How to Choose a Theory for Nursing Practice

All undergraduate nursing students take a nursing theory/nursing philosophy course. Masters and doctoral students take advanced courses in theory. What’s the point? To use theory for nursing practice, of course!

Many students wonder about the purpose of nursing theory — and just theory in general. Is it just an academic exercise? Just something to fill in your program plan? No, there is a reason for learning about theory. In this post, I’ll provide some tips on how to choose a nursing theory to guide your professional practice – whether that’s at the bedside, in the clinic or community, in the classroom, or in the boardroom.

First, I want to remind you of a free resource I have waiting for you that will help you understand the underlying terminology of professional nursing practice. My multiple page Nursing Theory and Philosophy: Terms & Concepts Guide will assist you to understand the many concepts and language specific to the study of theory and philosophy. Click Here for Your Free Nursing Theory and Philosophy: Terms & Concepts Guide!

Theory, Research, Education, and Practice are Linked!
Choosing a theory for practice can be challenging because there are so many theories from which to choose! There is no one universal theory for nursing, so you have to take some time to really think about the many different theories – nursing and non-nursing – to understand and choose the best theory for practice. Your choice of theory that will fit best with your personal nursing practice will depend on your purpose for using the theory — is it for quality patient care? is it to improve a system or process? is it to frame a research study? is it to educate patients or students?

Theory, research, education, and practice are all linked. Research, education, and practice should be guided by theories or frameworks. Research informs education and practice by providing evidence for best practices for teaching and nursing care delivery. Education is the setting for learning; faculty should teach based on research evidence on teaching and learning, teaching/learning theories, and needs of the practice arena. The practice setting is where students are educated and evidence-based nursing care is delivered to patients or clients; it also provides the experiences from which nurses identify future research topics and new nursing theories.

Theory for Nursing Practice, Research, & Education are Linked to Best Practice
Best Practice Results from linking Nursing Theory, Research, Education, & Practice

Theory forms the basis for how we:

Teach and learn about nursing (e.g., nursing theories, neurocognitive research, brain-based learning, adult learning theories, learning styles, educational theories, frameworks/philosophies),
Frame our research studies to make sense of the findings in a professional context and to build nursing science to practice most effectively,
Assess, plan, and intervene (i.e., treat, comfort, communicate, educate) for our patients/clients and their families, and then evaluate the outcomes.
The Theory-Practice Gap
I’ve talked about the purpose of nursing theory in my previous theory posts on theoretical concepts, the nursing metaparadigm concepts, beliefs, assumptions, and values in nursing theory, and how to tell the difference between a theoretical framework and conceptual model. In an early post on theory-based practice, I introduced you to my struggles with practicing according to a nursing theory. And I admitted that I was sorry that I didn’t remember my instructors emphasizing the need to practice according to a nursing theory (they probably did and I didn’t listen!). But, now that I see with more mature eyes, I know that using a specific theory for nursing practice would have elevated my professional practice and improved outcomes for my patients.

The major reason for learning philosophy and nursing theory is for you to USE the content in your basic and advanced practice to become a better nurse, promote positive outcomes for your patients, and ultimately help to move the profession of nursing forward.
I will tell you that many nurses, many who have been nurses for a while, will tell you that theory is a waste, not realistic, “never used” in practice — just academic busywork – not something “real” nurses do! I’m sure some of those feelings are a result of some deep reflection on the part of those nurses.

But I also think many of those sentiments are a result of the individual not really understanding theory; maybe because of the complex and confusing language or maybe because of faculty who didn’t know how to demonstrate how theory is used in the real world. Kenney (2013) noted that some nurses just don’t have enough information about the practical use of theory. But while nursing theories and models can “provide the rationale and consequences of nursing actions and lead to predictable client outcomes” (Kenney, p. 335), the “theory-practice gap” is real.

By the way, you all realize that you are taught a framework to use in practice from Day 1 in nursing school, right? Even if you think you don’t subscribe to a particular model, I don’t think I’ve ever met a nurse who didn’t use the Nursing Process!
So, I would submit that the resistance to theory-guided practice could be because these nurses never found a theory that resonated with them. They never “clicked” with a theory that they wanted to influence their thinking and subsequent actions, and therefore, influence how they cared for patients and families.

“Theory-driven practice [provides nurses] with a language that empowers them to speak about what they do and who they are with patients….[It helps them to] link … behaviors … with patient outcomes” (Pipe, 2013, p. 307-308).
Let’s see how we might become theory-driven professional nurses and do our part to close the theory-practice gap.

How Does a Theory for Nursing Practice Help Me?
There are a lot of nursing and non-nursing theories out there for you to choose from. Remember that theories will help to guide you in how to and which data you should be collecting, decide how you will interpret the data through the perspective of the theorist, how you will plan and implement care/make change, etc., and how you will evaluate the outcomes.

You can absolutely have more than one theory that you subscribe to — there is no one universal or “right” nursing theory. It is good for you to have a general understanding of the different theories that might help you in your practice. If you have that overview, you can think about the purpose of each unique task or patient-care situation that you are responsible for so that you can call up a theory that will help you manage that particular purpose.

For example, to change practice is a hard task. Clinical nurse specialists and nurses prepared at the doctoral level (i.e., DNPs) are the nurses who are educated to lead this effort in the practice setting. You want to choose a theory or framework that covers all the bases and allows you to plan for the different phases of change.

Personally, I have used Kotter’s 8-Step Process for Leading Change model, Rogers’ Diffusion of Innovations Theory, and Lewin’s Change Theory and Force-Field Analysis to guide clinical and organizational change (Mitchell, 2013). Prochaska’s Contemplation Model is another model that is frequently used to guide organizational change.

Many change models will work for evidence-based practice (EBP) change in the clinical setting, but there are also many EBP-specific models developed by nurses and nursing organizations (Canada, 2016; Schaffer, Sandau, & Diedrick, 2013) that can be used for individual or organizational change. Societal and healthcare changes impact nursing practice and many of the older models have undergone revisions. For example, a popular choice for EBP changes is the Iowa Model of Evidence-Based Practice, which has recently been revised (Buckwalter et al., 2017).

For nursing practice, having been a critical care nurse my whole nursing career, I’m partial to AACN’s Synergy Model for Patient Care. I’ve also studied King’s Theory of Goal Attainment. And, of course, there’s the old faithful nursing process framework.

The Nursing Process is considered a scientific method and it is used as a theory for nursing practice: it guides how you practice, in terms of nursing functions. I assess the patient, analyze the data I get to plan care, implement that care, and then evaluate the outcomes. While it may be rote – a part of muscle memory, if you will – if I practice this framework in a deliberate manner, it will guide how I think about each nursing actions with patients, family members, nursing staff, and other colleagues.

So that’s great. But, this framework doesn’t go far enough. What this framework will NOT guide me to do though is to think about all the details of my practice: the beliefs or underlying values to which I subscribe. For example, the nursing process doesn’t remind me to include the patient in care planning or about how culture influences health and healthcare decisions or how to identify and facilitate a caring moment or how to consider the family dynamic when planning care, or how to educate a child versus an illiterate adult, etc.

That’s why so many theories have been developed. Nurse theorists have identified gaps in how the work of nursing has been articulated. In developing their theories have put their assumptions, beliefs, and values — their own “spin,” if you will — on how nursing should be performed.

Some of you may work in a practice setting that subscribes to a “house-wide” theory – that is, a theory that all nurses use within that setting. In that case, as an employee, you will be obligated to practice according to that particular theory. You should learn about that theory and practice it deliberately – with intention – for the best patient outcomes.

But it doesn’t mean that you can’t supplement that prescribed theoretical practice with another theory that better fits your personal BAVs. So you might be told to practice and document your care according to Orem’s Self-Care Deficit Theory, but your own BAVs might align more closely with Watson’s Theory of Human Caring/Caring Science philosophy. So you make a point to interact and engage your patients using Watson’s caritas processes as a basis for your transpersonal caring relationship created by caring moments, in addition to empowering patients for optimal self-care and documenting according to Orem’s concepts.

Let’s discuss how to be deliberate about choosing a personal theory for nursing practice.

Five Quick Steps for Choosing a Theory for Nursing Practice
Choosing a theory that will guide your professional nursing practice is a systematic process. Obviously, we could get into a long discourse on the different methods you could use for choosing a theory to guide your practice. Multiple authors have outlined steps for nurses to consider when selecting a model for practice. For example, Kenney (2013) outlined multiple processes one could use when considering which theory to choose. We won’t get into the weeds in this post, so I’m going to meld ideas from my references and my experience to quickly outline these steps for you.

“The first step toward theory-based nursing practice is the conscious decision to use theories in practice” (Fawcett cited in Kenney, 2013, p. 346).
So, let’s take make a conscious decision to take that first step and look at how to begin to choose a theory that will be right for YOU.

Step 1: Take out and review your Personal Philosophy of Nursing. Your personal philosophy of nursing is your perspective about nursing practice that encompasses your beliefs, assumptions, and values (your BAVs) about the concepts important to nursing (i.e., nursing, health, patient, environment).

If you haven’t done this exercise in a nursing course, you can check out my blog post on how to develop your nursing philosophy. You should do this before you move on to Step 2.

Step 2: Critically reflect upon your professional nursing practice. Review your beliefs, assumptions, and values (BAVs) from your personal philosophy statement or clinical narratives so that you are clear on what you believe and value about nursing practice.

Step 3: Review the metaparadigm concept definitions in nursing theories that you already suspect may agree with your personal philosophy (perhaps one or two you learned from your nursing theory courses) or review theories that fit under the classifications of nursing that strike a chord with your beliefs (e.g., holism, healing, adaptation, energy fields, etc.). (Use your nursing theory texts or the Internet to remind you of theories that fit your criteria.)

Most nursing theory texts categorize nursing theories and models. For example, nursing theories may have human development, or interventions, or nursing role functions, or type of practice/health status or medical condition/type of care as their overarching framework (Alligood, 2014).

Theories may be described as holistic or adaptive or behavioral. Or they may be focused on interpersonal relationships, environmental foci, economic principles, organizational behavior and leadership, feminist principles, health equity and disparities, nursing goals and functions, systems, human existence and universal energy, competencies and skills, caring, culture, or suffering (Butts & Rich, 2018; Cody, 2013).

Theories for advanced practice nurses such as nurse practitioners and certified nurse midwives may be classified as family models, community models, patient education models, or health promotion/disease prevention models, for example (Cody 2013; Kenney, 2013). Quality improvement/process improvement models, EBP models, and organizational change/organizational culture models would be apropos for clinical nurse specialist or DNP practice.

Step 4: Now you should be able to put steps 2 and 3 together to identify which nursing theories resonate with you; which ones agree with or “closely match” with your own beliefs. Having your BAVs in the forefront of your mind will help you to more quickly identify a theory (or theories) that will be a good fit for your professional practice.

At this point, you might want to further investigate the theories or models you selected; do a deep dive into the assumptions and BAVs of the theorist to really see which theories work for you. You might want to compare your top three theories to see how they are similar and how they differ (Kenney, 2013).

Step 5: Alligood (2014) and Kenney (2013) suggested that you envision practice situations in which you might apply your chosen theory or theories. Again, you are looking for the best fit between a theory and patient or client situations you encounter or are likely to encounter. Will the theory/model help guide your nursing actions and provide the best approach to the patient/client?

Remember that there is no “right” way to practice nursing. You will likely use multiple theories in your daily nursing practice – find ones that fill in the gaps for your own practice.

I’d recommend that when you find the theory you want to incorporate into your practice, go to the nursing literature and look up how others have used your selected theories in practice. These articles will give you ideas for how to practically translate the theory into your practice. I’ll bet you will have at least one, if not many, “aha” moments as you realize how your theory-guided practice can transform you and your patients!

Don’t expect to change the way you practice overnight. Deliberate practice is based on really knowing and understanding a theory so that you can practice it as it was intended. As you practice with intention, the application of the theory or model will become clearer and you’ll become more comfortable practicing in this meaningful way. Fawcett calls this change “perspective transformation” (Kenney, 2013, p. 338).

I challenge you to find at least one nursing theory that fits with your personal beliefs and values. Let me know if you did and share your journey in the comments!

There are many articles published on practicing theory-based nursing; search for ones that report on practicing according to your theory of choice to see how other nurses practice intentionally and overcome obstacles to theory-based practice.
How to Cite this Blogpost in APA*: Thompson, C. J. (2017, October 31). How to choose a theory for nursing practice [Blogpost]. Retrieved from https://nursingeducationexpert.com/theory-for-nursing-practice *Citation should have hanging indent
References
Alligood, M. R. (2014). Nursing theory: Utilization & application (5th ed.). St. Louis, MO: Elsevier Mosby.

Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., . . . Tucker, S. (2017). Iowa model of evidence‐based practice: Revisions and validation. Worldviews on Evidence‐Based Nursing, 14(3), 175-182. doi:10.1111/wvn.12223

Canada, A. N. (2016). Probing the relationship between evidence-based practice implementation models and critical thinking in applied nursing practice. Journal of Continuing Education in Nursing, 47(4), 161. doi:10.3928/00220124-20160322-05

Cody, W. K. (2013). Values-based practice and evidence-based care: Pursuing fundamental questions in nursing philosophy and theory. In W. K. Cody (Ed.), Philosophical and theoretical perspectives for advanced nursing practice (5th ed., pp. 5-14). Burlington, MA: Jones & Bartlett Learning.

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37.

Pipe, T. B. (2013). Optimizing nursing care by integrating theory-driven evidence-based practice. In W. K. Cody (Ed.), Philosophical and theoretical perspectives for advanced nursing practice (5th ed., pp. 303-309). Burlington, MA: Jones & Bartlett Learning.

Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence‐based practice models for organizational change: Overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209. doi:10.1111/j.1365-2648.2012.06122.x