Nursing Theory

Review the following journal article that discusses the revival of nursing theory as a key component to nursing care.

In a 2-3 page paper, create your own holistic nursing theory or model. You may adapt portions or blend components from existing theories/models (please make sure to cite sources). Include your definitions of Person, Nursing, Environment, and Health.

APA format

Article attached

Discussion: Alternative Psychologies (Due 1/17/18)

Thus far in your experience as a psychology student, you have been introduced to the field of psychology in terms of the mind and its functions in relationship to human behavior. Most introductory psychology textbooks and resources for other psychology classes emphasize a cause-and-effect scientific model, which typifies traditional psychology in the United States and the Western hemisphere in general. Throughout this course and in your course text, you read about Western psychology, which is representative of the practice of psychology in the United States.

Alternative psychologies evolved independently of Western psychology because they are suitable for the needs of non-Western cultures. One notable difference is that alternative psychologies prioritize collective or group processes over isolated individual processes. Alternative psychologies view individuals as reflections of the larger culture or society. While the various alternative psychologies do have differences, they also have common themes such as those outlined in your course text: meaning-making, collective construction of psychological reality, time-dependent processes, and normative explanations.

Liberation psychology, which is one type of alternative psychology, has been used to address the needs of the poor and the oppressed in Latin America. With liberation psychology, the focus is on social change. Social change is possible when attempts are made to improve the conditions of the entire community rather than to only address the needs of one specific individual within the group. Additionally, this type of alternative psychology makes a difference by addressing challenges of the native people where they live, in their professions, and in the world around them. Liberation psychology also helps people understand what they need in order to facilitate change.

To prepare for this Discussion:

· Review Chapter 6 in your textbook, Toward a Global Psychology: Theory, Research, Intervention, and Pedagogy. Pay particular attention to the sections about alternative psychologies and liberation psychology.

· Referring to the video clips located in this week’s Optional Resources as examples, utilize the internet to identify one video that illustrates how liberation psychology empowers individuals to address their challenges.

· After viewing your selected video, identify the issues that were particularly challenging for the individuals in the video. Focus on two issues of particular interest to you.

· Reflect on how the common themes of alternative psychologies are evidenced in liberation psychology.

· Consider Walden University’s Mission for Social Change, which is to create scholar-practitioners who can effect positive social change.

With these thoughts in mind:

By Day 3

Post a description of the video you selected. Specify two issues that were particularly challenging for the individuals in the video. Explain how liberation psychology could be or was applied to address the two issues you identified. Discuss how liberation psychology reflects at least two of the themes common to alternative psychologies. Describe how you, as a Walden University scholar-practitioner, might utilize liberation psychology as a means to effect positive social change.

Course Text: Stevens, M. J., & Gielen, U. P. (2007). Toward a glob al psychology: Theory, research, intervention, and pedagogy. Mahwah, NJ: Lawrence Erlbaum Associates.

· Chapter 6, “Toward a Conceptual Foundation for a Global Psychology”

· Chapter 7, “Qualitative Research Methods for a Global Psychology”

Assignment: Culturally Appropriate Research Methods (Due 1/19/18)

In order to understand research methods that are suitable for global psychology, it is important to state what is meant by “global psychology.” Marsella (1998) refers to global psychology as “concerned with understanding, assessing, and addressing, the individual and collective psychological consequences of global events and forces by encouraging and using multicultural, multidisciplinary, multisectoral, and multinational knowledge, methods, and interventions” (p. 1284).

Culturally sensitive research methods employed by psychologists with a global perspective usually are qualitative, while Western psychologists often employ quantitative approaches. Quantitative approaches emphasize cause and effect and reflect a traditional scientific method. Quantitative methods also are objective and value statistical analyses. Qualitative methods allow more subjectivity and often involve observation and interviews that are harder to quantify. Recently, many Western psychologists have increased their acceptance of qualitative methods or blending quantitative and qualitative methods (mixed methods). However, even in the realm of qualitative methods, psychologists have identified some methods that are more appropriate than others in satisfying the needs of their discipline. Your course text explains four specific, culturally appropriate research methods: action theory, discourse analysis, grounded theory, and focus groups.

Despite global psychology’s preference for culturally appropriate qualitative methods, most peer review committees of professional journals publish studies that use traditional quantitative methods. Thus, psychologists who work internationally or globally continue to encourage researchers to apply culturally appropriate quantitative and qualitative methods.

To prepare for this Assignment:

· Review Chapter 7 in your course text.

· Think about culturally appropriate research methods, such as action theory, discourse analysis, grounded theory, and focus groups.

· Use the link provided in this week’s learning resources to review several past issues of the International Psychology Bulletin.

· Within the past issue of your choice, select one peer-reviewed article which is of interest to you that does not use action theory, discourse analysis, grounded theory, or focus groups.

· Think about whether the research used in the article is quantitative or qualitative.

· Consider how you might use action theory, discourse analysis, grounded theory, or focus groups to conduct a study about this same topic.

· Think about why the research method you selected could benefit a study of this topic.

The Assignment (3–4 pages):

· Summarize the study in the research article you selected, including a description of the type of research method that was used.

· Is the study qualitative or quantitative? Discuss how you know.

· Pick two culturally appropriate research methods (action theory, discourse analysis, grounded theory, or focus groups) and explain how you could apply each method to conduct a study about the same topic described in the research article you selected.

· Explain why the research methods you selected could benefit a study about this topic and describe how they compare to the type of research methods originally used.

Discussion: Healing as a Form of Intervention (Due 1/20/18)

A psychotherapeutic intervention is a treatment that addresses a physical problem, a mental problem, or both. Psychotherapeutic interventions are targeted differently in non-Western cultures. In Western cultures, such interventions tend to focus on the mind. They are separate from medicine, which focuses on the body. Psychotherapeutic interventions in non-Western cultures (referred to as “traditional cultures” in your text) often are identified as healing and focus on the health of the whole person rather than on addressing an individual problem. In non-Western cultures, medical interventions are not separated clearly from psychotherapeutic interventions.

The use of psychotherapeutic interventions in different parts of the world is influenced by both society and culture. Your text refers to these influencers as “the sociocultural context.” The term sociocultural context includes such factors as religion, community beliefs about health and illness, rituals such as initiation or purification ceremonies, and relationships with family.

To prepare for this Discussion:

· Review Chapter 8 in your course text, paying particular attention to the section on psychotherapy in its sociocultural context. Review non-Western healing therapies such as Morita, Naikan, and Zen.

· Review the articles: “Buddhist psychotherapy” and “The effect of yoga on functional recovery level in schizophrenic patients.”

· Review this week’s media about psychotherapy in Argentina. You may wish to view the clips more than once and take notes.

· Select a non-Western psychotherapeutic intervention and think about how that intervention is an expression of its sociocultural context.

· Consider the similarities and differences between the psychotherapeutic intervention you selected and psychotherapeutic interventions in Western cultures.

· Using the Walden University library, search and find one current peer-reviewed article that reports on a psychotherapeutic intervention practiced in traditional cultures.

With these thoughts in mind:
By Day 3

Post a description of the non-Western psychotherapeutic intervention you selected. Explain two ways in which this intervention is an expression of its sociocultural context. Finally, explain two similarities and two differences between the psychotherapeutic intervention you selected and psychotherapeutic interventions in Western cultures

Course Text: Stevens, M. J., & Gielen, U. P. (2007). Toward a glob al psychology: Theory, research, intervention, and pedagogy. Mahwah, NJ: Lawrence Erlbaum Associates.

· Chapter 8, “Psychotherapeutic and Related Interventions for a Global Psychology”

Shibusawa, T., & Chung, I. (2009). Wrapping and unwrapping emotions: Clinical practice with East Asian immigrant elders. Clinical Social Work Journal, 37(4), 312–319.

Note: You will access this article from the Walden Library databases.

Blando, J. A. (2009). Buddhist psychotherapy with older GLBT clients. Journal of GLBT Family Studies, 5(1/2), 92–81.

Note: You will access this article from the Walden Library databases.

Kavak, F., Ekinci, M. (2016). The effect of yoga on functional recovery level in schizophrenic patients. Archives of Psychiatric Nursing, 30(6), 761–767.

Note: You will access this article from the Walden Library databases.

Online Video: JerichoTV. (2008, August 19). Tango and analysis [Video file]. Retrieved from http://www.youtube.com/watch?v=0rRNczyT0OI&feature=related

This approximately 4-minute video explains why psychoanalysis is so popular in Argentina.

Online Video: JerichoTV. (2007, December 5). Argentina in therapy – Trailor film [Video file]. Retrieved from http://www.youtube.com/watch?v=Uqprzvx4pbY

This approximately 2-minute video reinforces the part that psychotherapy plays in Argentina.

Online Video: JerichoTV. (2008, August 18), Argentina in therapy – Pre-title sequence [Video file]. Retrieved from http://www.youtube.com/watch?v=qNprhvBjmP0&feature=related

This approximately 3-minute video continues to reinforce the part that psychotherapy plays in Argentina.
Assignment: Individual Therapy (Due 1/22/18)
In this week’s Discussion, you considered broad differences between non-Western and Western psychotherapeutic interventions. The focus of this week’s Application is individual therapy, one specific type of psychotherapeutic intervention. Most people think of individual therapy as a client sitting with their therapist to address the client’s concerns. This is indeed one type of individual therapy. This week’s learning resources refer to different approaches in individual therapy such as: psychoanalysis, behavioral therapy, cognitive therapy, and counseling. Regardless of the approach, individual therapy depends on a person’s willingness to seek therapy and the relationship between a therapist and a client. In this Application, you consider how sociocultural context influences individual therapy.
To prepare for this Assignment:
· Review Chapter 8 in your textbook, Toward a Global Psychology: Theory, Research, Intervention, and Pedagogy. Pay particular attention to the following sections: “A Global Panorama of Psychotherapy: Innovations, Modifications, and Elaborations”, “Psychotherapy in its Sociocultural Context”, and “Expectations, Preferences, and Styles: Cultural, Characteristics and Differences”.
· Consider the differences in the expectations, preferences, and styles of psychotherapy with Chinese clients and African and Indian Clients.
· Review the article, ” Wrapping and unwrapping emotions: Clinical practice with East Asian Immigrant Elders,” paying particular attention to attitudes toward psychotherapy and therapist-client relationships.
· Review the following videos: “Tango and Analysis,” “Argentina in Therapy – Trailer Film,” and “Argentina in Therapy – Pre-Title Sequence.” Focus on attitudes toward psychotherapy and therapist-client relationships.
· Consider similarities and differences in attitudes toward individual therapy in Argentina and Eastern Asia.
· Think about how sociocultural context, in general, influences attitudes toward therapy.
· Consider similarities and differences in therapist-client relationships between Argentina and Eastern Asia.
· Reflect on how sociocultural context, in general, influences therapist-client relationships.
The Assignment (3–4 pages):
· Explain how the sociocultural context influences attitudes toward both therapy and therapist-client relationships.
· Compare the differences in the expectations, preferences, and styles of psychotherapy among Chinese, African, and Indian clients.
· Describe the similarities and differences in attitudes toward both individual therapy and therapist-client relationships in Argentina and Eastern Asia.
Course Text: Stevens, M. J., & Gielen, U. P. (2007). Toward a glob al psychology: Theory, research, intervention, and pedagogy. Mahwah, NJ: Lawrence Erlbaum Associates.
· Chapter 8, “Psychotherapeutic and Related Interventions for a Global Psychology”
Shibusawa, T., & Chung, I. (2009). Wrapping and unwrapping emotions: Clinical practice with East Asian immigrant elders. Clinical Social Work Journal, 37(4), 312–319.
Note: You will access this article from the Walden Library databases.
Blando, J. A. (2009). Buddhist psychotherapy with older GLBT clients. Journal of GLBT Family Studies, 5(1/2), 92–81.
Note: You will access this article from the Walden Library databases.
Kavak, F., Ekinci, M. (2016). The effect of yoga on functional recovery level in schizophrenic patients. Archives of Psychiatric Nursing, 30(6), 761–767.
Note: You will access this article from the Walden Library databases.

Online Video: JerichoTV. (2007, December 5). Argentina in therapy – Trailor film [Video file]. Retrieved from http://www.youtube.com/watch?v=Uqprzvx4pbY

This approximately 2-minute video reinforces the part that psychotherapy plays in Argentina.

Online Video: JerichoTV. (2008, August 18), Argentina in therapy – Pre-title sequence [Video file]. Retrieved from http://www.youtube.com/watch?v=qNprhvBjmP0&feature=related

This approximately 3-minute video continues to reinforce the part that psychotherapy plays in Argentina.

Unite for Children (UNICEF). (n.d.). Photo essays. Retrieved January 31, 2017, from http://www.unicef.org/photoessays/index-pe.html

This UNICEF site houses a collection of photo essays which powerfully depict global issues and crises.

Discussion: Community Empowerment (Due 1/24/18)
Last week, you explored how individual therapy is viewed in both Western and non-Western cultures. This week, you discover how global psychology contributes to macro-level interventions. “Macro” refers to interventions that address large-scale needs at community, national, or global levels. Psychologists involved in macro-level interventions often contribute to policy development and social change by addressing psychological issues such as posttraumatic stress, anxiety, and depression.
According to Chapter 9 in your course text, “macro-level interventions consist of community-based programs implemented on a large scale in a manner that contributes to peace and social justice.” Psychologists collaborate with local leaders to gain the support of villages or tribes to initiate and implement interventions. Your course text also describes additional examples of macro-level interventions in which community empowerment was an important mechanism for successfully addressing the intervention and initiatives that address: the HIV/AIDS worldwide pandemic, school desegregation in the United States, and the institutionalization of orphans from war-torn regions.
To prepare for this Discussion:
· Review Chapter 9 in your course text, paying particular attention to the section on “Community Empowerment and Capacity Building.”
· Review photo essays of macro interventions on the UNICEF web site. Select one photo essay that interests you.
· In the photo essay you selected, consider whether you see evidence of community empowerment.
· Think about how community empowerment might have been increased if you do see existing evidence of it or how community empowerment might have been engendered if you do not see evidence of it.
· Consider how a capacity building approach can improve outcomes in at-risk environments.
With these thoughts in mind:
By Day 3
Post a brief description of the photo essay you selected. Explain whether you see evidence of community empowerment. If you see evidence, explain the evidence and explain how community empowerment might have been increased. If you do not see evidence, explain how community empowerment might have been engendered. Lastly, discuss how a capacity building approach can improve outcomes in at-risk environments.
Note: Identify the title of the photo essay you selected in the first line of your post. You will be asked to respond to a colleague who selected a photo essay that you did not.
Course Text: Stevens, M. J., & Gielen, U. P. (2007). Toward a glob al psychology: Theory, research, intervention, and pedagogy. Mahwah, NJ: Lawrence Erlbaum Associates.
· Chapter 9, “Macro-Level Interventions: Psychology, Social Policy, and Societal Influence Processes”
Website

Unite for Children (UNICEF). (n.d.). Photo essays. Retrieved January 31, 2017, from http://www.unicef.org/photoessays/index-pe.html

This UNICEF site houses a collection of photo essays which powerfully depict global issues and crises.

Assignment: Strategies for Change and Macro-Level Interventions (Due 1/26/18)
Child soldiers, HIV/AIDS, and education in war-torn countries are just some examples of macro-issues of global significance that are in need of macro interventions. Global psychologists intervene by implementing strategies called change strategies. The three change strategies detailed in your text are top-down, bottom-up, and middle-out. Top-down strategies are those that top-level leaders implement by directing action to those who report to them. Bottom-up strategies work from the grassroots. In bottom-up strategies, laypeople work together to create change. Middle-out strategies are implemented by mid-level leaders to influence top-level leaders as well as their public constituencies. In this Application, you review macro-issues and their macro-level interventions, identify a global issue that might benefit from the presence of a psychologist, and consider strategies that might be used to intervene in such situations.
To prepare for this Assignment:
· Review Chapter 9 in your course text, paying particular attention to the section that addresses change strategies.
· Identify one global issue currently in the news that might benefit from a macro-level intervention that includes a psychologist.
· Think about one bottom-up change strategy a psychologist might use to intervene and address the issue, one middle-out strategy, and one top-down strategy.
· For each strategy, consider which specific change strategy might be the most effective in addressing the issue you selected.
The Assignment (3–4 pages):
· Describe the global issue you selected.
· Determine the macro-level intervention (that includes a psychologist) that you assert will work best in this situation. Explain why you believe this intervention will work best.
· Provide examples of how a psychologist may use each of the following change strategies to address the situation:
· Bottom-up
· Middle-out
· Top-down
· Explain which change strategy or which combination of strategies you believe would be the most effective in addressing the situation and why.
· Chapter 9, “Macro-Level Interventions: Psychology, Social Policy, and Societal Influence Processes”
Website

Unite for Children (UNICEF). (n.d.). Photo essays. Retrieved January 31, 2017, from http://www.unicef.org/photoessays/index-pe.html

This UNICEF site houses a collection of photo essays which powerfully depict global issues and crises.

Discussion: Characteristics of Indigenous Psychology (Due 1/28/18)
Indigenous psychology is an emerging field of psychology that relies on a local understanding of human behavior to develop theories, conduct research, and address challenges. Indigenous psychology evolved in response to the use of Western psychology in countries where it did not seem to fit. The main purpose of indigenous psychology is to practice psychology in a way that is appropriate for the social, political, historical, and cultural contexts in the area it serves.
Your course text highlights the limitations of general psychology, a term the authors frequently use interchangeably with Western psychology and mainstream psychology. In the article “Origins and Development of Indigenous Psychologies: An International Analysis,” 15 contributing authors describe the characteristics of indigenous psychology in different regions. They also detail the limitations of Western psychology when applied to non-Western countries.
To prepare for this Discussion:
· Review Chapter 5 in your course text, paying particular attention to the sections on “Limitations of General Psychology” and “Indigenous Psychologies.”
· Review the article “Origins and Development of Indigenous Psychologies: An International Analysis.” Consider the similarities and differences in what authors from different parts of the world have to say.
· Think about the limitations of Western psychology in non-Western countries.
· Reflect on the characteristics of indigenous psychology.
· Think about how indigenous psychology responds to the limitations of Western psychology.
· Select two limitations of Western psychology in non-Western cultures.
· Then, select two characteristics of indigenous psychology that could be used in response to the limitation you selected.
With these thoughts in mind:
By Day 3
Post an explanation of two limitations of Western psychology in non-Western countries. Next, describe two characteristics of indigenous culture that speak to the need for indigenous psychology. Finally, provide examples as to how these two characteristics of indigenous culture could be used in response to the two limitations of Western psychology you identified.
Course Text: Stevens, M. J., & Gielen, U. P. (2007). Toward a glob al psychology: Theory, research, intervention, and pedagogy. Mahwah, NJ: Lawrence Erlbaum Associates.
· Chapter 5, “Development of Indigenous Psychologies: Understanding People in a Global Context”
Article: Allwood, C. M., & Berry, J. W. (2006). Origins and development of indigenous psychologies: An international analysis. International Journal of Psychology, 41(4), 243–268.
Note: You will access this article from the Walden Library databases.

This seminal article examines the development of indigenous psychology in different parts of the world.
Article: Kim, U., & Park, Y. (2006). Indigenous psychological analysis of academic achievement in Korea: The influence of self-efficacy, parents, and culture. International Journal of Psychology, 41(4), 287–292.
Note: You will access this article from the Walden Library databases.

This article explains how indigenous psychology has contributed to academic achievement in Korea.
Assignment: Applications of Indigenous Psychology: Educational Achievement (Due 1/30/18)
One research area of indigenous psychology is the study of educational achievement in different countries. The research questions why students in some countries perform much better than students in other countries. Their findings have emphasized four major factors that impact educational achievement. The first factor, interdependence and proxy control, refers to a child’s dependence on parents. The second factor, self-regulation, refers to the effort a student puts into academic pursuits. The third factor, collective control, refers to cooperation between family members and educators. Organizational cultural, the fourth factor, refers to the underlying cultural value system that emphasizes human-relatedness. Your text provides further details about each of these factors. The article provided in this week’s resources illustrates the four factors and their effect on educational achievement in Korea. (Note that the authors of the article use the terms educational achievement and academic achievement interchangeably).
Studies show that East Asian students are high academic achievers, particularly in math and science. In contrast, studies indicate that students in the United States perform poorly in science, math, and often other academic areas as well. Psychologists are interested in understanding whether factors that influence high achievement in East Asia might somehow be “imported” into the United States to improve educational achievement.
To prepare for this Assignment:
· Review Chapter 5 in your course text, paying particular attention to the section on understanding achievement in East Asia.
· Review the article “Indigenous psychological analysis of academic achievement in Korea: The influence of self-efficacy, parents, and culture.” Focus on the following sections: “Traditional approaches; cultural values,” “Family and self-cultivation in Korea,” and “Discussion.”
· Think about how the factors of interdependence and proxy control, self-regulation, collective control, and organizational culture contribute to high educational achievement in East Asian countries such as Korea.
· Consider how the absence of interdependence and proxy control, self-regulation, collective control, and organizational culture may correspond with low educational achievement in the United States.
· Think about whether you believe the East Asian approach to interdependence and proxy control, self-regulation, collective control, and organizational culture might somehow be “imported” into American culture in order to improve educational achievement.
The Assignment (3–4 pages):
· Explain how the East Asian approach to interdependence and proxy control, self-regulation, collective control and organizational culture contributes to high educational achievement in East Asian countries.
· Explain how the absence of interdependence and proxy control, self-regulation, collective control, and organizational culture may correspond to low educational achievement in the United States.
· Explain whether you believe the East Asian approach to interdependence and proxy control, self-regulation, collective control, and organizational culture might be “imported” into American culture in order to improve educational achievement. Explain your answer.
Course Text: Stevens, M. J., & Gielen, U. P. (2007). Toward a glob al psychology: Theory, research, intervention, and pedagogy. Mahwah, NJ: Lawrence Erlbaum Associates.
· Chapter 5, “Development of Indigenous Psychologies: Understanding People in a Global Context”
Article: Allwood, C. M., & Berry, J. W. (2006). Origins and development of indigenous psychologies: An international analysis. International Journal of Psychology, 41(4), 243–268.
Note: You will access this article from the Walden Library databases.

This seminal article examines the development of indigenous psychology in different parts of the world.
Article: Kim, U., & Park, Y. (2006). Indigenous psychological analysis of academic achievement in Korea: The influence of self-efficacy, parents, and culture. International Journal of Psychology, 41(4), 287–292.
Note: You will access this article from the Walden Library databases.

This article explains how indigenous psychology has contributed to academic achievement in Korea.

Discussion 1: Ethics of Global Psychology (Due 2/2/18)
The future of global psychology may rest on the ethics that guide its practice. It is these moral principles that guide global psychologists to act in ways that are the most beneficial for the individual and their communities. Many psychological associations from around the world have established ethical codes or principles for the practice of psychology in the countries or regions they serve. The codes typically include references to dignity and human rights, education and training, privacy and confidentiality, and licensing. In contrast, some countries and regions do not abide by any ethical codes. As psychologists expand their global practice, many associations have expressed a need for a universal code of ethics that is applicable internationally. They argue that a universal code would ensure uniformity as psychologists work throughout the world.
To prepare for this Discussion:
· Review Chapter 10 in your course text, paying special attention to the following sections: “Guidelines for ethical practice,” “Going international,” “Ethical guidelines of allied international associations,” and “Observations on where to go from here.”
· Utilize the websites provided in this week’s resources to review ethical codes from the following associations:
· American Psychological Association
· Psychology and Counseling Organization of the Islamic Republic of Iran
· Singapore Psychological Society
· European Federation of Psychologists’ Associations
· Review the third draft of “The Universal Declaration of Ethical Principles for Psychologists”.
· Review the four ethical situations described below and their related questions to consider in terms of the ethical codes specified above:
4. Suppose Minneapolis, MN is hit by an enormous natural disaster. Many people were unprepared for such a disaster and suffered mental and physical trauma. Would it be ethical for a psychologist to provide his or her services if he or she had not been specifically trained in disaster response? Do the ethical concerns change if the care is provided at the site of the natural disaster as opposed to at an office visit after the disaster has already occurred? Why or why not? Refer to the specific standards involved and provide a rationale for your answer.
4. Iran is under the threat of war from neighboring countries. There is concern that there are enemy sympathizers responsible for attacks within Iranian borders. Under what circumstances is it allowable for an Iranian psychologist to disclose confidential information without the consent of the client? Refer to the specific standards involved. Is there a possibility the Iranian government could misuse these standards? Why or why not?
4. A psychologist in Singapore wishes to refer a client because of a conflict in values and feelings of underlying threats to his safety. Due to these circumstances, the psychologist feels that he cannot provide competent services to his client. What steps should the psychologist take to ensure an appropriate referral? Can the psychologist “warn” the future psychologist that his client may pose harm to them? Why or why not? Refer to the specific standards involved.
4. A psychologist who is bound by the European Federation of Psychologists’ Association is contacted by a former client who, after a six-month absence from therapy, would like to resume his sessions. The psychologist is completely booked. What are the psychologist’s ethical responsibilities to the client? What should the psychologist do? Refer to the specific standards involved.
With these thoughts in mind:
By Day 3
Post a response to one of the four ethical situations described above using the ethical codes specified. Be sure to address each question posed in the situation you selected. Next, select two ethical codes from all listed above that you believe are the most important for the future of global psychology and explain why. Finally, respond to this question: Do you believe it is possible for there to be one set of ethical principles to govern all psychologists globally? Why or why not?

Course Text: Stevens, M. J., & Gielen, U. P. (2007). Toward a glob al psychology: Theory, research, intervention, and pedagogy. Mahwah, NJ: Lawrence Erlbaum Associates.
· Chapter 3, “Current Trends in Global Psychology”
· Chapter 10, “Toward a Global Professionalization of Psychology”
Article: Berry, J. (2016). Global, indigenous, and regional perspectives on international psychology. In J.L. Roopnarine, D. Chadee, J.L. Roopnarine, D. Chadee (Eds.), Caribbean psychology: Indigenous contributions to a global discipline (pp. 45–68). Washington, DC, US: American Psychological Association. doi:10.1037/14753-003
Note: You will access this article from the Walden Library databases.
Websites

Gauthier, J. (2008). The universal declaration of ethical principles for psychologists: Third draft. Retrieved from http://www.sagepub.com/cac6study/pdf/UniversalDeclaration

The International Association of Applied Psychology provides a working draft of a Universal Declaration Code of Ethics for Psychology.

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American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved from http://www.apa.org/ethics/code/code-1992.aspx
Discussion 2: Is Psychology Global? (Due 2/6/18)
Throughout this course, you have seen the words global and international frequently. Your course text has used the words interchangeably. Chapter 3 in your course text refers to the growth in psychology around the world. In your work throughout this course, you have explored psychological issues from a global perspective, and you have discovered how psychology is practiced internationally. Despite the many times you have seen the phrase global psychology, there are questions about defining psychology as a global discipline. The assigned article “Global, indigenous, and regional perspectives on international psychology” states that psychology “claims” to be a global discipline. What do you think based on what you have examined so far in this course?
To prepare for this Discussion:
· Review Chapter 3 in your course text, paying particular attention to the section titled “Current Global Trends.”
· Review the article “Global, indigenous, and regional perspectives on international psychology” Focus on the following sections: “International Psychology: A Critique,” and “Global Psychology”.
· Consider the reasons given to support the claim that psychology is a global discipline, and think about the status and future of psychology as a global discipline.
· Consider the reasons given to refute the claim that psychology is a global discipline, and think about progress yet to be made toward that goal.
· Reflect on the reasons you believe psychology is or is not a global discipline.
With these thoughts in mind:
By Day 5
Post two convincing reasons why psychology is a global discipline. Explain why each reason you stated reflects future progress in establishing psychology as a global discipline. Next, post two of the most convincing reasons that refute the claim that psychology is a global discipline. Explain why each reason reflects a lack of progress or progress yet to be made. Finally, take a position on whether you believe psychology is a global discipline. Justify your position.
Be sure to support your postings and responses with specific references to the Learning Resources.
The American Psychological Association provides its ethics code.

Psychology Resources from around the World. (n.d.). Iran – Iranian Organization of Psychology and Counseling Code of Ethics. Retrieved March 27, 2017, from http://ethics.iit.edu/ecodes/sites/default/files/iran-code-eng

European Federation of Psychologists’ Associations. (2008). Ethical principles. Retrieved June 25, 2009, from http://www.efpa.eu/

This is the ethics code of the European Federation of Psychologists’ Associations.

Singapore Psychological Society. (2005). Code of professional ethics. Retrieved June 25, 2009, from https://singaporepsychologicalsociety.org/code-of-professional-ethics/

The Singapore Psychological Society provides its ethics code.

D I S C U S S I O N P A P E R

Whither Nursing Models? The value of nursing theory in the context

of evidence-based practice and multidisciplinary health care

Niall McCrae

Accepted for publication 23 July 2011

Correspondence to N. McCrae:

e-mail: n.mccrae@kcl.ac.uk

Niall McCrae PhD RMN

Lecturer

Mental Health Nursing

Florence Nightingale School of Nursing &

Midwifery, King’s College London, UK

M C C R A E N . ( 2 0 1 2 )M C C R A E N . ( 2 0 1 2 ) Whither Nursing Models? The value of nursing theory in the

context of evidence-based practice and multidisciplinary health care. Journal of

Advanced Nursing 68(1), 222–229. doi: 10.1111/j.1365-2648.2011.05821.x

Abstract
Aim. This paper presents a discussion of the role of nursing models and theory in

the modern clinical environment.

Background. Models of nursing have had limited success in bridging the gap

between theory and practice.

Data sources. Literature on nursing models and theory since the 1950s, from health

and social care databases.

Discussion. Arguments against nursing theory are challenged. In the current context

of multidisciplinary services and the doctrine of evidence-based practice, a unique

theoretical standpoint comprising the art and science of nursing is more relevant

than ever.

Implications for nursing. A theoretical framework should reflect the eclectic,

pragmatic practice

of nursing.

Conclusion. Nurse educators and practitioners should embrace theory-based

practice as well as evidence-based practice.

Keywords: evidence-based practice, nursing models, nursing theory, philosophy

Introduction

The legitimacy of any profession is built on its ability to

generate and apply theory. While enjoying a cherished status

in society, nursing has struggled to assert itself as a

profession. Despite efforts to improve its academic

credentials, the discipline lacks esoteric expertise, and while

an eclectic pragmatism may serve patients well, failure to

articulate a distinct theoretical framework exposes nursing to

external control (Macdonald 1995). Aggleton and Chalmers

(2000, p. 9) assert: ‘Until nurses themselves value the unique

contribution that they make to health care and the special

body of knowledge that informs their practice, the subordi-

nate role to that undertaken by doctors will continue’. Over

several decades, scholars have attempted to encompass the

trinity of physical, psychological and social aspects of care in

theories and models of nursing, which were intended to guide

practice and provide a platform for training curricula and

research, thus supporting the development of professional

knowledge.

Misunderstood and misused, the models of nursing that

pervaded preregistration training in the 1970s and 1980s

failed to bridge the gap between theory and practice. While

evidence of successful application has continued to flow in

the United States of America (Meleis 2007), where nursing

science is supported by substantial funding by federal

government and private foundations, nursing models faded

from professional discourse in the United Kingdom.

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222 Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd

J A N JOURNAL OF ADVANCED NURSING

However, it could be argued that the baby was thrown out

with the bathwater, and there is now a growing movement to

rejuvenate nursing theory (Pridmore et al. 2010). The Mag-

net Recognition Program (American Nurses Credentialing

Center 2008) is an international accreditation of excellence in

nursing, and a key requirement for organizations is to

describe and implement a professional practice model. The

author, who is involved in introducing such a model in a large

mental health service provider, argues that theoretical devel-

opment is crucial to the progress of nursing as a caring

profession.

Background

Nursing models were identified in the 1950s, as a thinking

profession began to emerge from its traditional handmaiden

status, with a primary objective to advance from a narrow

focus on illness to a broader concern with human needs. The

first recognized theory of nursing was by Hildegard Peplau,

who was highly influential in reconceptualizing the role from

‘doing things to people’ to a therapeutic relationship.

Illustrating the barriers faced by nurses at the time, Peplau’s

Interpersonal Relations in Nursing was completed in 1948

but not published until 1952 due to lack of medical

co-authorship or endorsement (Johnson & Webber 2005).

Influenced by the psychodynamic psychiatrist Harry Stack

Sullivan and the human motivation theory of Abraham

Maslow, Peplau emphasized the nurse (rather than physical

treatments and service organization) as the agent of change.

Although her expertise was in psychiatric nursing, Peplau

described an interactional process relevant to all nurses:

• Orientation – person feels a need and seeks professional
help; nurse helps patient understand problem.

• Identification – patient relates to someone who they believe
can help.

• Exploitation – patient attempts to make most of helping
situation; nurse formulates goals for patient.

• Resolution – patient discards previous goals and accepts
new goals, while relinquishing dependence on nurse.

An important step for theorists was to provide a definition

of nursing. In the textbook The Principles and Practice of

Nursing (Harmer & Henderson 1955), Virginia Henderson

presented nursing as a response to human functional needs.

Equating health with independence, she described 14 funda-

mental needs: breathing, eating and drinking, eliminating,

mobilizing, sleeping and resting, dressing, maintaining body

temperature, cleaning and grooming, avoiding injury, com-

municating and expressing emotions, worshipping, working,

playing and learning. Although Henderson and Peplau

intended their theories to apply across the spectrum of care

settings, the contrast between the mindsets of general and

mental nursing are evident here.

As the theoretical enterprise gained momentum, models

diversified, each based on assumptions about human nature

and nurture, and extending to the wider socio-environmental

context. Systems thinking was prominent in the Adaptation

Model of Sister Callista Roy (1980), who described a natural

human tendency towards biological, psychological and social

equilibrium, with maladaptive responses the target of nursing

intervention. Drawing on her scientific education, polymath

Rogers (1970) devised a novel theory of the human being as a

unitary energy field in dynamic interaction with the environ-

ment. Rejecting a Cartesian division of somatic and mental

functioning, Rogers propounded holism in its true meaning.

Health and illness were reinterpreted as manifestations of the

rhythmic fluctuations of life, and the role of the nurse was to

decipher each patient’s patterns, and to promote synergy with

his or her surroundings. Riehl’s Interaction Model (1980),

based on the symbolic interaction theory of Chicago sociol-

ogists, emphasized unique meaning in each situation, with the

nurse helping the patient to acquire or adapt roles in response

to health changes. Citations in the nursing literature

(Alligood 2002) indicated that the most widely used model

is that of Orem (1991), which facilitates progress from self-

care deficit to independent living skills.

The authorship of nursing theory has reflected the relatively

advanced intellectual culture of nursing in the USA. In the fifth

edition of Nursing Theorists and Their Work, a compendium

of nursing models (Marriner-Tomey & Alligood 2002), all but

one model was from North America (later editions have wider

international representation including the work of Katie

Erikkson; Alligood & Marriner-Tomey 2010). The exception

was by British nurses Nancy Roper, Winifred Logan and Alison

Tierney (1980), who orientated nursing to 12 activities of

living: maintaining a safe environment, communicating,

breathing, eating and drinking, eliminating, personal cleansing

and dressing, controlling body temperature, mobilizing, work-

ing and playing, expressing sexuality, sleeping and dying.

Similarities with Henderson are clear, but Roper et al. explic-

itly applied the nursing process, with its logical sequence of

assessment, planning, implementation and evaluation.

From this brief resumé, theorists have attempted in various

ways to present a comprehensive, rational and systematic

approach to nursing. With a plethora of models and theories,

various classifications have been offered; Aggleton and

Chalmers (2000), for example, categorize models as devel-

opmental, systemic or interactional. Unwittingly, such epis-

temological discussion has muddied the waters, as illustrated

by McKenna and Slevin (2008, p. 109): ‘Callista Roy’s work

was seen as a conceptual framework by Williams, a grand

JAN: DISCUSSION PAPER The value of nursing theory

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Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd 223

theory by Kim, an ideology by Beckstrand and as neither a

model nor a theory by Webb’. Meleis (2007, p. 40) argued

that ‘differences are tentative at best, and hair-splitting,

unclear and confusing at worst’. Semantic resolution is not

attempted here, but the definition of a nursing model by Riehl

and Roy (1980, p. 6) may be helpful:

A systematically constructed, scientifically based and log-

ically related set of concepts, which identify the essential

components of nursing practice together with the theoretical

basis of these concepts and values required for their use by

the practitioner.

A hierarchical clarification is provided by Fawcett (2005),

ranging from metaparadigms (the most abstract) to empirical

indicators (the most concrete). Between these poles, nursing

theorists have provided plenty of conceptual models, but not so

much at the level of theory, which comprises testable propo-

sition on which may be generated evidence of utility and benefit.

Theorists anticipated that models of nursing would enable

practitioners to become more autonomous and accountable

in their clinical decisions and organization of care, while

boosting the development of nursing as a discipline. So what

has gone wrong? Instead of elevating nursing to the sunny

uplands of theoretically grounded practice, models have been

perceived as unrealistic dogma from the ivory towers, and as

diversions from intuitive care; consequently, manuals gather

dust on library shelves. Constructing, teaching and applying a

theory of nursing is undoubtedly a great challenge, but that is

no justification for abandoning the endeavour. Practical

application has been hindered by a range of constraints, but

all of these may be overcome.

Data sources

This paper was informed by literature on nursing models and

theories from the 1950s to date, with material gathered from

ISI Web of Knowledge and other health and social care

databases. Use of literature was not driven by search strategy

but as a qualitative selection of the major contributions to

theory and relevant debate.

Discussion

Arguments against nursing models

Various arguments presented against nursing models are

scrutinized here.

Nursing eludes definition

Hesook Suzie Kim argues (2000, p. 2) that ‘a rigorous and

exact delineation of nursing as a role and as a scientific dis-

cipline is necessary specifically when it is used as the con-

ceptual basis for the development of nursing’s theoretical

knowledge’. Yet despite protracted debate, a consensual

statement on the meaning of nursing remains elusive. With-

out a satisfactory definition, how can a theory of nursing be

produced? To accommodate the diversity of practice, the

concept of holistic care is often presented as a defining

statement. Models devised by writers of general hospital

background have been perceived as incompatible with spe-

cialties such as mental health (Gournay 1995), and clearly for

the patient in acute nephritic pain immediate physical inter-

vention is a priority over attending to existential needs, but to

compartmentalize bodily and psychological care would be

regressive to a holistic ethos. However, as explained by

Clarke (1999), the philosophical idea of holism tends to be

misunderstood by nurses as an eclectic approach, when it

really means integration of soma and psyche. The medical

model and positivism are often the straw men of nursing

literature, but medicine too considers the patient in context,

as in the biopsychosocial model espoused by psychiatry.

Holistic care should be central to nursing theory, but is

insufficient as a raison d’être. Theoretical development is a

step forward from vague ideals of the nursing mission to

more clearly demarcated scope, purpose and method, but this

is an iterative process whereby theory informs practice and

vice versa. Similarly, we should not expect a static definition

of nursing.

Lack of prescription for practice

As a vehicle for nursing theory, a model should comprise

clear concepts, processes and goals. Difficulty in utilization of

nursing models was possibly exacerbated by terminology

such as Newman’s ‘expanding consciousness’ (1994) and the

‘dynamic energy fields’ of Rogers (1970), which deviate from

contemporary nursing discourse. However cogent a theory, it

is soon redundant if it does not make sense to the practi-

tioner. Yet theorists spent years refining their models to make

the unavoidable theoretical complexity readily comprehensi-

ble for everyday application. The problem was not only an

intellectually lukewarm attitude that theory belongs to aca-

deme, but also a tendency for task orientation in practice,

leading to the original spirit of a nursing model being lost. In

a previous paper, the author (1992) described his training

experience with the Roper-Logan-Tierney Model, which was

presented in readily accessible terms. The nursing school and

general hospital had pursued integration of teaching and

practice by instilling this model throughout clinical settings,

but in reality the system deteriorated into a ritualistic docu-

mentary procedure mostly performed by students as a

learning exercise. The apparent strength of the model as a

N. McCrae

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224 Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd

straightforward implementation of the nursing process made

it prone to compartmentalized, concrete thinking. Roper-

Logan-Tierney was set in stone, with its immutable 12

activities of daily living etched in tablets afoot patients’ beds.

By contrast with some theoretically orientated centres of

excellence in the USA, there is little evidence that models have

changed practice in the British context. Comparing two

wards using different nursing models, Griffiths (1998) found

no difference in how nursing care was provided. This finding

would not surprise many nurses, but it must be acknowledged

that a model can only be as good as the theoretical inclination

of the discipline. In a qualitative study of postregistration

training in nursing models (Wimpenny 2002), nurses

expressed dissatisfaction with the burden imposed by models,

one participant commenting: ‘When I see models, I see

documentation’. This is a fault in application rather than in

design. Applying theory demands thought as well as action:

nursing needs ‘knowledgeable doers’ to integrate theory and

practice (McCaugherty 1992). Without being naively opti-

mistic, it may be anticipated that the capacity of nurses to

comprehend and use theory will be enhanced as a graduate

profession and advanced practice develops.

Incompatibility with evidence-based practice

With a plethora of conceptual frameworks for nursing,

Barnum (1998) appealed for systematic evaluation, and the

need for rigorous validation is pronounced by the current

mantra of evidence-based practice. Much nursing theory may

be criticized as untested philosophical musings that would

fail the Popperian test of falsifiability. However, we must be

wary of the notion that practices with the best evidence are

the best practices. For example, patients often feel distressed

on being admitted to the strange environment of the hospital.

To engage in the anxious patient’s world, the nurse is guided

not by positivist research findings but by an intuitive

humanistic ethos tuned by professional training and experi-

ence. The most valued activities of nurses are those relating to

compassion and empathy (Attree 2001), but these are the

elements least supported by hard scientific data. Indeed,

the prioritization of evidence has troubled some scholars,

particularly in mental health, where bold empiricism is least

appropriate to understanding patients’ problems. Holmes

et al. (2006) argue that ‘the evidence-based movement in the

health sciences is outrageously exclusionary and dangerously

normative’.

Nonetheless, nurses should not stand on the sidelines

muttering a postmodern critique of objective science, as this

would perpetuate their perceived deficits in research literacy

and the power imbalances in health care. All healthcare

practitioners apply a mixture of personal and professional

knowledge, not all of which is supported by causal analysis.

To illustrate, in a medical outpatient session, scientifically

validated concepts are applied in diagnosis and treatment

decisions, but patient and physician contribute to an inter-

personal rapport; accordingly, there is a phenomenological

whole greater than the sum of technical parts. A more

persuasive argument for nursing is that its core activities are

devalued by an episteme that gives primacy to physical

science methodology, and to privileged professions. Regard-

ing scientific evidence as the sole basis of knowledge is

intellectually sterile, and of dubious validity. The real value

of nursing can only be represented by a broad theoretical

framework that includes both tested procedures and the

humane caring role, and which is operationalized not

primarily for research, but for utility. As Kim (2000)

emphasizes, there is a distinction between theory in nursing,

and little theory of nursing. Unsupported by overarching

theory, nursing is more susceptible to bureaucratically

imposed outcomes, critical pathways and quality standards

(Chambers 1998), amidst a targets regime in public services

that serves administrative rather than clinical objectives,

while creating perverse incentives (Seddon 2008).

Limits to professional demarcation and autonomy

An impediment to the utilization of models is the context of

de facto medical leadership and managerial control. As

Clarke (1999, p. 16) observes: ‘Unlike their medical coun-

terparts, nurses are seemingly unwilling to rely on profes-

sional rationales for their actions, opting instead for

occupational/managerial justifications’. Yet most nursing

occurs as a one-to-one interaction, and there is no reason why

this therapeutic relationship should not be underpinned by

theory. In the past, nursing was almost entirely hospital

based, with clear demarcation between medical and nursing

tasks. In the multidisciplinary, community-orientated health

care of today, nursing must be able to define its role, rather

than leaving other disciplines, managers and policy makers to

do this by proxy. A firmer theoretical foundation would

protect nursing from managerialism and cost-saving

replacement by workers without professional training.

Multidisciplinary teamwork is generally found stimulating

and rewarding by nurses, although blurring of roles may lead

to professional insecurity. According to Lewy (2008), the

interprofessional approach is a positive development that

‘should not be misinterpreted and used as a management tool

for undermining professions because this effectively destroys

the essence of what the agenda has been developed to

achieve’. Nursing-specific theory and research may be

frowned upon in a multidisciplinary ethos, but there is a

problem with a generic concept of evidence: a standardized

JAN: DISCUSSION PAPER The value of nursing theory

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Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd 225

procedure such as cognitive behaviour therapy is well

supported by research, but does it matter whether this is

provided by a clinical psychologist or a nurse? It would not

be unreasonable to surmise that each of these disciplines

would bring something different to the therapeutic table, and

this requires clarification at a theoretical level. The multidis-

ciplinary context therefore is an argument for nursing theory.

Irrelevance to modern health care

Gournay (2001) rejected nursing models as anachronisms in

the evidence-based schema of modern multidisciplinary ser-

vices, while Clarke (2006, p. 72) claims that theoretical

frameworks did little more than ‘cosmetically enhance the

credibility of nursing’.

Perhaps we have passed a necessary stage in the evolution

of nursing from subservient vocation to professional account-

ability. McKenna and Slevin (2008) argue that models

written three or four decades ago are now outmoded, but

this is contestable. Theory of nursing should be regarded as a

continual developmental process, but it should also be

emphasized that while practice and wider society have

transformed, human needs are basically the same.

The relationship between theory and evidence in nursing

can be analogized to the timeless debate between science and

ethics. The former entails what we can do; the latter what we

should do. While morality in modern society does not

necessarily have the permanence given by monotheist reli-

gions, there are human values that transcend time and

technology. The issue of assisted dying is an example of

conflict between the enduring concept of the sanctity of life

and the possibilities of a medically ameliorated passage for

the terminally ill patient. Such controversy raises unavoidable

questions about the role of nursing. A balance must be found

between instrumental flexibility to the changing expectations

of individuals and society, and a durable ethical stance;

ideally, these will evolve in tandem, but there will be

contentious issues where nurses are expected to act against

their professional inclinations. A code of conduct protects

nurses to some extent, but a coherent theory of nursing would

provide a rationale for practice in difficult circumstances.

Implications for nursing

From basic tasks to skilled therapeutic interventions, nursing

is a pragmatic discipline, whose role and responsibilities are

determined by a range of factors including the code of

conduct, local and national policies and procedures, research

evidence, professional and social norms, and cultural trends.

It is also heuristic, the nurse’s problem-solving approach

coloured by personal values and experience. Edwards and

Liaschenko (2003) describe a commonly expressed a theo-

retical stance whereby nursing is considered as practical

rather than propositional knowledge; hence there cannot be a

theory of nursing. Erroneously, nurses may separate the

intellectual domain of theory from the clinical setting in the

belief that different types of knowledge are used in practice.

Carper (1978) identified four equally valid elements of

nursing episteme:

• Empirics (verifiable, objective knowledge)
• Aesthetics (tacit, intuitive)
• Ethics (moral)
• Personal knowing (unique perspective based on character

and life experience)

At the nurse–patient interface, personal ‘knowing’ is often

more useful than impersonal knowledge. However, as scien-

tific thinking is inculcated in trainees and practitioners, nurses

are appreciating the advantages (if not supremacy) of the

generalizable over the anecdotal. Kim (2000, p. 2) argues that

‘the essential features of nursing knowledge required for

practice must embrace the science of control and therapy as

well as the science of understanding and care’. Note the term

‘science’ for what others might consider the ‘art’ of nursing.

This is the crux of the modelling issue: if therapeutic use of self

is not conducive to scientific testing, nursing can never achieve

objectivity. The challenge is to build theory in a way that

maximizes evidence while minimizing reductionism. Research

has repeatedly shown correlation between good nursing and

positive patient outcomes, but without establishing a concep-

tual and empirical link. Recent theoretical offerings have

emphasized the caring relationship as fundamental to nursing,

such as Relationship-Based Care (Koloroutis 2004) and

Joanne Duffy’s Quality-Caring Model (2003). The latter

model, however, claims that relationships are tangible phe-

nomena and thus measurable, but this is a dubious proposi-

tion: nursing cannot be objectified by conjecture.

Johnson (1996) asserts that nursing should be pursued as a

practical rather than basic or applied science. In other words,

it is a means to an end, helping patients to adapt positively to

illness, to resume independence and to achieve personal

growth. Perhaps pragmatism provides a reasonable and

realistic philosophical basis for building the theory of

nursing. According to Benner and Wrubel (1989), p.5), ‘a

theory is needed that describes, interprets, and explains not

an imagined ideal of nursing, but actual expert nursing as it is

practised day to day’. However, while practice theory, as

defined by Ada Jacox (1974), tells the nurse what actions are

necessary to achieve a particular goal, a prescriptive

approach cannot embody the whole of nursing practice,

and as experience with nursing models has shown, it may

exacerbate impersonal, ritualized care.

N. McCrae

� 2011 The Author
226 Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd

In a report on the future of nursing commissioned by the

Chief Nursing Officer in England, Maben and Griffiths

(2008) present a trinity of nurse roles, each entailing a

relationship to others:

• Practitioner
• Partner
• Leader

This shows the relative breadth of nursing to other

professions, but can this be encompassed in an overarching

theory of nursing? Theoretical development may help

practitioners to articulate their purpose in an increasingly

complex healthcare environment, with roles and responsi-

bilities in constant flux. It is also important for the

advancement of the discipline, as its function extends into

care episode management, prescribing and specialist skills

previously performed by physicians. Credibility and confi-

dence in nursing depends on a change of perception of the

role in society, which continues to harbour an angelic

image of the nurse as a caring accessory to heroic

medicine.

Generation of nursing theory should proceed as a creative,

collaborative enterprise, taking account of the diverse settings

in which nursing operates. Where possible theory should be

of global relevance, covering generic and specialist fields, thus

maintaining the unity of nursing. This project need not start

afresh, but build on the work of earlier theorists. As urged by

Fawcett (2005), scholars should pursue epistemological

progression from conceptual model (which are foundational

but not testable), to empirical ‘middle-range’ theories with

operationalized variables and relationships (as espoused by

sociologist Robert K Merton). However, we must also

embrace the unquantifiable elements of nursing. Eriksson

(2002) highlights the ethical essence of caring science, and the

need for a ‘different key’ in constructing a humanistic

knowledge for practice. Acknowledging the measurable and

abstract properties of nursing, integration should be pursued

in three key dualisms:

• Art/science
• Mind/matter
• Teaching/practice

According to Fawcett (1992), ‘nursing knowledge, as

formalized in a conceptual model, is the starting point in

the reciprocal relationship with nursing practice’. Knowledge

therefore has primacy when the nurse first enters the ward. A

coherent theoretical framework would combine the tremen-

dous diversity of theoretical, experiential and intuitive

knowledge into a single schema, guiding nurses in the

procedures, interpersonal engagement and values of profes-

sional practice.

Conclusion

In recent years, broad theories and conceptual models have

been overshadowed by empirical evidence in the episteme of

nursing. Attempts to infuse a theoretical outlook in the

humanistic enterprise of nursing have had limited success, but

the structural and philosophical challenges are not insur-

mountable. Without being prescriptive, this paper argues for

the promotion of theory in preregistration curricula, and for

its rightful place in the cycle of nursing knowledge, thus

helping practitioners to assert, apply and evaluate their

unique role in health care. Current schemes such as the

Magnet Recognition Program have encouraged fresh thinking

on theoretical foundations for nursing. While no panacea,

theory potentially enhances the practice and development of

the profession as it responds to the challenges of a continually

evolving clinical environment.

Acknowledgements

The author thanks Susan Sookoo and Katie Gallagher,

colleagues at the Florence Nightingale School of Nursing &

Midwifery, for constructive advice.

Funding

This research received no specific grant from any funding

agency in the public, commercial, or not-for-profit sectors.

What is already known about this topic

• Models and theories were intended to provide a
framework for nursing knowledge and practice.

• Models of nursing have had limited success in bridging
the gap between theory and practice.

What this paper adds

• Arguments against nursing theory are challenged.
• Evidence-based practice and multidisciplinary health

care do not preclude the development of distinct nursing

knowledge.

Implications for practice and/or policy

• Theory of nursing should be reinstated in teaching,
practice and research.

• Alongside the pursuit and application of empirical
evidence, nursing should embrace theory-based practice.

JAN: DISCUSSION PAPER The value of nursing theory

� 2011 The Author
Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd 227

Conflict of interest

No conflict of interest has been declared by the author.

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N. McCrae

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228 Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd

The Journal of Advanced Nursing (JAN) is an international, peer-reviewed, scientific journal. JAN contributes to the advancement of

evidence-based nursing, midwifery and health care by disseminating high quality research and scholarship of contemporary relevance

and with potential to advance knowledge for practice, education, management or policy. JAN publishes research reviews, original

research reports and methodological and theoretical papers.

For further information, please visit JAN on the Wiley Online Library website: www.wileyonlinelibrary.com/journal/jan

Reasons to publish your work in JAN:

• High-impact forum: the world’s most cited nursing journal and with an Impact Factor of 1Æ540 – ranked 9th of 85 in the 2010
Thomson Reuters Journal Citation Report (Social Science – Nursing). JAN has been in the top ten every year for a decade.

• Most read nursing journal in the world: over 3 million articles downloaded online per year and accessible in over 10,000 libraries
worldwide (including over 6,000 in developing countries with free or low cost access).

• Fast and easy online submission: online submission at http://mc.manuscriptcentral.com/jan.
• Positive publishing experience: rapid double-blind peer review with constructive feedback.
• Early View: rapid online publication (with doi for referencing) for accepted articles in final form, and fully citable.
• Faster print publication than most competitor journals: as quickly as four months after acceptance, rarely longer than seven months.
• Online Open: the option to pay to make your article freely and openly accessible to non-subscribers upon publication on Wiley

Online Library, as well as the option to deposit the article in your own or your funding agency’s preferred archive (e.g. PubMed).

JAN: DISCUSSION PAPER The value of nursing theory

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Journal of Advanced Nursing � 2011 Blackwell Publishing Ltd 229

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