based on these three theories, it is possible to develop a nursing theory in action and prove that professional self-development among nurses is a crucial aspect for consideration and an appropriate achievement nurses have to strive for.
General Evaluation of Nursing Theories
Three theories should be discussed in this paper. One of the theories is non-nursing. The change theory is developed by Kurt Lewin in the middle of the 1900s and explained as one of the most successful theoretical approaches which help to explain the importance of change in different organizations as well as in nursing and the healthcare sphere (Stichler, 2011).
This theory is frequently used in different spheres of life including management, science, psychology, and marketing. Organizations and individuals are eager to use Lewin’s ideas to promote the development, consider the current environment, and achieve success using reasonable steps and making fast and clear decisions. The theory could also be used by nurses to understand what they can do to improve the quality of their services and support patients. There are also two nursing theories developed by two bright researchers and theorists.
Virginia Henderson offered the need theory and explained the importance of patient self-determination (Alligood, 2014). The Science of Unitary Human Beings is the theory elaborated by Martha Rogers, who believed that nursing was the kind of learned profession that contained the characteristics of science and art (Masters, 2009). These two theories help to understand that nursing is the sphere that involves not only nurses as the main doers of actions but also patients, who use the services and prove the importance of nursing as a profession.
The main feature of all these three theories includes the necessity of nurses to develop their skills, understand the peculiarities of the nursing environment, and offer the services with the help of which patients could be satisfied and properly treated. The chosen theoretical background should help to develop a new theory that includes the importance of professional self-development among nurses in their current environment.
Virginia Henderson and Her Nursing Need Theory
Virginia Henderson is usually defined as a pioneer among nursing theorists because she intends to define nursing from different points of view. In 1966, this theorist explained that patients have the right to be treated in the way they could take care of themselves after they leave the places where medical care was offered to them (Goudreau & Smolenski, 2013).
On the one hand, she was interested in the ideas of how society understood nursing and the goals nurses have to achieve. On the other hand, it was also important to clarify how nurses themselves comprehended nursing and identified their roles. As soon as the concept of nursing could be explained, some working principles and duties could be offered for nurses to follow.
The influence of Henderson’s theory remains to be integral to society because the definition that theorist offered were adopted by the International Council of Nurses (Timby, 2009). She explained that nursing had to be more than just a kind of care for people under certain medical orders. Her definition of nurses sounded as follows:
The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he could perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. (Timby, 2009, p.6).
Any patient could have their own needs and expectations, and nurses have to identify those needs and take the steps in regards to all patients’ expectations to help, assist, and direct. At the same time, it is wrong to believe that all nursing activities should be all about patients only. Henderson tried to clarify each aspect of nursing and introduce several major concepts that have to be identified and understood by nurses.
According to Henderson, there are four main concepts of nursing including an individual, the environment, health, and nursing, and 14 components according to which all nurses’ tasks should be organized. Each concept has its meaning and importance in the sphere of nursing and advanced nursing practice. Not only nurses but all stakeholders in the sphere of health care should be aware of their meanings. An individual is a person with several psychological and emotional needs. The patient is the type of individual who needs nursing care and who has mind and body inseparable and interrelated.
In other words, the patient is “a sum of parts with biophysical need rather than a type of a client or consumer” (Goudreau & Smolenski, 2013, p. 124). The environment is another concept that introduces the settings within the frames of which an individual could learn all-important patterns for living and the settings which underline the relation to families (Goudreau & Smolenski, 2013).
Health is the concept that does not have a clear definition in Henderson’s theory. Still, it is introduced as the required portion of the balance between all individual’s needs. The explanation of nursing as a concept was given above. It helps to explain the main goal of nurses that is to assist patients in their intentions to be complete and independent. Such a goal requires cooperation between nurses and doctors.
This theory also introduces a list of basic human needs that have to be taken into consideration in nursing care. The offered 14 components are divided in regards to human physiological, psychological, spiritual, moral, and sociologically oriented needs that could be compared with the hierarchy of needs developed by Maslow (Alligood, 2014, p. 46; Koutoukidis, Stainton, & Hughson, 2012, p. 15):
- Breathe normally;
- Eat and drink adequately;
- Eliminate body wastes;
- Move and maintain desirable postures;
- Sleep and rest;
- Select suitable clothes; dress and undress;
- Maintain body temperature within a normal range;
- Keep the body clean and well-groomed;
- Avoid dangers in the environment;
- Communicate with others;
- Worship according to faith;
- Work at something that provides a sense of accomplishment;
- Play or participate in various forms of recreation;
- Learn, discover, or satisfy the curiosity that leads to normal development and health.
All these components and concepts are simple and clear for nurses and ordinary people. Therefore, it is easy to use them and explain the duties that have to be complete by the representatives of the healthcare sphere. Still, their several shortages in the theory as well. First, it is hard to understand the meaning of peaceful death that could be contributed by a nurse. Henderson did not give a clear explanation of this term. Then, it is also hard to identify the connection between all those needs. The list is impressive indeed. However, some nurses and patients could be confused if all those needs should be considered at the same time.
The area of nursing practice that the chosen theory could be applied to is nurse education about the needs of their patients. This theory could be used as a guide for nurses, as well as the list of principles each patient should consider. Patients have to understand what kind of their needs should be satisfied by nurses, and nurses have to investigate if patients have to be assisted in having some kind of need.
Martha Rogers and Her Theory of Unitary Human Beings
The Theory of Unitary Human Beings developed by Martha Rogers introduces a conceptual model of nursing. This theory is based on the idea that nursing is both, science and art (Rahim, 2016). Therefore, nurses need to know how to use the connection between a person and the environment, support the integrity of a human being, and achieve the possible health potential. The concepts of Rogers’ theory are similar to the concepts identified by Henderson. Rogers based her work on the combination of such issues as a person, the environment, health, and nursing (Masters, 2009).
Also, this theorist underlined that it was important to identify “dynamic energy fields integral with environmental energy fields” (Masters, 2009, p. 51). In other words, a patient and the environment cannot be introduced isolated from each other. A person is a kind of indivisible energy field with its characteristics.
The environment is a kind of continuation of a person that helps to create the concept of a unitary human being that is an “irreducible, indivisible, pan-dimensional energy field identified by pattern and manifesting characteristics that are specific to the whole” (Alligood, 2014, p. 223). Health is defined as a significant part of the continuum a person could be involved in. Finally, nursing includes the connection between people and the environment and promotes health potential.
According to Rogers, there are three main principles in nursing including helices (continuous evolution of energy fields), resonancy (gradual evolution of energy from lower to higher pattersn), and integrality (mutual processes of a person and the environment) (Masters, 2009). People have to understand that the five main rules cannot be neglected. For example, a person and the environment cannot be separated. A person is the only source of their characteristics. Patterns and organizations could identify a person and the wholeness.
The main disadvantage of this theory is that all notions and concepts are abstract. Though they could be applied to practice, the way of how nurses could use them is hard to predict. Mistakes could occur, and misunderstandings cannot be avoided. Still, the theory could be used in such an area of advanced nursing as education. Nurses have to understand that each patient is a unique creature with their demands, needs, and expectations. The idea of energy fields helps to combine different attributes and introduce one system according to which advanced nurses could work.
Rogers provided nurses with a guide to view and treat patients. First, assessment should be done. Then, mutual patterning should be developed under voluntary conditions. Finally, an evaluation of the situation has to be offered. Therefore, the process of cooperation between nurses and patients does not have specific rules and explanations. Still, there are the principles and generalizations that could facilitate the process and encourage nurses to make the right decisions and conclusions.
Kurt Lewin and the Change Theory
Kurt Lewin is the representative of non-nursing theorists whose Theory of Change could be used by the representatives of the health care, as well as by the representatives of other spheres. He is usually called the father of planned organizational change that is based on the ideas developed in the 1800s. Many researchers and theorists define Lewin’s model as one of the main fundamental aspects of organizational development (Burke & Noumair, 2015).
According to this theorist, it is not enough to help people change something. It is important to provide people with knowledge so that they could comprehend the essence and nature of change and survive it with as many personal and professional benefits as possible. His Change Theory is a considerable contribution to understanding a human system and behavior and defining the required balance of forces that make people work and promote development.
There are three stages in Lewin’s theory: unfreezing, change, and refreezing. Each stage has its goal and impact on how people could be ready for changes and improvements in their skills and the environment. The current world is characterized by some changes that occur very often. It is hard to predict what kind of change should be done and when this process should occur.
Therefore, it is necessary to be prepared for changes that could be obligatory, unexpected, or planned. Regarding the fact that Lewin’s theory was introduced in 1947 (Burke & Noumair, 2015) and several requirements and new standards were added to the idea of organizational development, the concept of change has been changed dramatically. The theory was criticized, improved, and developed by the current requirements. Still, the basic three stages cannot be neglected. The stage of unfreezing is a crucial period when a company or a single person has to comprehend the importance of change.
It is also necessary to clarify if a company/person is ready to change something and leave the zone of comfort that has been already established. It is important to be prepared, and Lewin underlined the ideas of motivation and rewarding as the possible steps to be taken. In this stage, there are two types of forces that should be taken into consideration. On the one hand, driving forces that include opportunities, possible achievements, personal beliefs, and benefits should be identified and increased to prove the importance of change.
On the other hand, restraining forces that include doubts, challenges, and oppositions should be decreased to promote the idea of movement. As soon as the forces are identified and the goals are clarified, it is high time to move to the second stage that is a transition or change itself. Lewin admitted that change could not be identified as some kind of event. It is the process that people have to accept. To succeed in such a transition, it is necessary to believe, feel, and behave accordingly. The main shortage of Lewin’s theory is that the author neglected the role of power at this stage.
Though people have to accept change and make a list of steps to promote this process, they cannot do it on their own. There are several external factors such as leaders or politics that have to approve/disprove the process. Anyway, as soon as the second stage is taken, the last phase begins. Refreezing is the period when the change should be established as a new rule or even a habit.
A certain portion of time should be spent to accept the change as a standard that cannot be neglected. If this stage is neglected, a company or a person is under a threat of coming back to the old way. At this stage, people should share their opinions, suggest their ideas, and investigate the benefits and shortages of the change. There are no time limitations for this phase.
This theory could be used in advanced nursing practice in some ways. For example, nurses could improve their level of knowledge and gain an understanding of new concepts of their practice with the help of the theory. Besides, Lewin’s model is a helpful tool for nurses who have to cooperate with different people in a short period. It is important to understand the importance of changes that occur around, get ready for new ideas, take new steps, and accept the changes that cannot be avoided. As a rule, the change process is short because nurses have to accept as many changes as many patients and doctors are in the hospital or any other place of work.
Theory in Action: Professional Self-Development among Nurses
During the last years, nursing made phenomenal attainment and introduced itself as a significant educational discipline and profession at the same time (Arora, 2015). As a discipline, nursing helps to describe, explain, and investigate the experiences of nurses. As a profession, nursing is the sphere where people offer the best services to improve the quality of human life. Still, evolutions and changes in nursing environments cannot be neglected (Im & Ju, 2012). The already offered theories such as Henderson’s need theory, Rogers’ theory of unitary human beings, and Lewin’s theory of change could be used by nurses.
However, their effectiveness and appropriateness can be impugned with time. Therefore, the creation and development of a new theory could be offered. For example, the theory of self-development may be introduced. Taking into consideration the three theories discussed above, it is possible to say that nurses should be changed and improved regarding the needs and demands of patients. In other words, patients play a central role in nurses.
However, the chosen theorists forget about the importance of nurses in this practice. The utilization of the ideas leads to the creation of a new theory that states how crucial professional self-development among nurses could be. Its purpose is to describe the methods for effective nursing development in advanced practice and introduce the ways nurses could follow to improve nursing as discipline and profession.
Based on the theory of self-development, an important view could be offered: a nurse, as well as any other kind of employee, has the right to self-realization, self-development, and personal improvement in regards to the environment and standards set by an organization and society and the needs and expectations defined by patients. This theory aims at discussing the steps to be taken by nurses to provide patients with the best services and doctors with the best assistance and the conclusions to be made by nurses to meet their own needs and expectations.
The theory of self-development introduces three main concepts. First, socialization plays an important role in nursing development. As soon as nurses clarify how they are regarded by doctors, patients, and other healthcare stakeholders, they could create an image they want to follow. This concept aims at helping nurses to modify their behaviors and considering the changing environment. It is connected with the ideas of Lewin’s change theory when a person should understand the reason for a change, take steps, and analyze the worth of results and Henderson’s need theory when the recognition of patients’ needs should create the basis for a change. Another important concept is the self-recognition.
Literally speaking, it is necessary to look in the mirror, analyze if the expectations correspond with the reality, and make the list of contributions that could be appropriate. Finally, there is also a concept of professional standards that should be met. Each sphere has its own rules and requirements to be considered by its employees. Nurses have to understand that their activities should be directed at patients and doctors. This kind of combination should be a form of art-recognized by Rogers. To be developed as professional nurses means having the required portion of knowledge about duties to fulfill, patients to care for, and doctors to assist in. Regarding the identified concepts, the following definitions could be given:
- A person is unique by their nature with an ability to develop and consider personal and other people’s needs;
- The environment is integral for nurses because it creates the conditions for work, care, and development;
- Health is the characteristic of the activities that should be developed by nurses;
- Nursing is the discipline where people could develop their personal and professional skills, assist each other, and take care of people who are in need.
To put the theory in action, APNs have to clarify their level of understanding of personal needs, abilities, and intentions. It is possible to measure the theory with the help of such questions as:
- Am I ready to develop my skills?
- What improvements do I want to achieve?
- Are my patients satisfied with the services I offer?
- Do the doctors I cooperate with have some suggestions to be offered?
These open-ended questions provide the required portion of information about the current environment, the changes, and the abilities of nurses to self-development. The following exemplification proves that the theory could be implemented in advanced nursing practice. A graduate nurse starts working in a hospital. She tries to follow the rules and theories discussed in classes. However, her new duties and practice show that it is not enough to use the theoretical knowledge.
It is important to consider the current environment, unpredictable needs of patients, and urgent duties set by doctors. A nurse has to consider her abilities, understand what is expected of her in the hospital, and develop in regards to those expectations. Her self-development is her chance to succeed in nursing not only as a discipline but as a profession as well.
Conclusion
In general, nursing theories help to create the norms and standards that improve advanced nursing practice. Henderson, Rogers, and Lewin are the theorists whose ideas improve health care and promote the development of new theories. The theory of professional self-development among nurses is developed in this project to prove that nurses have enough sources to succeed in their job and choose the activities that could be beneficial for patients and doctors which nurses have to work with.
References
Alligood, M.R. (2014). Nursing theorists and their work. St. Louis, MO: Elsevier Health Sciences.
Arora, S. (2015). Integration of nursing theories in practice. International Journal of Nursing Science Practice and Research, 1 (1), 8-12.
Burke, W.W. & Noumair, D.A. (2015). Organization development: A process of learning and changing. Upper Saddle River, NJ: FT Press.
Goudreau, K.A. & Smolenski, M. (2013). Health policy and advanced practice nursing: Impact and implications. New York, NY: Springer Publishing Company.
Im, E.O. & Ju, C. (2012). Current trends in nursing theories. Journal of Nursing Scholarship, 44(2), 156-164.
Koutoukidis, G., Stainton, K., & Hughson, J. (2012). Tabbner’s nursing care: Theory and practice. Chatswood, NSW: Elsevier Australia.
Masters, K. (2009). Role development in professional nursing practice. Sudbury, MA: Jones & Bartlett Publishers.
Rahim, L. (2016). Comparison between two nursing theories: Rogers and Leddy. I-Manager’s Journal on Nursing, 6(1), 1-5.
Stichler, J. F. (2011). Leading change. Nursing for women’s health, 15(2), 166-170.
Timby, B.K. (2009). Fundamental nursing skills and concepts. Philadelphia, PA: Lippincott Williams & Wilkins.