Recently, a local hospital created a nursing patient care model to profile the facility's approach to professional nursing practice. Early career and seasoned nurses described each component of the model in a video, including how central tenets of the model benefit patient care and ways the model facilitates meaningful connections with patients and other professionals.
Nursing departments across the country are using a variety of engaging graphic representations to show patients, visitors, and colleagues what is important about how care is delivered. These models highlight aspects of care any nurse would be proud to name as guiding principles. However, while researchers have determined that many current professional practice models use nursing concepts (for example, shared governance and relationship-based care), an explicit underpinning in nursing theory is sometimes missing from professional nursing practice models.
Omitting nursing theory from—or failing to highlight its foundational role in—professional nursing practice models diminishes nursing as a unique discipline. When science and theory do not appear to guide professional practices, we risk showcasing only the art of nursing and being seen as task agents who move through patient care checking boxes instead of improving the lives of patients.
Nurses, even during our busiest days, know we are doing more than just checking boxes. We synthesize a broad range of knowledge, research, and critical thinking to address patient needs. Whether we know it or consciously stop to think about it, individual nurses and hospital groups are constantly using models shaped by theory to guide patient care.
For example, during shift handoff, an off-going nurse reports that a patient admitted for a stroke who has a history of drug dependence has been constantly using the call bell for unnecessary requests. Entering the patient's room, the nurse finds her looking away, with tears in her eyes. The nurse pulls up a chair and takes a few moments to listen to the patient's concerns about her depression and the challenge of maintaining sobriety so she can regain custody of her child. The nurse suggests talking with the psychiatrist about the emotional stressors and offers to help her create a plan for maintaining sobriety. By now far less distressed, the patient thanks the nurse for taking the time to listen.
Although the nurse may not have thought of it in these terms, her approach could be described as “being authentically present,” “practicing loving kindness,” and “developing a helping, trusting relationship” with the patient—all “caritas processes” described by Jean Watson in her influential theory of human caring.
Nurses can guide care, education, and research with concepts and constructs from established nursing theories. For example, Jackson Health System in Florida touts its nursing practice model grounded in relationship-based and family-centered care. This practice model acknowledges Madeline Leininger's theory of transcultural nursing as a foundational framework. Leininger's theory was chosen by this hospital as well suited to the multicultural, multiethnic population they serve.
Creating a professional nursing practice model seems like a lot of work, and many nurses contributing to practice models, education, and research may find theory cumbersome or unimportant. But by using nursing theory to guide professional practice models, nursing leaders may model the application of such theories to practice.
Nurses interested in infusing theory into practice should think about their personal philosophy of nursing and the mission of the practice environment. Conducting a web search for nursing theories and their attributes may be a first step toward identifying a theory that the facility can use to guide a practice model. With purposeful use of nursing theory, nurses can help ensure the discipline of nursing continues to advance as a professional practice.