Nursing Theories

Overview of Grand Nursing Theories

Evelyn M. Wills

Janet Turner works as a nurse on a postsurgical, cardiovascular floor. Because she desires a broader view of nursing knowledge and wants to become a clinical specialist or family nurse practitioner, she recently began an online RN to BSN degree program that would prepare her to enter a master’s degree program in nursing. The requirements for a course entitled “Scholarly Foundations of Nursing Practice” led Janet to become familiar with some of the many nursing theories. From her readings, she learned about a number of ways to classify theories: grand theory, conceptual model, middle range theory, practice theory, borrowed theory, interactive–integrative model, totality paradigm, and simultaneous action paradigm. She came to the conclusion that there is no cohesion among authors of nursing theory and even wondered what relation theory had to what she was doing in her critical care nursing practice.

Janet’s theory course was delivered through online distance learning methods. To express her frustration and to try to understand the material, she consulted with her theory professor via the Web-based live chat room that was part of the course. The entire class eventually logged on to the chat and a long discussion resulted in which students shared their frustration with these new and abstract ideas. The instructor, a teacher who had come from an RN to BSN program herself, shared with them that frustration and confusion were the normal feelings one had when learning these abstractions. She presented them with several interesting ways to conceptualize grand nursing theories. The chat broke up with the agreement that each student would review the assigned readings again and return to next week’s live chat ready to discuss their findings.

Theories evolved from several schools of philosophical thought and differing scientific traditions. To better understand the theories, Janet looked for ways to group or categorize them based on similarities of perspective. As she studied theories based on similar perspectives, she was able to read and analyze the theories more effectively, and to select three that she intended to examine further.

In Chapter 2, the reader was introduced to grand nursing theories and given a brief historical overview of their development. Fawcett and DeSanto-Madeya (2013) distinguish between conceptual models and grand theories, and this chapter discusses that differentiation in an effort to assist nursing students to understand the material. According to Fawcett and DeSanto-Madeya (2013), conceptual models are broad formulations of philosophy that are based on an attempt to include the whole of nursing reality as the scholar understands it. The concepts and propositions are abstract and not likely to be testable in fact. Grand nursing theories, by contrast, may be derived from conceptual models and are the most complex and widest in scope of the levels of theory; they attempt to explain broad issues within the discipline. Grand theories are composed of relatively abstract concepts and propositions that are less abstract than those of conceptual models (p. 15) and may not be directly amenable to testing (Butts, 2011; Fawcett & DeSanto-Madeya, 2013; Higgins & Moore, 2000). They were developed through thoughtful and insightful appraisal of existing ideas as opposed to empirical research and may provide the basis for scholars to produce innovative middle range or practice theories (Figure 6-1).