APPLICATION OF NURSING THEORY

Application of Nursing Theory



Application of Nursing Theory

Introduction

One of the most challenging expectations for nurses today—in research or practice settings—is the translation of nursing theory and science for use in practice and research. There are many ways to think about practice issues, such as symptom experience, and nurse researchers and practitioners are looking at frameworks to guide study and intervention with people experiencing symptoms. Symptoms are a subjective experience, appraised by the patient. Examples of symptoms are pain, nausea, or fatigue. By contrast, signs are observable indicators of a change in health status. A nurse identifies a sign through careful observation and evaluation. Pain, nausea, and fatigue may be evaluated as signs when measured as the amount of pain medication used, the frequency of vomiting, and the number of hours spent recumbent, respectively.

Chronic pain has recently been a common topic in the lay press, in part because of the withdrawal of cyclooxygenase-2 inhibitors. Chronic pain affects approximately 1 in 6 Americans and costs the United States approximately $100 billion annually. Most people seek pain relief solely from medication (ie, “pharmaceutical salvation”), but pain is affected by many factors (physiologic and non-physiologic), which may demand pain management approaches other than medication. Generally, pain is undertreated because patients and physicians underestimate its effects on functioning. Non-pharmacologic treatments for pain have expanded to include interventions, such as lifestyle changes, mindfulness therapy, or alternative therapies (eg, vitamins and herbs). All of these interventions are within the realm of nursing practice and could be considered in addition to traditional pharmacologic interventions. The effect of pain on psychosocial factors and the effect of psychosocial factors on pain can be difficult to quantify and assess, but this reciprocal relationship falls squarely within the realm of nursing practice. Nurses think about and approach pain differently than other members of the healthcare team, and nurses can have a significant impact on pain experience when viewing pain through their disciplinary lens.

The Ladder of Abstraction

Each discipline offers its own constructs for considering theories and theory applications. The Ladder of Abstraction is a construct depicting 3 different levels of ideas regarding a health issue, such as pain. As shown in Figure 1, the Ladder of Abstraction has 3 rungs: the philosophical, theoretical, and empirical rungs—3 different ways to think about and approach a health issue. The higher the level on the ladder, the more abstract is the ideas. Hence, philosophical levels of thought are more abstract than theoretical levels, which in turn are more abstract than empirical levels. A brief overview is given later in this section, followed by an example of how it applies to the symptom of pain. The philosophical level of thought is a global view, which guides perspectives about health issues.

A philosophy is based on and represents well-accepted ways of viewing the world. The theoretical level is expressed as symbols, ideas, and concepts. Middle-range theory resides at this level. The empirical level represents what can be observed (eg, self-reports, behavior, biologic indicators, ...