Chapter 5 Theories of nursing practice

A nurse who has practiced on an orthopedic unit for 10 years unexpectedly becomes pregnant. At delivery the physician informs the mother, "Your baby has Alport syndrome, but then I don't have to explain what that means with your medical background." The mother is unfamiliar with this disease and withdraws as a coping mechanism. Which nursing theory would provide a framework to guide nursing care for this mother? a. Mishel's uncertainty of illness b. Orem's self-care deficit model c. Nightingale's canons of nursing d. Levine's conservation model

ANS: A In Mishel's uncertainty of illness theory, the core position is that uncertainty in illness must be addressed. When uncertainties are not addressed, clients' negative perceptions will escalate and they will suffer. Nursing responsibility based on this theory consists of reframing the client's perceived loss of control, or uncertainty, and helping the client develop new skills of assimilation and accommodation. DIF: Comprehension REF: p. 86

A community health nurse has been visiting a postpartum client who suffered domestic violence throughout the pregnancy, and now the infant may be at risk. The nurse assisted the client in finding shelter and legal protection. The nurse's role and the conceptual framework involved are: a. change agent, according to Roy's adaptation model. b. translator, according to Leininger's theory of cultural care diversity and universality. c. case manager, according to Peplau's interpersonal relations model. d. caregiver, according to Rogers' science of unitary human beings.

ANS: A In Roy's adaptation model, when the client incurs an insult that renders him or her in need of environmental modification, the nurse will be the change agent in assisting the individual with this adaptation.

A young child is having abdominal pain, and the doctor informs the parents that a computed tomography (CT or CAT) scan of the abdomen will be ordered. The doctor tells the child, "This CAT scan won't hurt you." The child is visibly upset because of a fear of cats. According to Mishel's uncertainty in illness theory, which stage of the framework is represented? a. Stimuli frame b. Appraisal stage c. Initiation of coping mechanisms d. Adaptation

ANS: A In the stimuli frame, the client reacts to some stimulus in a negative manner. The nurse at this stage should listen carefully and then initiate, seek, and clarify concerns and questions. DIF: Comprehension REF: p. 81, Case Study 5-1

A nurse is evaluating Levin's Theory of Conservation to determine if it can be applied to patients in the initial phases of chemotherapy treatment. During this phase of theory acceptance, the nurse wants to determine if all the concepts of energy, structural integrity, personal integrity, and social integrity are included in the care of cancer treatment. The nurse is applying which criteria of theory acceptance? a. Inclusiveness b. Consistency c. Accuracy d. Fruitfulness

ANS: A Inclusiveness asks the question, "Does the theory include all concepts related to the area of interest?" DIF: Application REF: p. 77, Box 5-2

A nurse practicing on a unit where domestic violence is common wants to learn how to apply nursing theory to practice on this unit. She considers the interrelatedness of the constructs of Watson's Theory of Caring and designs: a. conceptual model of caring. b. hypothesis of the impact of caring on domestic violence. c. proposition of how caring is conceptualized. d. theory of scientific inquiry.

ANS: A The conceptual model demonstrate how the concepts of compassion, commitment, conscience, confidence, and competence form a theme of caring (Watson). DIF: Comprehension REF: p. 85

What are general explanations that scholars use to explain, predict, control, and understand commonly occurring events? a. Theories b. Constructs c. Systems d. Propositions

ANS: A Theories are a group of related concepts that explain existing phenomena and predict events. Theories provide us with a frame of reference, the ability to choose concepts to study, or ideas that are within one's practice.

Which of the following are concepts related to nursing theory? (select all that apply) a. Environment b. Health c. Nursing d. Relevance e. Comfort

ANS: A, B, C, E Environment is a concept, which is a label given to ideas, objects, or events; concepts become the "pieces" that make up a conceptual model or theory. Health is a concept, which is a label given to ideas, objects, or events; concepts become the "pieces" that make up a conceptual model or theory. Nursing is a concept, which is a label given to ideas, objects, or events; concepts become the "pieces" that make up a conceptual model or theory. Comfort is a concept, which is a label given to ideas, objects, or events; concepts become the "pieces" that make up a conceptual model or theory. DIF: Comprehension REF: p. 83, Table 5-2

When reading Peplau's theory, a nurse was unable to determine the relationships among concepts. The nurse listed each concept and drew lines denoting relationships to be able to understand the effect of each element. The nurse created a: a. hypothesis. b. model. c. construct. d. variable.

ANS: B A model is a group of concepts that are associated because of their relevance to a common theme.

A group of nurses are interested in the how to improve teaching effectiveness for patients who have a hearing impairment and lack family involvement while hospitalized. They believe "hearing loss decreases the teaching effectiveness while hospitalized." The group plans to evaluate teaching effectiveness using a 10-point Likert scale pre-post teaching, perform a hearing test to determine degree of hearing loss on admission, and have social work evaluate the impact of hearing impairment on patient's ability to safely live alone prior to discharge. The group is working in which step of the scientific process? a. Hypothesis b. Method c. Results d. Evaluation

ANS: B During the method step, the group decides what data will be collected to answer the question and identifies step-by-step procedures that will be used to collect these data. DIF: Application REF: p. 77, Box 5-1

Einstein's theory of relativity laid the groundwork for theories of mathematics, and Freud and Jung provided the basis for a philosophy of man. Which nursing theory served as the foundation for nursing science? A. Rogers' science of unitary human beings B. Nightingale's theory of practice C. Watson's theory of human caring D. King's theory of goal attainment

ANS: B Florence Nightingale investigated the effect of the environment on healing, and this serves as the foundation for nursing science.

A client is hypertensive, and the doctor prescribes weight reduction. The client is excited about beginning the diet, but on arriving home the spouse states, "You have always been fat, and I am not going to starve because you can't control yourself." The client becomes anxious and is unable to participate in the diet plan, resulting in a weight gain of 5 pounds in 2 weeks. Which theorist could best be referred to for guidance regarding interventions in this situation? a. Martha E. Rogers b. Hildegard E. Peplau c. Florence Nightingale d. Myra Estrin Levine

ANS: B Hildegard Peplau's theory describes interpersonal relations as a nursing process. Nursing intervention in Peplau's model focuses on reducing related incapacitating stressors through therapeutic interpersonal interaction. DIF: Application REF: pp. 83-84, Table 5-2

Which type of theory most often guides present nursing practice? a. Grand theory b. Middle range theory c. Developmental theory d. Values theory

ANS: B Middle range theory is a nursing theory that refers to a specific population or to a specific situation, thereby making the theory easy to understand. An example is the theory of unpleasant symptoms (Lenz and Pugh), which examines symptoms that are influenced by physiologic, psychological, and situational factors as they relate to performance.

The statement, "Nursing is a caring profession that focuses on helping people be as healthy as possible," is an example of a: a. concept. b. construct. c. philosophy. d. model.

ANS: C A philosophy is the values and beliefs of the discipline.

A nurse in a rehabilitation unit plans activities of daily living to prevent excessive fatigue, helps the patient dress before the family visits, assists with range of motion, and allows the patient to decide which clothes to wear during the visit. This nurse is best applying which theory to practice? a. Watson's Theory of Caring b. Rogers' Theory of Unitary Humans c. Levine's Theory of Conservation d. Leininger's Theory of Transcultural Nursing

ANS: C Certain parts of all the theories can be applied; however, all the constructs of Levine's Model of Conservation are applied, including energy conservation, structural integrity, personal integrity, and social integrity. In this situation, the nurse conserved energy by planning ADLs, conserved structural integrity through ROMs, conserved social integrity by helping patient with appearance during family visits thus improving the milieu for social visits. DIF: Application REF: p. 83, Table 5-2

A client involved in a motor vehicle accident is blinded. The nurse helps the client obtain a guide dog so the client may continue grocery shopping and visiting friends and family. This enables the client to cope with the handicap and perform activities of daily living. Which nursing theory can be applied to this scenario? a. Watson's philosophy and science of caring and humanistic nursing b. Mishel's uncertainty in illness c. Orem's self-care deficit d. Rogers' science of unitary human beings

ANS: C In Orem's self-care deficit theory, the nurse implements measures to help clients meet self-care needs by matching them with an appropriate supportive intervention. DIF: Application REF: pp. 83-84, Table 5-2

A nurse develops a new nursing theory related to stress and viability. The nurse determines the theory accounts for historical events in which soldiers suffering from the stress of inadequate clothing to protect them from the cold and lack of correspondence from home had an increased mortality related to gunshot wounds. The theory will predict gunshot victims' need for proper clothing and letters from significant others as they serve in Iraq. Which criterion for theory acceptance is being validated? a. Inclusiveness b. Consistency c. Accuracy d. Simplicity

ANS: C The accuracy of a theory is its ability to explain past occurrences while being useful in determining future outcomes. DIF: Application REF: p. 77, Box 5-2

A nurse is heard making this comment, "I believe human dignity is based on perceived self-worth while caring is based on perceived role in society that forms the basis of nursing practice." This nurse is: A. demonstrating a model of human dignity. B. evaluating the relevance of Leininger's Theory. C. applying Mishel's Theory of Disease Uncertainty. D. making a proposition concerning the constructs of nursing practice.

ANS: D A proposition is a statement that proposes the relationship between and among concepts. DIF: Application REF: p. 76 |p. 78

A nurse researcher determines whether findings are substantial by calculating the level of significance. Which aspect of the scientific inquiry is being conducted? a. Hypothesis b. Method c. Data collection d. Evaluation

ANS: D During evaluation, results are examined with the goal of determining the relevance of outcome data in answering the hypothesis; the significance of the data and the potential for future research are also explored.

Which nursing theory might a nurse use as a conceptual framework to determine how to meet the needs of immigrants while ensuring provision of high-quality and culturally sensitive care? a. Martha Rogers' nursing theory b. Dorothea Orem's nursing theory c. Hildegard Peplau's nursing theory d. Madeleine Leininger's nursing theory

ANS: D Madeleine Leininger proposed the theory of cultural care diversity and universality. This theory of transcultural nursing comprises concepts involving caring and the components of a cultural care theory: diversity, universality, worldview, and ethnohistory.

If a nurse applies Nightingale's theory to current practice, the nurse's first step will be to evaluate the hospital room's air quality and, second, to: a. make certain that the volume of the television is not too loud. b. consult the dietitian to check that essential nutrients are added to meet requirements noted on MyPyramid. c. ask the client's family to bring family photographs and bright-colored throws for the bed. d. arrange for the client to go outside, weather permitting, while keeping the room's window blinds open.

ANS: D Nightingale believed the need for light was second only to the need for fresh air. DIF: Application REF: p. 82

A nurse believes that humans use creativity and critical thinking to balance their connections with their surroundings. The nurse decides to conduct a study on the basis of this belief. Which nursing theory would be best for this study? A. Peplau's interpersonal relations as a nursing process: man as an organism that exists in an unstable equilibrium B. Roy's adaptation model: assistance with the adaptation to stressors to facilitate the integration process of the client C. Orem's self-care deficit model: self-care, self-care deficits, and nursing systems D. Rogers' science of unitary human beings: humans as energy fields that interact constantly with the environment

ANS: D Rogers' science of unitary human beings, in which humans are seen as energy fields that interact constantly with the environment, is a theory in which the nurse promotes synchronicity between human beings and their universe/environment. DIF: Comprehension REF: pp. 83-84, Table 5-2

The basic ingredients of theory are ____________.

ANS: concepts A theory is defined as a group of related concepts that explain existing phenomena and predict future events. DIF: Knowledge REF: p. 76