Grand Nursing Theories

Donald Crawford is an intensive care unit (ICU) clinical nurse specialist (CNS) who has just completed his graduate degree. Donald strongly believes that evidence guiding nursing practice should be experiential and measurable, and during his master’s program, he derived a system for evaluation of the needs of the seriously ill individuals for whom he cared. He also devised a way to diagram the disease pathophysiology for many of his patients based on the Neuman Systems Model (Neuman & Fawcett, 2009).

During his graduate studies, Donald began to apply concepts and principles from Neuman’s model in his practice with encouraging results. He observed that the model helped predict what would happen next with some patients and helped him define patient’s needs, predict outcomes, and prescribe nursing interventions more accurately. In particular, he appreciated how Neuman focused on identification and reduction of stressors through nursing interventions and liked the construct of prevention as intervention. Using his position as CNS, he is developing a proposal to implement his methods throughout the ICU to help other nurses apply Neuman’s model in managing patient care.

The earliest theorists in nursing drew from the dominant worldviews of their time, which were largely related to the medical discoveries from the scientific era of the 1850s through 1940s (Artinian, 1991). During those years, nurses in the United States were seen as handmaidens to doctors, and their practice was guided by disease theories of medical science. Even today, much of nursing science remains based in the positivist era with its focus on disease causality and a desire to produce measurable outcome data. Evidence-based medicine is the current means of enacting the positivist focus on research outcomes for effective clinical therapeutics (Cody, 2013).

In an effort to define the uniqueness of nursing and to distinguish it from medicine, nursing scholars from the 1950s through the 1970s developed a number of nursing theories. In addition to medicine, the majority of these early works were strongly influenced by the needs theories of social scientists (e.g., Maslow). In needs-based theories, clients are typically considered biopsychosocial beings who are the sum of their parts, who are experiencing disease or trauma, and who need nursing care. Further, clients are thought of as mechanistic beings, and if the correct information can be gathered, the cause or source of their problems can be discerned and measured. At that point, interventions can be prescribed that will be effective in meeting their needs (Dickoff, James, & Wiedenbach, 1968). Evidence-based nursing fits with these theories completely and comfortably.