Non-Nursing or Borrowed Theories in Nursing Practice

Nursing is a dynamic and multifaceted profession that continually evolves to meet the changing needs of patients, healthcare systems, and society at large. While nursing has developed its own rich body of theoretical knowledge, the field also benefits greatly from incorporating theories and concepts from other disciplines. These “borrowed” or non-nursing theories provide valuable insights, frameworks, and tools that can be applied to various aspects of nursing practice, education, and research.

In this comprehensive exploration, we’ll delve into the world of non-nursing theories and their applications in nursing. We’ll examine why these theories are important, discuss a wide range of commonly used borrowed theories, and provide detailed examples of how they can be applied to enhance patient care and nursing practice.

Why Use Non-Nursing Theories?

Before we dive into specific theories, it’s crucial to understand the rationale behind incorporating non-nursing theories into nursing practice. Here are several compelling reasons:

1. Broader Perspective

Non-nursing theories often offer fresh viewpoints on healthcare issues, helping nurses think outside the box. By drawing on insights from fields such as psychology, sociology, management, and even physics, nurses can gain a more comprehensive understanding of the complex factors influencing health and healthcare delivery.

2. Interdisciplinary Approach

Modern healthcare is increasingly collaborative, involving professionals from various disciplines working together to provide optimal patient care. Understanding theories from other fields can improve communication and teamwork among healthcare professionals, leading to better coordinated and more effective care.

3. Enhanced Problem-Solving

Borrowed theories often provide new tools and frameworks for addressing complex patient care challenges. These different approaches can complement nursing-specific problem-solving methods, leading to more innovative and effective solutions.

4. Professional Growth

Exploring theories from other disciplines can expand a nurse’s knowledge base and foster critical thinking skills. This intellectual growth not only benefits individual nurses but also contributes to the advancement of the nursing profession as a whole.

5. Bridging Theory and Practice

Non-nursing theories can sometimes provide practical applications that bridge the gap between theoretical knowledge and clinical practice. They can offer concrete strategies for implementing abstract nursing concepts in real-world situations.

6. Addressing Gaps in Nursing Theory

While nursing has developed many of its own theories, there may be areas where nursing-specific theories are limited or underdeveloped. In such cases, borrowing from other disciplines can fill these gaps and provide necessary frameworks for practice and research.

Now that we understand the importance of non-nursing theories, let’s explore some commonly used borrowed theories in nursing practice. For each theory, we’ll provide an overview, discuss its application in nursing, and offer detailed examples to illustrate its practical use.

Commonly Used Non-Nursing Theories in Nursing Practice

1. Systems Theory

Overview:

Systems theory, originally developed in biology and engineering by scholars such as Ludwig von Bertalanffy, views organizations or groups as interconnected systems made up of various parts that work together. The theory emphasizes that these parts are interrelated and that changes in one part can affect the entire system.

Application in Nursing:

In healthcare, systems theory helps nurses understand how different parts of the healthcare system interact and influence patient outcomes. It encourages a holistic approach to patient care, considering not just the individual but also their environment, support systems, and the broader healthcare context.

Detailed Example:

Consider a nurse caring for a diabetic patient. Using systems theory, the nurse would approach the patient’s care as follows:

1. Individual level: Assess the patient’s physical condition, blood sugar levels, medication adherence, and understanding of their condition.
2. Family system: Evaluate the family’s knowledge about diabetes, their ability to support the patient’s dietary needs, and their involvement in the patient’s care.
3. Community level: Consider the patient’s access to healthy food options, safe places for exercise, and local diabetes support groups.
4. Healthcare system: Examine the coordination between different healthcare providers (e.g., primary care physician, endocrinologist, dietitian) and the patient’s access to necessary medical supplies and medications.
5. Societal level: Take into account cultural attitudes towards diabetes, public health initiatives related to diabetes prevention and management, and health insurance policies that might affect the patient’s care.

By considering all these interconnected systems, the nurse can develop a comprehensive care plan that addresses not only the patient’s immediate medical needs but also the broader factors that influence their ability to manage their diabetes effectively. This might include advocating for better food options in the patient’s neighborhood, connecting the family with educational resources, or working with the healthcare team to streamline the patient’s care coordination.

2. Maslow’s Hierarchy of Needs

Overview:

Developed by psychologist Abraham Maslow in 1943, this theory suggests that human needs are organized in a hierarchy, with basic physiological needs at the bottom and self-actualization at the top. The hierarchy typically includes five levels:

1. Physiological needs (e.g., food, water, sleep)
2. Safety needs (e.g., security, stability)
3. Love and belonging needs (e.g., relationships, social connections)
4. Esteem needs (e.g., respect, recognition)
5. Self-actualization (achieving one’s full potential)

Maslow proposed that individuals are motivated to fulfill these needs in order, starting with the most basic physiological needs before moving on to higher-level needs.

Application in Nursing:

Nurses can use Maslow’s hierarchy to prioritize patient care and understand how unmet basic needs might affect a patient’s ability to focus on higher-level health concerns. This framework can guide nurses in addressing the most pressing needs first and in understanding the interconnectedness of various aspects of a patient’s well-being.

Detailed Example:

Let’s consider a nurse working in a homeless shelter’s health clinic. Using Maslow’s hierarchy, the nurse might approach patient care as follows:

1. Physiological needs:
   • Ensure patients have access to food, water, and a safe place to sleep.
   • Address immediate health concerns like infections, injuries, or chronic condition management.
2. Safety needs:
   • Help patients access secure housing options or shelter services.
   • Assist with obtaining necessary medications and establishing a stable healthcare routine.
3. Love and belonging needs:
   • Connect patients with social workers or community support groups.
   • Encourage rebuilding relationships with family or friends when appropriate.
4. Esteem needs:
   • Treat patients with respect and dignity, regardless of their circumstances.
   • Encourage patients to set and achieve small health-related goals to build self-esteem.
5. Self-actualization:
   • Support patients in pursuing education or job training programs.
   • Encourage engagement in meaningful activities or hobbies that promote personal growth.

In this scenario, the nurse recognizes that addressing a patient’s need for food and shelter (basic physiological needs) is crucial before expecting the patient to adhere to a complex medication regimen or engage in preventive health measures (which relate to higher-level needs like health and safety).

For instance, if a patient with diabetes comes to the clinic, the nurse might first ensure the patient has access to regular meals and a safe place to store insulin before focusing on detailed diabetes education or long-term complications prevention. By addressing these fundamental needs first, the nurse creates a foundation upon which higher-level health interventions can be built more effectively.

3. Lewin’s Change Theory

Overview:

Kurt Lewin, a social psychologist, developed this theory in the 1940s to describe the process of change in human systems. Lewin’s Change Theory outlines three stages of change:

1. Unfreezing: Recognizing the need for change and preparing for it.
2. Changing (or Moving): Implementing the change.
3. Refreezing: Stabilizing and maintaining the new state after the change has been made.

Application in Nursing:

This theory can be applied in nursing to help patients make lifestyle changes, to implement new practices in healthcare settings, or to guide organizational changes in nursing departments or healthcare institutions.

Detailed Example:

Let’s consider a nurse helping a patient quit smoking using Lewin’s Change Theory:

1. Unfreezing Stage:
   • The nurse helps the patient recognize the need to quit smoking by discussing health risks and personal motivations.
   • They explore the patient’s current smoking habits and identify triggers.
   • The nurse assists the patient in overcoming initial resistance by addressing concerns and misconceptions about quitting.
2. Changing Stage:
   • Together, the nurse and patient develop a quit plan, which might include:
     • Setting a quit date
     • Choosing a quitting method (e.g., cold turkey, nicotine replacement therapy)
     • Identifying alternative coping strategies for stress and cravings
   • The nurse provides education on withdrawal symptoms and how to manage them.
   • They practice refusal skills for situations where the patient might be tempted to smoke.
   • The nurse offers regular check-ins and support throughout the quitting process.
3. Refreezing Stage:
   • The nurse helps the patient establish new routines that support a smoke-free lifestyle.
   • They work together to reinforce the patient’s new non-smoker identity.
   • The nurse connects the patient with ongoing support resources, such as support groups or follow-up counseling.
   • They develop strategies to prevent relapse, including how to handle slips if they occur.
   • The nurse encourages the patient to become an advocate for smoking cessation, which can help solidify their new habits.

Throughout this process, the nurse recognizes that change is not just about the physical act of quitting smoking, but also about shifting the patient’s self-perception and lifestyle. By guiding the patient through each stage of Lewin’s theory, the nurse provides a structured approach to a complex behavioral change, increasing the likelihood of long-term success.

4. Social Learning Theory

Overview:

Developed by psychologist Albert Bandura in the 1970s, social learning theory suggests that people learn by observing and imitating others. This theory emphasizes the importance of social context in learning and introduces several key concepts:

1. Observational learning: People can learn by watching others perform behaviors.
2. Modeling: The process of demonstrating a behavior for others to observe and imitate.
3. Self-efficacy: An individual’s belief in their ability to succeed in specific situations.
4. Reciprocal determinism: The idea that a person’s behavior both influences and is influenced by personal factors and the social environment.

Application in Nursing:

Nurses can use this theory to design effective patient education programs, model healthy behaviors for patients, and understand how social factors influence health behaviors. It’s particularly useful in health promotion and disease prevention efforts.

Detailed Example:

Consider a pediatric nurse using social learning theory principles to teach a child with asthma how to use an inhaler correctly:

1. Modeling:
   • The nurse demonstrates the correct inhaler technique step-by-step, explaining each action clearly.
   • They might use a placebo inhaler to show the process without administering medication.
2. Observational Learning:
   • The nurse encourages the child to watch carefully, pointing out key aspects of the technique.
   • They might use a video demonstration as well, showing other children successfully using inhalers.
3. Practice and Feedback:
   • The child is given a chance to practice the technique with a placebo inhaler.
   • The nurse provides immediate, constructive feedback, praising correct actions and gently correcting mistakes.
4. Reinforcement:
   • The nurse offers positive reinforcement for correct usage, which might include verbal praise, stickers, or a small reward system.
   • They explain the positive outcomes of correct inhaler use (better breathing, fewer symptoms) to motivate the child.
5. Self-Efficacy Building:
   • The nurse breaks down the process into manageable steps to build the child’s confidence.
   • They encourage the child to teach back the technique, which can boost their sense of mastery.
6. Social Support:
   • The nurse involves the child’s parents or caregivers in the learning process, encouraging them to model and reinforce correct inhaler use at home.
   • They might introduce the child to peer support groups where they can see other children managing their asthma effectively.
7. Environmental Considerations:
   • The nurse discusses with the family how to create a supportive home environment for managing asthma, such as reducing triggers and keeping the inhaler easily accessible.
8. Ongoing Learning:
   • The nurse schedules follow-up sessions to reinforce learning and address any new questions or challenges.
   • They provide resources for continued learning, such as age-appropriate educational materials or apps that gamify asthma management.

By applying social learning theory in this way, the nurse creates a comprehensive learning experience that goes beyond simply instructing the child. They leverage social influences, build self-efficacy, and create a supportive environment for long-term behavior change. This approach not only teaches the technical skills of inhaler use but also helps the child develop a positive attitude towards managing their asthma.

5. Diffusion of Innovation Theory

Overview:

Developed by Everett Rogers in 1962, the Diffusion of Innovation Theory explains how new ideas or practices spread through a population over time. The theory identifies five categories of adopters:

1. Innovators: The first to adopt new ideas, risk-takers (2.5% of the population)
2. Early Adopters: Opinion leaders who embrace change opportunities (13.5%)
3. Early Majority: Thoughtful people who accept change more quickly than average (34%)
4. Late Majority: Skeptical people who adopt new ideas after the majority (34%)
5. Laggards: Conservative people who are bound by tradition and very skeptical of change (16%)

The theory also outlines five stages in the adoption process: awareness, interest, evaluation, trial, and adoption.

Application in Nursing:

In healthcare, this theory can help nurses understand and facilitate the adoption of new practices, technologies, or health behaviors among patients or healthcare providers. It’s particularly useful in implementing evidence-based practices and health promotion strategies.

Detailed Example:

Let’s consider a nurse leader working to implement a new hand hygiene protocol in a hospital:

1. Assessing the Innovation:
   • The nurse leader evaluates the new hand hygiene protocol, considering its relative advantage over current practices, compatibility with existing routines, complexity, trialability, and observability of results.
2. Identifying Adopter Categories:
   • Innovators: The nurse leader identifies staff members who are always eager to try new approaches. These might be newer nurses or those with a particular interest in infection control.
   • Early Adopters: The nurse leader recognizes respected senior nurses or infection control specialists who can influence others.
   • Early Majority: This group might include nurses who are open to change but want to see evidence of effectiveness first.
   • Late Majority: The nurse leader identifies staff members who are more skeptical and may need more convincing.
   • Laggards: The nurse leader notes any staff who are particularly resistant to changing established routines.
3. Implementation Strategy:
   • Awareness Stage:
     • The nurse leader introduces the new protocol through staff meetings, emails, and posters, explaining the rationale and benefits.
   • Interest Stage:
     • They organize informal sessions where interested staff (likely innovators and early adopters) can learn more about the protocol.
   • Evaluation Stage:
     • The nurse leader provides data on how the new protocol has improved hand hygiene compliance and reduced infection rates in other hospitals.
   • Trial Stage:
     • They set up a pilot program on one unit, allowing staff to try the new protocol and provide feedback.
   • Adoption Stage:
     • Based on the success of the pilot, the nurse leader rolls out the protocol hospital-wide.
4. Targeting Different Adopter Categories:
   • For Innovators and Early Adopters:
     • The nurse leader involves them in the planning process and asks them to champion the new protocol.
   • For Early Majority:
     • They provide hands-on training sessions and clear, evidence-based rationales for the change.
   • For Late Majority:
     • The nurse leader shows data from the pilot program and testimonials from respected colleagues who have adopted the protocol.
   • For Laggards:
     • They provide extra support and one-on-one training, addressing specific concerns and emphasizing the mandatory nature of the change.
5. Continuous Monitoring and Reinforcement:
   • The nurse leader sets up a system to monitor compliance and provide regular feedback to staff.
   • They celebrate successes and improvements in hand hygiene rates and associated outcomes.
6. Addressing Barriers:
   • The nurse leader identifies and addresses barriers to adoption, such as time constraints or skin irritation from frequent hand washing, by adjusting workflows or providing gentler hand hygiene products.
7. Sustaining the Change:
   • They incorporate the new protocol into orientation for new staff and regular competency assessments.
   • The nurse leader continues to communicate the impact of improved hand hygiene on patient outcomes to maintain motivation.

By applying the Diffusion of Innovation Theory, the nurse leader can strategically implement the new hand hygiene protocol, tailoring their approach to different groups of staff members and systematically addressing potential barriers to adoption. This approach increases the likelihood of successful, widespread, and sustained implementation of the new practice.

6. Transtheoretical Model of Change

Overview:

Developed by James Prochaska and Carlo DiClemente in the late 1970s, the Transtheoretical Model of Change describes the stages individuals go through when changing behavior. The model outlines six stages of change:

1. Precontemplation: Not yet acknowledging that there is a problem behavior that needs to be changed
2. Contemplation: Acknowledging that there is a problem but not yet ready or sure of wanting to make a change

3. Preparation: Getting ready to change
4. Action: Actively changing the behavior
5. Maintenance: Maintaining the behavior change
6. Termination: The change is fully integrated and there’s no risk of relapse (though this stage is often omitted in practical applications)

Application in Nursing:

Nurses can use this model to assess a patient’s readiness to change and tailor interventions accordingly. It’s particularly useful in health promotion and disease management, where behavior change is crucial.

Detailed Example:

Let’s consider a nurse working with a patient who needs to lose weight for health reasons. The nurse might approach this using the Transtheoretical Model as follows:

1. Precontemplation Stage:
   • The patient doesn’t see their weight as a problem or isn’t interested in change.
   • Nurse’s approach: Provide information about the health risks of obesity and the benefits of weight loss, without pushing for immediate change.
2. Contemplation Stage:
   • The patient acknowledges that their weight is a problem but is unsure about making changes.
   • Nurse’s approach: Explore the patient’s concerns about weight loss, discuss potential benefits, and help the patient weigh pros and cons of change.
3. Preparation Stage:
   • The patient is ready to take action within the next month.
   • Nurse’s approach: Help the patient set specific, achievable goals. Assist in creating a realistic action plan, such as starting with 10-minute daily walks.
4. Action Stage:
   • The patient is actively making changes to lose weight.
   • Nurse’s approach: Provide support and encouragement. Offer practical tips for healthy eating and exercise. Help the patient track progress and overcome obstacles.
5. Maintenance Stage:
   • The patient has sustained the weight loss for at least 6 months.
   • Nurse’s approach: Work with the patient to identify potential relapse triggers. Develop strategies to maintain motivation. Encourage the patient to become a role model for others.
6. Termination Stage (if applicable):
   • The patient has no temptation to revert to their previous unhealthy behaviors.
   • Nurse’s approach: Celebrate the patient’s success. Encourage them to share their story with others who are trying to lose weight.

Throughout this process, the nurse continually assesses which stage the patient is in and adjusts interventions accordingly. For example, if a patient in the Action stage experiences a setback and moves back to Contemplation, the nurse would shift focus from practical weight loss strategies to rebuilding motivation and addressing barriers.

7. Chaos Theory

Overview:

Chaos theory, originating in mathematics and physics, deals with complex systems that are sensitive to initial conditions and can produce unpredictable outcomes. Key concepts include:

• The Butterfly Effect: Small changes can lead to large, unpredictable consequences
• Nonlinearity: The outcome is not proportional to the input
• Self-organization: Order can emerge from chaos without external control

Application in Nursing:

In healthcare, chaos theory can help nurses understand and navigate the complexities of patient care and healthcare systems. It encourages flexibility, adaptability, and a holistic approach to healthcare challenges.

Detailed Example:

Consider a nurse manager in an emergency department (ED) using concepts from chaos theory:

1. Recognizing Complexity:
   • The nurse manager understands that the ED is a complex system with many interacting variables (patient influx, staff availability, resource allocation, etc.).
2. Anticipating Unpredictability:
   • They prepare for sudden surges in patient volume or unexpected resource shortages, knowing that small events (like a multi-car accident) can have large ripple effects throughout the department.
3. Flexible Staffing:
   • Instead of rigid staffing ratios, the manager implements a flexible staffing model that can quickly adapt to changing patient needs.
4. Encouraging Self-Organization:
   • The manager empowers staff to make decisions at the point of care, trusting in their ability to organize effectively in response to changing conditions.
5. Nonlinear Problem-Solving:
   • When faced with a persistent problem (like long wait times), the manager looks for small, strategic changes that might have outsized impacts, rather than assuming that big problems always require big solutions.
6. Feedback Loops:
   • The manager implements real-time data tracking and frequent team huddles to create feedback loops that allow for rapid adjustments in response to changing conditions.
7. Edge of Chaos:
   • The manager seeks to keep the ED operating at the “edge of chaos” – a state of dynamic equilibrium where the department is stable enough to function effectively but flexible enough to adapt quickly to new challenges.

By applying chaos theory principles, the nurse manager can create a more resilient and adaptive emergency department, better equipped to handle the unpredictable nature of emergency care.

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Nursing research: A marriage of theoretical influences

8. Organizational Culture Theory

Overview:

Organizational culture theory, developed in the field of management, examines how shared values, beliefs, and assumptions shape behavior within organizations. Key elements include:

• Artifacts: Visible organizational structures and processes
• Espoused Values: Strategies, goals, and philosophies
• Basic Underlying Assumptions: Unconscious, taken-for-granted beliefs and perceptions

Application in Nursing:

Nurses can use organizational culture theory to understand and influence the culture of their workplace, which can impact patient care, job satisfaction, and overall healthcare outcomes.

Detailed Example:

A nurse leader implementing a new patient safety initiative might approach it as follows:

1. Assessing Current Culture:
   • The nurse leader conducts surveys and focus groups to understand the existing safety culture, including attitudes towards reporting errors and near-misses.
2. Identifying Cultural Artifacts:
   • They examine visible elements like safety posters, incident reporting systems, and how safety is discussed in team meetings.
3. Uncovering Espoused Values:
   • The leader reviews the organization’s mission statement and official policies related to patient safety.
4. Exploring Underlying Assumptions:
   • Through observation and discussion, they identify unspoken beliefs about safety, such as “mistakes are inevitable” or “reporting errors leads to punishment.”
5. Aligning the Initiative with Culture:
   • The leader frames the new safety initiative in a way that resonates with the organization’s values, such as emphasizing how it supports the mission of providing excellent patient care.
6. Addressing Cultural Barriers:
   • If there’s a culture of blame around errors, the leader works to shift towards a just culture that encourages reporting and learning from mistakes.
7. Leveraging Cultural Strengths:
   • If the organization has a strong teamwork culture, the leader emphasizes the collaborative aspects of the safety initiative.
8. Creating New Rituals and Symbols:
   • They introduce safety huddles at the start of each shift and create a visual management board to track safety metrics.
9. Role Modeling:
   • The leader consistently demonstrates the desired safety behaviors and openly discusses their own near-misses to normalize error reporting.
10. Reinforcing Cultural Change:
    • They align reward and recognition systems to reinforce the new safety culture, celebrating staff who contribute to safety improvements.