Usefulness of nursing theory-guided practice: an integrative review.

BACKGROUND: Nursing theory-guided practice helps improve the quality of nursing care because it allows nurses to articulate what they do for patients and why they do it. However, the usefulness of nursing theory-guided practice has been questioned and more emphasis has been placed on evidence-based nursing and traditional practice. Therefore, an examination of experimental studies was undertaken to analyse the extent of use and usefulness of nursing theories in guiding practice. We reviewed experimental studies because in this era of evidence-based practice, these designs are given more weightage over other research designs. This examination would corroborate the usefulness of nursing theory-guided practice compared to traditional practice. METHODS: An integrative review was conducted. Literature search was performed within multiple databases, and 35 studies were reviewed and appraised. RESULTS: Majority of the studies were from Iran, the United States and Turkey and used Orem's self-care model, Roy's adaptation model and Peplau's theory of interpersonal relations. The effect of theory-guided interventions was evaluated in improving quality of life, self-efficacy, self-care and stress of patients with chronic, acute, cardiac and psychological illnesses. The quality rating was judged to be strong for three studies, moderate for 25 studies and weak for seven studies. All of the strongly rated studies found nursing theory-guided interventions useful. Overall, nursing theory-guided interventions improved all of studied outcomes in 26 studies and at least one outcome in nine studies. None of the studies reported that nursing theory-guided interventions as not useful. CONCLUSION: Nursing theories have guided practice in both eastern and Western countries, and theory-guided practice has been found useful compared to traditional nursing practice. Therefore, nurses should continue to guide their nursing practice through the lens of nursing theories and should continue to evaluate the effectiveness of nursing theory-guided practice.

The American Academy of Nursing 50th Anniversary of the Nursing Theory Guided Practice Expert Panel (NTGPEP): Exploring the Past-Re-envisioning the Future.

The Nursing Theory-Guided Practice Expert Panel (NTGP-EP), one of the 14 Expert Panels, is officially designated to advance the mission and strategic goals of the American Academy of Nursing. The NTGP-EP has created a forum for dialogue among nurse scholars interested in advancing nursing theory to promote health and wellbecoming. The purpose of this paper is to share the important work of the NTGP-EP and its history, contributions, and accomplishments, and to propose a member-driven agenda to re-envision our preferred future and the impact of the use of nursing theory to guide nursing education, research, practice, and policy.

Knowledge for Nursing Practice: Beyond Evidence Alone.

OBJECTIVE: For the past 30 years there has been a growing emphasis on evidence as the primary or exclusive basis for nursing practice. METHODS: Critical examination of literature related to evidence-based practice from the 1990s to the present. RESULTS: This review of the nursing literature from the 1990s to the present reveals that in the midst of the movement to promote evidence-based practice as the gold standard, there have been persistent expressions of concern. These concerns are (a) lack of alignment of evidence-based practice with nursing's disciplinary perspective; (b) wrongful privileging of empirical knowledge over other sources of knowledge; (c) underappreciation of the complexity of practice and practice wisdom;(d) possibilities of evidence-based practice thwarting innovation and creativity;(e) vulnerabilities of empirical evidence to be flawed, inconsistent, and influenced by competing interests; (f) situational realities that limit access to and critical appraisal of evidence that access to and critical appraisal of evidence is not feasible or practical; and (g) lack of relationship of evidence-based practice to theory. CONCLUSIONS: We call for a recalibrated practice epistemology that promotes a greater appreciation for the myriad sources of knowledge for nursing practice, and offer recommendations for international change in education, literature, scholarship, and public media.

Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem's Self-Care Deficit Nursing Theory.

INTRODUCTION: Many researchers have commended the self-care deficit nursing theory (SCDNT) developed by Orem as a means of improving patients' health outcomes through nurses' contributions. However, experimental research has investigated specific aspects of SCDNT, such as self-care agency and self-care requisites, rather than how the construct is practiced and understood as a whole. The current research presents a case study in which an advanced practice nurse (APN) used SCDNT-led practice within a primary healthcare setting that illustrates how the theory is applied to case management. METHODS: A case study was conducted by observing an APN during her work in the asthma clinic of a public hospital in Hong Kong. A comparison was made between the case management of the APN under observation with the nursing processes stipulated by the SCDNT across four key operations: diagnostic, prescriptive, treatment or regulatory, and case management. CONCLUSION: During the observed consultation, the APN applied the four key operations. In SCDNT, the role of the APN is to apply practical nursing knowledge by determining how a patient can best undertake self-care within the circumstances of their living arrangements and support facilities. The case study also demonstrated that SCDNT-based nursing practice has strengths and limitations in a primary healthcare setting. The study concluded that Orem's SCDNT serves as an appropriate theoretical framework for nursing practice within primary healthcare settings. One practical consequence of using SCDNT is that it enables APNs to use nurse-sensitive indicators when evaluating their clinical practice. This study offers a practice update to increase the accountability of nursing practice for nurse-led healthcare services.