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SECOND EDITION

Fundamentals of
Nursing Models, Theories and Practice

Hugh P. McKenna

CBE, PhD, BSc(Hons), RMN, RGN, RNT, DipN(Lond), AdvDipEd, FFN FRCSI FEANS, FRCN, FAAN
Professor and Pro Vice Chancellor, Research and Innovation
University of Ulster, UK

Majda Pajnkihar

PhD, RN
Associate Professor, Dean, Senior Research Fellow, Head of Institute of Nursing Care
Faculty of Health Sciences
University of Maribor, Slovenia

Fiona A. Murphy

PhD, MSc, BN, RGN, NDN, RCNT, PGCE(FE)
Associate Professor
College of Human and Health Sciences
Swansea University, UK



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About the series

Wiley’s Fundamentals series are a wide-ranging selection of textbooks written to support preregistration nursing and other healthcare students throughout their course. Packed full of useful features such as learning objectives, activities to test knowledge and understanding, and clinical scenarios, the titles are also highly illustrated and fully supported by interactive MCQs, and each one includes access to a Wiley E-Text: powered by VitalSource – an interactive digital version of the book including downloadable text and images and highlighting and note-taking facilities. Accessible on your laptop, mobile phone or tablet device, the Fundamentals series is the most flexible, supportive textbook series available for nursing and healthcare students today.

Dedication

This book is dedicated to all the patients, families and communities with whom we have worked over the years. It is also dedicated to those scholars and students who have shaped our thinking on nursing theories.

In addition, we wish to acknowledge the patience and fortitude of our friends and families, specifically Tricia, Gowain and Saoirse McKenna, Grega and Jasna Pajnkihar, Boris Kac and Phil, Katie and Kieran Murphy. M.P. would also like to thank Dr Verena Tcshudin and Dominika Jakl for their help.

Hugh P. McKenna
Majda Pajnkihar
Fiona A. Murphy

Preface

The stimulus for this second edition was the very positive feedback we received for the first edition from nursing students, nurse lecturers and clinical nurses. It helped that the publishers were extremely keen on an updated version being produced. Initially, there was some reluctance on our part because we felt that the first book had dealt with the subject matter very thoroughly. However, on reflection we realised that in the intervening years there had been a growth in discussion and debate about nursing theory. A preface to a later edition of a book should set out to explain in what respects that edition differs from the previous one. There are a number of differences. Fiona Murphy and Majda Pajnkihar have joined the team and they bring with them new insights into how theory can inform nursing practice and research and how this, in turn, improves the quality and safety of patient care. The literature has been updated considerably and we have taken account of developments outside the USA and the UK. In particular, Majda provides information on how nursing theories are being taught and used in Slovenia, Croatia, Russia and Poland. Readers will also find that we have included more exercises. These include key concept boxes, reflective exercises, multiple choice questions, true/false questions, additional reading sources and a number of case studies.

Therefore, for these reasons and many others, we believe that this new edition is a considerable improvement on the previous book. It still takes the reader on a journey, from presenting the case for the use of theory in nursing practice through to considering the extent to which practice influences the development of theory, the definitions of theory and the different types of theory. We illustrate for readers the fact that theory is linked to science and why this is important for the profession of nursing. We spend a considerable amount of time outlining the different ways in which nurses know and the role of research and reasoning in building nursing knowledge.

One of the main movements for the profession worldwide is the emergence of new nursing roles. We show how such roles are linked to theories and we highlight the importance of ‘role theory’. We describe how grand nursing theories have evolved and the importance of mid-range and practice theories for guiding patient care. We unravel the often controversial relationship between nursing theories and nursing models, and examine these terms in detail and compare and contrast them, taking into account their advantages and disadvantages. We show how the biomedical model has influenced nurse education, practice and research over the years, and not always for the benefit of nursing.

We make a case for nursing being mainly about building and sustaining interpersonal relationships with patients, their families and communities. Several nursing theories have their roots in such relationships. We share a number of these with the readers, explaining Hildegard Peplau’s theory in considerable detail. We consider the differences between a normal interpersonal relationship and a therapeutic interpersonal relationship, stressing that practising nurses use both. We also outline the actual and potential barriers to the development of therapeutic interpersonal relationships.

Selecting an unsuitable theory can have a detrimental effect on patient care, and when this happens nurses are often reluctant to admit it and they try to mould the patient’s needs to fit the theory rather than moulding the theory to fit the patient’s needs! Conversely, we believe that a theory that is appropriate for practice will benefit patients and improve the working practices and morale of nurses. Therefore, choosing an appropriate theory to underpin nursing practice or nurse education needs a great deal of thought. We discuss 12 different criteria that can be used to help readers select a nursing theory for practice.

Since the first edition of this book, there has been a great deal written about evidence-based practice. We believe that no reasonable nurse would argue that an important part of every clinical nurse’s role is to ensure their practice is informed by the best available evidence. We show the link between theory and research and best evidence. We discuss how theory is generated by research, tested by research and evaluated by research. We also highlight how theory can help to shape a research study.

Every day in clinical practice, nurses are exposed to phenomena that influence patient care. Sometimes such phenomena are ignored because they seem commonplace or unimportant. We guide the readers through the process of identifying these phenomena, naming them and finding relationships between them. This provides an insight into how readers can construct a nursing theory.

Finally, we highlight how the worth of a theory is ascertained. The characteristics of a good theory are reviewed and these are presented as the basis for evaluating and analysing nursing theory. The particular place of testing a theory is considered, and the relationship between theory evaluation and theory testing is clarified.

We hope you enjoy reading this textbook as much as we have enjoyed writing it. We anticipate that it will open up new and interesting perspectives in your thinking about nursing theories and how they can be used to increase the knowledge base for the profession and enhance clinical practice.

Hugh P. McKenna
Majda Pajnkihar
Fiona A. Murphy

How to use your textbook

Features contained within your textbook

Every chapter begins with an outline of the chapter and an introduction to the topic.

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Learning outcome boxes give a summary of the topics covered in a chapter.

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Key concept boxes give definitions of theories.

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Reflective exercises provide ways to put theories into practice.

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Each chapter ends with a list of Revision Points to summarize important topics.

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Your textbook is full of illustrations and tables.

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