Types of Theories In Nursing Leonore Ann Dumlao I. PHILOSOPHY OF NURSING Philosophy According to Meleis (2007), philosophy philosophy is a distinct d istinct discipline in its own right, and all disciplines can claim their own philosophical bases t hat form guidelines for their goals. It is concerned with the values and beliefs of a discipline and with the values and beliefs held by members of the discipline. It focuses on providing the framework and worldview for asking bot h ontological and epistemological questions. Philosophy helps in defining or questioning priorities and goals goa ls.. Philosophy of Nursing Philosophies present the general meaning of nursing and nursing phenomena through reasoning and logical presentation of o f ideas (Alligood, 2010). Each philosophy provides a unique view of nursing practice. Philosophies address questions such as t he following: y What is nursing? y What is the nature of human caring? y What is the nature o f nursing practice? o f nursing practice? y What is the social purpose of
Nightingale¶s Philosophy of Nursing According to Alligood (2010), Nightingale provides an a nswer to the question ³What is nursing?´ in her work Notes Notes on Nursing: What It Is and What It Is Not. In that work, Nightingale 1) distinguishes nurses from the household servant of her d ay, 2) contrasts the differences between nursing and medicine, and 3) specifies the concern of nursing to be involved with health as well as illness. Also within this work includes directives for her unique perspect ive that is focused on the relationshi re lationship p of patients pat ients and their surroundings. Watson¶s
Philosophy of Nursing As proposed in Nursing: in Nursing: The Philosophy and Science of Caring, Watson provides a unique approach to nursing. Her work states that nursing is ³a human science that addresses the nature of human caring´. Watson also introduces theoretical propositions for the human-tohuman relationships of nursing and specifies 10 carat ive factors to guide application of her work in nursing practice. Transpersonal caring is the propo sed approach to achieve connectedness co nnectedness in which the nurse and the patient change together. Benner¶s Philosophy of Nursing Benner¶s philosophy of nursing emphasizes the nature o f nursing practice, specifically on 1) how knowledge of practice is acquired, and 2) how it develops overtime. According to Alligood (2010), her interpretative research led to a description of the progress of nurses from novice to expert.
II. THEORY Definition A theory is an organized system of accepted knowledge that is composed of concepts, propositions, definitions, and assumptions intended to exp lain a set of fact, event, or phenomena. (Octaviano, 2008) According to Kozier (2008), theory is a supposition or system of ideas that is proposed to explain a given phenomenon. Theories may be derived from a philosophy, a nursing model, a more abstract theory, or another model or framework (Alligood, 2010). Characteristics: y can correlate concepts to generate a different way of looking at a certain fact or phenomenon y logical in nature y simple but generally broad in nature y source of hypotheses that can be tested y contribute in enriching the general body of knowledge y used by practitioners to direct and enhance their practice y consistent with other validated theories, laws and principles
III. NURSING THEORY
Definition Meleis (2007) defined nursing theory as a co nceptualization of some aspect of nursing reality communicated for the purpose of 1) describing phenomena, 2) explaining relationships between phenomena, 3) predicting consequences, or 4) prescribing nursing care. They serve as a reservoir in which findings are stored that are related to nursing concepts, as well as for answers related to significant nursing phenomena. In short, nursing theory is defined by Octaviano (2008) as a group of interrelated concepts that are developed from various studies of disciplines and related experiences. They reflect particular views of person, health, environment, nursing and other concepts that contribute to the development o f a body of knowledge specific to nursing concerns. According to Barnum (1994), a complete nursing theory is one that has context, content, and process. Context refers to the environment to which nursing act t akes place, content refers to the subject of the theory, and process refers to the method by which nurse acts in using nursing theory. IV. TYPES OR CATEGORIES OF NURSING THEORIES A. According to Function
1) Descriptive (Factor- Isolating)
Considered as the primary level of theory development, descriptive theories identify and describe major concepts of phenomena. Their main purpose is to present a phenomenon, and not explain the relationship of concepts of the phenomenon. E xample: A descriptive research about the Filipino nursing practices like the u se of herbal medicines and other alternative forms of treatment. 2) Explanatory (Factor- Relating) These are the type that present relationships among concepts and propositions, including cause and effect relationships. They aim to provide information on how or why concepts are related. E xample: A research study about the factors affecting newborns in failing to thrive. 3) Predictive (Situation-Relating) This type of theory is achieved when the relationships of concepts under a certain condition are able to describe future outcomes consistently. This is generated and tested us ing experimental research. E xample: A Theoretical model based on the observation of the effects of unsanitary environmental condition on the reco very of the post-operative patients. 4) Prescriptive (Situation- Producing) This deals with nursing actions, and test the validity and certainty of a specific nursing intervention. This type of theory is co mmonly used in testing new nursing interventions. E xample: Laurente¶s (1996) theory validates and explains the different nursing management in the emergency room in relieving anxiety among its clients. B.
According to Scope (Tomey & Alligood, 2002)
1) Philosophies Theorists had developed philosophies that were derived through ³analysis, reasoning and logical arguments´, and that the theorists provided the meaning of nursing pheno mena. Writings of the following are considered philosophies by Tomey and Alligood: y Florence Nightingale- Environmental Theory y Ernestine Wiedenbach- The Helping Art of Clinical Nursing y Virginia Henderson- 14 Basic Needs y Faye Glenn Abdellah- 21 Nursing Problems y Lydia Hall- Three Interlocking Circles Theory y Jean Watson- The Philosophy and Sc ience of Caring y Patricia Benner- Stages of Nursing Expertise 2) Conceptual Models or Grand Theories These are less universal than the philosophies, but are comprehensive in that they pro vide structure for all the views that interest nurses- human, environment, and health, and ³propositional direction for the profession in a scientific field.´ Tomey a nd Alligood consider the following as grand theories: y Dorothea Orem- Self-Care Theory y Myra Levine- Conventional Model
y Martha
Rogers- Science of Unitary Human Beings y Dorothy Johnson- Behavioral System Model y Sr. Callista Roy- Adaptation Model y Betty Neuman- Health Care System Model y Imogene King- Goal Attainment Model 3) Middle Range Theories These theories are more limited in scope. They relate more clearly to nursing situations that can be placed within the model from which each theory was derived. Examples of theorists are the following: y Hildegard Peplau- Psychodynamic Theory y Ida Jean Orlando- Nursing Process Theory y Joyce Travelbee- Human-to-Human Relationship Model y Katherine Kolkaba- Comfort Theory y Madeleine Leininger- Transcultural Nursing y Rosemarie Rizzo Parse- Human Becoming Theory y Margaret Newman- Health as Expanding Consciousness C. According to Nursing Domains (Meleis, 2004)
1) Nursing Clients The major influence on each of the theorists was the client and the client¶s need for nursing. y Dorothy Johnson- Behavioral System Model y Sr. Callista Roy- Adaptation Model y Betty Neuman- System Model in Nursing Practice 2) Client- Environment Interactions The major points in this domain were t hat human beings and environments are unitary, irreducible, and pandimensional energy fields that are identifiable by patterns. Humans and their environment cannot be discussed, considered, or understood in isolation from the other; they are interrelated in an irreducible way. y Martha Rogers- The Science of Unitar y and Irreducible Human Beings 3) Interactions The theories that were included in this category are those that consider Nursing as a process of interaction, including those often classified by others as grand or as practice and middle range theories. y Imogene King- Goal Attainment Theory y Ida Jean Orlando- Nursing Process Theory y Joyce Travelbee- Human-to-Human Relationship Model y Ernestine Wiedenbach- The Helping Art of Clinical Nursing 4) Nursing Therapeutics
This category is defined by the type of activities and interventions nurses design to assist actual or prospective clients or people who are vulnerable. The stance o f the theorist and the substance of the theory dictate the design and type of interventions. y Myra Levine- theory was concerned with the conservation of client¶s energy y Dorothea Orem- theory focused on returning clients to self-care D. According to Paradigms
1) Parse¶s Categorization a) Totality Paradigm This includes all theoretical perspectives in which humans are biopsychosocial-spiritual beings, adapting to their environment, in whatever way the theory defines environment. y Dorothea Orem- Self-Care Theory y Sr. Callista Roy- Adaptation Model y Dorothy Johnson- Behavioral System Model b) Simultaneity Paradigm This includes the theoretical perspectives in which humans are identified as unitary beings, which are energy systems in simultaneous, continuous, mutual process with, and embedded in, the universal energ y system. y Rosemarie Rizzo Parse- Human Becoming Theory y Martha Rogers- The Science of Unitar y and Irreducible Human Beings y Margaret Newman- Health as Expanding Consciousness 2) Newman¶s Categorization a) Particulate-Deterministic This paradigm is characterized by the po sitivist view of the theory of science and stresses research methods that demanded control in the search of knowledge. Entities (e.g. humans) are viewed as reducible, and change is viewed as linear and causal. These paradigms are conceptualized as evolving; the more complex paradigms encompass but extend the knowledge in a previous paradigm. From the perspective of the theories within the particulate±deterministic paradigm, human health and caring are understood through their component parts or activities; there is an underlying order and predictable antecedents and consequences, and knowledge development progresses to uncover these causal re lationships. Reduction and causal inferences are characteristics of this paradigm. (Smith & Liehr, 200 8) y Florence Nightingale y Dorothea Orem y Ida Jean Orlando y Hildegard Peplau b) Interactive-Integrative Objectivity and control are still important but reality is seen as mu ltidimensional and contextual, and both objectivity and subjectivity are viewed as desirable. This parad igm acknowledges contextual, subjective, and multidimensional relationships among the phenomena central to the discipline. The interrelationships among parts and the probabilistic nature of change are assumptions that guide the way phenomena are conceptualized and studied. (Smith & Liehr, 2008) y Patterson
y Sr.
Callista Roy y Margaret Jean Watson c) U nitary-Transformative Humans are viewed as unitary beings, which are self-evolving and self-regulating. The person± environment unity is a patterned, self-organizing ¿eld within larger patterned selforganizing ¿elds. Change is character ized by Àuctuating rhythms of organization, disorganization, toward more complex organization. Subject ive experience is primary and reÀects the whole pattern. (Smith & Liehr, 2008) y Margaret Newman y Martha Rogers y Rosemarie Rizzo Parse 3) Fawcett¶s Categorization This model was synthesized from the analysis of views of mechanism versus organism, persistence versus change, and the Parse and Newman and colleagues¶ nursing paradigm structure. (Smith & Liehr, 2008) a) Reaction Humans are classified as biopychosocial-spiritual beings who react to the environment in a causal way. The interaction changes predictably and controllably as humans survive and adapt. Reactions are causal and stability is valued; cha nge is a mechanism for survival. b) Reciprocal Interaction Humans are viewed as ho listic, active, and interactive with their environments, with the environments returning interactions. She noted t hat these theorists viewed reality as multidimensional, dependent on context (the surrounding conditions), and relative. This means that change is probabilistic and a result of multiple antecedent factors. These theories support the study of both objective and subjective phenomena, and both qualitative and quantitative research. c) Simultaneous Action Humans and their environment are constantly interacting, changing, and evolving. Human beings are characterized by pattern and are in a mutual rhythmic open process with the environment. Change is continuous, unpredictable, and toward greater complexity and organization. E. According to Scope or Level of Abstraction Scope refers to the qualified level of precision of a certain theory and the accuracy of its concepts and propositions (Octaviano, 2008). Level of abstraction refers to the level of ³complexity´ by which a system is viewed. The higher the level, the less detail; the lower the level, the more detail. According to Octaviano (2008), there are three categories that relate to the scope of a theory: Grand Theor ies, Middle-range Theories, and Micro-range Theories.
1) Grand Theories According to Potter & Perry (2009), grand theories are broad in scope, complex, and therefore require further specification through research. They are simply known t o speak about a broad range of important relationships among concepts of a discipline (Octaviano, 2008). Grand theories are composed of relatively abstract concepts, typically lack operational definitions, and are not amenable to testing. They are developed through thoughtful and insightful appraisal of
existing ideas as opposed to empirical research. Early theorizations in nursing are considered grand theories, when Nursing was addressing its nature, mission, and goals. Grand theories are further categorized based o n human needs, interactive process, and unitary process. a) Based on Human Needs Majority of early works were strongly influenced by the needs t heories of social scientists (Maslow). These theories followed the philosophical school of thought o f the time by considering the person to be biopsychosoc ial being and focusing on meeting the individual¶s needs. y Florence Nightingale- ³Nursing: What It Is and What It Is Not´ (1860) Nightingale¶s ³basis tenet was healing and secondar y to it are the tenets of leadership and global action which are necessary to support healing at its deepest level´ (Dossey, 2005). Nightingale¶s philosophy was inductively derived, it is abstract yet descriptive in nature, and it is classified as a grand theory or philosophy by most nursing writers. (Dossey, 2000; Selanders, 1993, 2005a; Tomey & Alligood, 2002) y Virginia Henderson- ³The Principles and Practice o f Nursing´ Henderson was educated during the empiricist era in medicine and nursing, which focused on patient needs. The t heory presents the patient as a sum of parts with biopsychosocial needs, and the patient is neither client nor consumer. The major assumption of the t heory is that nurses care for patients until patients can care for themselves once again. y Faye G. Abdellah- ³Patient-Centered Approaches to Nursing´ Abdellah¶s patient-centered approach is considered a human needs theory. The theory was created to assist with nursing education and is most applicable to education and practice. Abdellah had six assumptions. These relate to change and anticipated changes that affect nursing; the need to appreciate the interconnectedness of social enterprises and soc ial problems; the impact of problems such as po verty, racism, pollution, education, and so forth o n health and health care delivery; changing nursing education; continuing education for professional nurses; and development of nursing leader from underserved groups (Abdellah, Beland, Martin, & Matheney, 1973). She was one of the early writers who referred to ³nursing diagnosis´ dur ing a time when nurses are taught that diagnosis was not a nurse¶s prerogative. Nursing diagnoses were a determination of the nature and extent of nursing problems presented by individuals receiving nursing care. y Dorothea E. Orem- ³The Self-Care Deficit Nursing Theory´ According to Orem, Nursing is seen as an art through which the pract itioner of nursing gives specialized assistance to persons with disabilities which makes more than o rdinary assistance necessary to meet needs for self-care. y Dorothy Johnson- ³The Behavioral System Model´ Nightingale¶s philosophical leanings prompted Johnson to co nsider the person experiencing a disease more important than the disease itself. The concept o f human was defined as a behavioural system that strives to make continual adjustments to achieve, maintain or regain balance to the steady ± state that is adaptation. y Betty Neuman- ³ The Neuman Systems Model´ Neuman¶s model uses a systems approach that is focused on the human needs of protection or relief from stress. Neuman believed that the cause s of stress can be identified and remedied through nursing interventions. She emph asized the need for humans for dynamic
balance that the nurse can provide through identification of problems, mutually agreeing on goals, and using the co ncept of prevention as intervention. Neuman¶s model is one o f only a few considered prescriptive in nature. The model is universal, abstract, and applicable for individuals form many cultures. b) Based on Interactive Process Theorists believe that humans are holistic beings who interact with and adapt to situations in which they find themselves. These theorists ascribe to systems theory and agree that there is constant interaction between humans and their environments. y Myra Levine- ³The Conservation Mo del´ She state that ³nursing is a human interaction´. Her model deals with the interactions of nurse and client. It considers multiple factorial interactions, which may produce predictable effects using probability as the reality. y Barbara Artinian- ³The Intersystem Model´ In the Intersystem Model, there is a differentiation between the human as a system (the intrasystem) and the interactive systems of individuals or groups, known as the intersystem. Nursing is specified as ³nursing action,´ which is identified by the mutual communication, negotiation, organization, and priorities of both t he client and nurse intrasystems. This is accomplished through intersystem interaction; feedback loops are necessary to produce a mutually determined plan of care. y Helen Erickson, Evelyn Tomin, & Mary Ann Swain- ³Modeling and Ro leModeling, a Paradigm and Theo ry for Nursing´ Philosophically, Erickson, Tomlin, and Swain believe ³that Nursing is a process between the nurse and client and requires an interpersonal and interactive nurse-client relationship´. For this reason, their work is considered to be human interaction theory. y Imogene King- ³Theory of Goa l Attainment and Transactional Process´ The Theory of Goal Attainment lists several assumptions relating to individuals, nurseclient interactions, and nursing. Regarding nurse-client interactions, King believes that perceptions, as well as the goals, needs, and values, of the nurse and client influence the interaction process. If the nurse and client make transactions, goals will be attained. If transactions are made in nurse-client interactions, growth and development will be enhanced. y Roper, Logan, and Tierney- ³Model of Nursing Based on Activities of Living´ The model was developed from the nursing education experiences of the authors as they analyzed data from numerous hospitals and other clinical practicum locations to identify a co re of nursing knowledge across specialties. The dat a they gathered from clinical areas were analyzed and they determined that there was a core of common, everyday living activities. Thus, the model was inductively formulated. Health refers to how the individual carries out the activities of living in interaction with the five factors (biological, psycho logical, sociocultural, environmental, and politicoeconomic) along the continuum from dependence to independence, and across the lifespan of the person. y Sister Calista Roy- ³The Roy Adaptation Model´ Like many of the models/ theories, it is a deductive theory based o n nursing practice. The Roy Adaptation Model is focused on the interrelatedness of four adaptive systems/ modes that constitute the specific categories that serve as framework for assessment. Through the four modes, ³responses to and interaction with the client¶s environment are carried out and adap tation can be observed´.
y Jean Watson-
³Caring Science as Sacred Science´ Watson called her earlier work a descriptive theory of caring and stat ed that it was the only theory of nursing to incorporate the spiritual dimension of nursing at the time it was first conceptualized. The theory was both deductive and inductive in its origins and was written at an abstract level of discourse. One of the basic assumptions of this theory states that ³caring can be effectively demonstrated and practiced only interpersonally´ (Octaviano, 2008). c) Based on U nitary Process This group of theorists believed that humans are unitary beings: e nergy systems embedded in the universal energy system. Within this group of theories, human beings are seen as unitary, ³whole, open and free to choose ways of becoming.´ Health is described as continuous humanenvironmental interchanges. y Martha Rogers- ³The Science o f Unitary and Irreducible Human Beings´ This theory started as an abstract theory that was synthesized from theories of numerous sciences. According to Rogers, human systems are open systems, embedded in larger, open environmental systems. Man is a unified whole possessing integrity and man ifesting characteristics that are more than and different from the sum o f its parts. Man and environment are continuously exchanging matter and energy with one another. y Margaret Newman- ³Health as Expanding Consciousness´ Built on the works of Rogers and others, this theory is one of the most recent nursing theories. As a student of Rogers, Newman believed that ³the human is unitary, that is, cannot be divided into parts, and is inseparable for the larger unitary field´. She saw humans as o pen energy systems in continual contact with a universe of open systems. A fundamental propos ition in Newman¶s model is the idea that health and illness are synthesized as ³health´. The fusion of one state of being (disease) with its opposite (nondisease) results in what can be regarded as health. Health and disease are the same and not separate in the life of the individual. y Rosemarie Parse- ³The Theory of Human Becoming´ The theory comes from her experience in nursing and from a synthesis of theoretical principles of human sciences. According to Parse, nursing is grounded in view that the human is a unitary being who is free to choose in situations. Nursing is guiding humans to ward ways of being, finding meaning in situations, choo sing ways of cocreating their own health, and living true presence in the day-to-dayness of the person¶s life. 2) Middle- Range Theories Middle-range theories have a more limited scope, and are considered as the least abstract level of knowledge because t hey include details specific to nursing practice. They o ffer a more direct application to research and practice. They emerge at the intersection of research and practice, when theory guides practice, practice generates research questions, and research creates/ informs understanding of theory and pract ice. Descriptions, explanations, and predictions are made with the purpose of answering questions about different nursing phenomena. They specify such things as the health condition, the patient population, the location of practice and the different interventions of the nurse (Octaviano, 2008). Based on Source and Development Process: a) Derived from Research &/or Practice The approach is induction through research and practice.
y Chronic
Illness Trajectory Framework (Corbin & Strauss, 1991,1992)- developed from a series of studies related to management o f chronic illness, combined with numerous accounts of practice experiences by nurses. y Model for Cultural Competence (Purnell, 2000)- developed from practice and working with staff and students in culturally diverse c linical settings. b) Derived from a Grand Theory The approach is deduction from research and pract ice or application of grand theories. Many nursing theorists and scholars agree that grand theories are difficult to apply in research and practice. They suggest the development of middle range t heories derived from grand theories. y Theory of Self-Care (Rew, 2003)- developed from experiences of homeless youth based on Orem¶s work y Theory of Prevention as Intervention (August-Brady, 2000)- employed Neuman Systems Model as basis c) Combining E xisting Nursing and Non-Nursing Theories The approach is a combination of existing nursing and non-nursing middle range theories. Combining concepts or elements of multiple theories is very co mmon in middle range theory development. y Theory of Exercise as Self-Care (Ulbrich, 1999)- developed through ³triangulation of Orem¶s self-care deficit theory of nursing, the, and characteristics of a population at risk for cardiovascular disease.´ d) Derived from Non-Nursing Disciplines The approach is the derivation from theories of other disciplines that relate to nursing. A very significant number of middle rang nursing t heories are developed from one or more nonnursing theories, including those from the behavioral sciences, soc iology, physiology and anthropology. y Theory of Comfort (Kolcaba, 1994)- reportedly derived from a review of literature from medicine, psychiatry, ergonomics, and psycho logy, as well as from nursing literature and history. y Uncertainty in Illness Theory (Mishel, 2003)- incorporated elements of chaos theory e) Derived from Practice Guidelines or Standard of Care The approach is the derivation from practice gu idelines and standards rooted in research. Practice guidelines or standards appear to be the least common source for middle range theory development, as only a few examples could be found. y Public Health Nursing Practice Model (Smith & Bazini-Barakat, 2003)- developed by ³melding of nationally recognized components´ of public health nursing practice. The identified components were the Standards of PHN practice, the 10 Essential Services of Public Health, Healthy People 2010¶s 10 Leading Health Indicators, and Minnesota¶s Public Health Interventions Model. y Theory of the Peaceful End of Life (Ruland and Moore, 1998)- used standards of care for terminally-ill patients Based on their Level of Abstraction: Liehr and Smith (1999) analyzed 22 middle range theories published during the previous decade. They are categorized as follows: a) High Middle Range Theories
These include concepts such as caring, growth and development, self-transcendence, resilience, and psychological adaptation. y Benner¶s Model of Skill Acquisition in Nursing o The model outlines five stages of skill acquisition: novice, advanced beginner, competent, proficient, and expert. Benner¶s work delineates the importance of retaining and rewarding nurse clinicians for their clinical expertise in practice settings, because it describes the evolution of ³excellent caring practices´. y Leininger¶s Cultural Care Diversity and Universality Theory o Madeline Leninger has been instrumental in demonstrating to nurses the importance of considering the impact of culture on health and healing. She is credited with starting the specialty of transcultural nursing. The purpose of the t heory is to generate knowledge related to the nursing care of people who value their cultural heritage and lifeways. y Barker¶s Tidal Model o This describes psychiatric nursing practice, and emphasizes the fluid nature of human experience characterized by change and unpredictability. It is a philosophical approach to the discovery of mental health, focused on helping people recover t heir personal story of distress, as a first step towards reclaiming control over their lives. b) Middle Middle Range Theories These include concepts such as uncertainty in illness, unpleasant symptoms, chronic sorrow, peaceful end of life, cultural brokering, and nurse-expressed empathy. y Mishel¶s Uncertainty of Illness Theory o The theory explains how clients cognitively process illness-related stimuli and construct meaning in these events. In the theory, adaptation is the desirable end-state achieved after coping with the uncertainty. Nurses may develop nurs ing interventions that attempt to influence the person¶s cognitive process to address the uncertainty. y Kolcaba¶s Theory of Comfort o Kolcaba defined comfort within nursing practice as ³the satisfaction of the basic human needs for relief, ease, or transcendence arising from health care situations that are stressful. Increasing comfort can result in having negative tensions reduced and positive tensions engaged. Co mfort is viewed as an outcome of care that can promote or facilitate health-seeking behaviors. y Theory of Unpleasant Symptoms o This was developed by a group of nurses interested in a variety of nursing issues including symptom management, theory development and nursing science. The theory was developed to integrate existing knowledge about a variety of symptoms to better prepare nurses in symptom management. c) Low Middle Range Theories These include hazardous secrets, women¶s anger, nurse midwifery care, acut e pain management, helplessness, and intervention for postsurgical pain. The nu mber of low middle range theories appears to be growing rapidly as nursing researchers and nursing scholars describe phenomena directly related to practice. y Eakes, Burke, and Hainsworth¶s Theory of Chronic Sorrow o The concept of chronic sorrow describes the grief observed in the parents of children with mental deficiencies. The theory was induct ively derived and validated through a series of studies and a critical review of existing research. y Beck¶s Postpartum Depression Theory
o The theory provides insight into the experience of postpartum depression. The concepts or stages were defined as 1) encountering terror (anxiety attacks), 2) dying of self (isolation), 3) struggling to survive (seeking solace, praying for relief), and 4) regaining control (recovery). y Urine Control Theory o The purpose of this model is to ³provide a framework for practicing nurses as well as nurse researchers in addressing urine control problems´. The t heory was developed following a research study of 119 incontinent, memory-impaired elders and their caregivers. The researchers identified significant correlations between incontinence and impaired mobility. 3) Micro- Range or Situation-Specific Theories According to Octaviano (2008), micro-range theories are known to be the most concrete and narrow in scope. They focus on specific nursing phenomena, and are limited to specific populations or a particular field of practice. y Menopausal transition of Korean immigrant women y Learned response to chronic illness of patients with rheumatoid arthritis y Women¶s responses when dealing with their multiple roles
