Evelyn M. Wills
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.
The grand theories and models of nursing described in this chapter focus on meeting clients’ needs for nursing care. These theories and models, like all personal statements of scholars, have continued to grow and develop over the years; therefore, several sources were consulted for each model. The latest writings of and about the theories were consulted and are presented. As much as possible, the description of the model is either quoted or paraphrased from the original texts. Some needs theorists may have maintained their theories over the years with little change; others have updated and adapted theirs to later ideas and methods. Nevertheless, new research has often extended the original work. Students are advised to consult the literature for the newest research using the needs theory of interest.
It should be noted that a concerted attempt was made in this book to ensure that the presentation of the works of all theorists is balanced. Some theories (e.g., Orem and Neuman) are more complex than others, and the body of information is greater for some than for others. As a result, the sections dealing with some theorists are a little longer than others. This does not imply that shorter works are inferior or less important to the discipline.
Finally, all theory analysts, whether novice or expert, will comprehend theories and models from their own perspectives. If the reader is interested in using a model, the most recent edition of the work of the theorist should be obtained and used as the primary source for any projects. All further works using the theory or model should come from researchers using the theory in their work. Current research writings are one of the best ways to understand the development of the needs theories.