Grand Nursing Theories Based on Interactive Process
Evelyn M. Wills
Jean Willowby is a student in an RN to master of science in nursing program. She is working to become a pediatric nurse practitioner. For one of her practicum assignments, she must incorporate a nursing theory into her clinical work, using the theory as a guide. During an earlier course on theory, Jean read several nursing theories that focused on interactions between the client and the nurse and between the client and the health care system. She remembered that in the interaction models and theories, human beings are viewed as interacting wholes and client problems are seen as multifactorial.
The theories that stress human interactions best fit Jean’s personal philosophy of nursing because they take into account the multitude of factors she believes to be part of clinical nursing practice. Like the perspective taken by interaction model theorists, Jean understands that, at times, the results of interventions are unpredictable and that many elements in the client’s background and environment have an effect on the outcomes of interventions. She also acknowledges that there are many interactions between clients and their environments, both internal and external, some of which cannot be measured.
To better prepare for the assignment, Jean studied several of the human interaction models and theories, focusing most of her attention on the works of Roy and King. But after discussing her thoughts with her professor, she was referred to the Artinian Intersystem Model (AIM), a relatively new model by Barbara Artinian. After reviewing some of the precepts of the model, she thought that it appeared to best fit her pediatrics practice and determined that she would learn more about it.
As discussed in Chapter 6, interactive process nursing theories occupy a place between the needs-based theories of the 1950s and 1960s, most of which were philosophically grounded in the positivist school of thought, and the unitary process models, which are grounded in humanist philosophy, which expresses the belief that humans are unitary beings and energy fields in constant interaction with the universal energy field. The interactive theories are grounded in the postpositive schools of philosophy.
The theorists presented in this chapter believe that humans are holistic beings who interact with and adapt to situations in which they find themselves. These theorists ascribe to systems theory and agree that there is constant interaction between humans and their environments. In general, human interaction theorists believe that health is a value and that a continuum of health ranges from high-level wellness to illness. They acknowledge, however, that people with chronic illnesses may have healthy lives and live well despite their illnesses.
Nursing models that can be described as interactive process theories include Levine’s Conservation Model; Artinian’s Intersystem Model; Erickson, Tomlin, and Swain’s Modeling and Role-Modeling; King’s Systems Framework and Theory of Goal Attainment; Roy’s Adaptation Model; and Watson’s Philosophy and Science of Caring. Each is discussed in this chapter. The models treated in this chapter are not arranged historically; some date back to the 1960s, whereas some are relatively new. Levine’s model is placed early in the chapter because it is one of the classic models.
An attempt was made to ensure that a balanced approach was used in presenting the works of these theorists. However, some of the theories are quite complex (e.g., those of Erickson, Tomlin, and Swain; King; and Roy), whereas others are quite parsimonious (e.g., those of Levine and Watson). Additionally, some of the models have been revised repeatedly (e.g., Artinian, King, Roy, and Watson). As a result, the sections dealing with some models are longer or more involved than others, but this does not imply that the works of any of the theorists discussed are more or less important to the discipline than others.
Myra Estrin Levine: The Conservation Model
The ideal of conservation pervades the background of some nurses’ ideas (Mefford, 2004). Myra Levine (1973) stated that “nursing is a human interaction” (p. 237). Her model deals with the interactions of nurse and client. It considers multiple factorial interactions, which may produce predictable effects using probability as the reality.
Background of the Theorist
Myra Levine earned a diploma in nursing from Cook County School of Nursing in Chicago, Illinois, in 1944; a bachelor’s degree in science at the University of Chicago in 1949; and a master of science in nursing from Wayne State University in Detroit, Michigan, in 1962. She held numerous clinical and education positions during her long career (Schaefer, 2010). She published An Introduction to Clinical Nursing in 1969; this work was revised in 1973 and again in 1989 (Levine, 1989). Levine enjoyed a long and productive career, which included a distinguished publication record. She died in 1996, at age 75, leaving a legacy to nursing of education, administration, and scholarship (Schaefer, 2002).
Philosophical Underpinnings of the Theory
Levine (1973) based the Conservation Model on Nightingale’s idea that “the nurse created an environment in which healing could occur” (p. 239). She drew from the works of Tillich on the unity principle of life, Bernard on internal environment, Cannon on the theory of homeostasis, and Waddington on the concept of homeorrhesis. The works of other scientists were also used. Four conservation principles form the basis of the model; these were synthesized from her scientific study and practice (Levine, 1990).
Major Assumptions, Concepts, and Relationships
The following four conservation principles are the major principles around which the model is constructed:
· The principle of the conservation of energy
· The principle of the conservation of structural integrity
· The principle of the conservation of personal integrity
· The principle of the conservation of social integrity (Levine, 1990, p. 331)
According to Levine’s model, nursing interventions are based on conservation of the client’s integrity in each of the conservation domains. The nurse is seen as a part of the environment and shares the repertoire of skill, knowledge, and compassion, assisting each client to confront environmental challenges in resolving the problems encountered in the client’s own unique way. The effectiveness of the interventions is measured by the maintenance of client integrity (Levine, 1973, 1990).
Assumptions About Individuals
· Each individual “is an active participant in interactions with the environment constantly seeking information from it” (Levine, 1969, p. 6).
· The individual “is a sentient being and the ability to interact with the environment seems ineluctably tied to his sensory organs” (Levine, 1973, p. 450).
· “Change is the essence of life and it is unceasing as long as life goes on. Change is characteristic of life” (Levine, 1973, p. 10).
Assumptions About Nursing
· “Ultimately the decisions for nursing intervention must be based on the unique behavior of the individual patient” (Levine, 1973, p. 6).
· “Patient-centered nursing care means individualized nursing care. It is predicated on the reality of common experience: every man is a unique individual, and as such he requires a unique constellation of skills, techniques and ideas designed specifically for him” (Levine, 1973, p. 23).