For some nurses the impulse to provide care is innate, which is part of the reason they became a nurse. For others, nursing represents an opportunity to apply knowledge and experience in the navigation of the varying circumstances and scenarios to provide patients the care they need. Advanced nursing theory is a set of predictive models for how to treat patients, developed through a combination of field observation and scientific testing. Some are used more widely than others in nursing practice. A primary role of graduate education, especially an MSN degree, is to provide a theoretical framework that helps students know how to give care in different settings. However, the practice of care remains on some level an individual and instinctive process, and deciding which has more value – theory or practice – is an ongoing debate within the nursing field.
Advanced Nursing Theory
Before Florence Nightingale advanced her environmental theory of nursing, there were no recognized models in the field. Since then, several theories about how to provide the best model of care have been advanced. Some of the more popular of these, and the women who developed them, are as follows:
- Sister Simone Roach developed a nursing theory based on caring as the central premise. Her 5 C's of Caring – commitment, conscience, competence, compassion, and confidence – form the cornerstone of her theoretical model.
- Martha Rogers contributed the theory of "Unitary Human Beings," which posits that treatment needs to focus on the symphonic interaction between patients and their environment, which can be directed and redirected to improve patient health.
- Dorothea Orem is responsible for the "Self-Care Deficit Theory," the basic premise of which is people should be responsible for their own care insofar as it is possible, developing an awareness of their potential health problems and applying self-care to ameliorate them.
- Madeleine Leininger advanced the model of "Transcultural Nursing," a more recent theory that views empathetic care as essential to wellness and argues that, in order to provide caring, the nurse must provide treatment congruent with the patient's cultural beliefs and values.
- Jean Watson's Theory of Caring, well-known in nursing programs, also views empathetic care as the nurse's primary responsibility, focusing on ways of making a heart-felt connection with the patient in order to facilitate the healing process.
Advanced nursing theory, more generally speaking, can be broken into processes. General system theory breaks a system down into its component parts and studies the interaction among them. Adaptation theory focuses on how well patients adjust to changes in their internal and external environments. Developmental theory looks at how people have changing needs as they move through the stages of life.
Advanced Nursing Practice
First, this term needs to be distinguished from the title Advanced Practice Registered Nurse (APRN), which describes any nurse with a post-graduate education who can practice without a physician's supervision. Advanced nursing practice, on the other hand, is the study of how nurses operate within the complex, dynamic world of medicine. It examines both the theoretical foundations of nursing and the challenges nurses face in contemporary clinical settings that make it difficult for them to adhere to proven models. It seeks to answer a question addressed by the various theoretical models but not resolved by them completely: How does one best live up to the nurse's code of ethics while providing treatment in an ever-changing clinical setting?
The reality is, nursing practice tries to emulate theoretical models, but it is not always possible. Nurses often find that they experience a disconnect between treatment options presented in a theoretical framework and real life situations. Frustration can lead to their abandoning such models altogether – even where the models might be warranted – in favor of what has worked in their personal experience. Sometimes they are pressured to abandon their models out of deference to prevailing hospital or clinic policy. One of the real challenges in the nursing field today is to find a way to bridge the theory-practice gap in such a way that quality care continues to be a priority.
Bridging the Gap between the Two
Nursing degree programs are the best place to integrate the valuable, often intuitive insights that inform nursing practice with theoretical models that provide a meaningful standard of care. Every attempt should be made to understand the full scope of the health care industry, including how the use of new technologies and an adherence to changing regulations potentially impact the standard of ethical care in the United States.
Perhaps one of the best ways an RN can contribute to the nursing field is to go back to school and obtain a MSN online degree with an administrative or education focus. The degree allows individuals to combine their practical experience with theoretical models and dynamic changes in the field of health care. Graduates can then apply their leadership skills to the development of new best practices in the field.