Modern nursing theory began with Virginia Henderson in the 1960s. In her grand theory of nursing, she de? ned nursing as “assisting individuals to gain independence in the performance of activities contributing to health or its recovery (Henderson, 1966, p. 15). Since the 1970s, the literature on nursing theory has focused upon two levels of nursing theories: the “grand nursing theory” and the “middle-range nursing theory.
” Grand nursing theories are broad in scope and often emphasize relationships that are dif cult to actually test. Examples of grand nursing theories include Rogers “science of unitary human being”, Newman’s “health and expanding consciousness”, and Parse’s “theory of human becoming” in addition to Henderson. Middle range theories are more modest in scope and have the potential to be validated through research. Examples include Rogers’ “theory of accelerating change,” Roy’s “theory of the person as an adaptive system, and King’s “theory of goal attainment.
” Educators spent a great deal of energy moving middle range theories into the academic curriculum, care planning processes, and languages that purported to capture clinical practice. Today there seems to be less of a need for nursing to have its “own” theory that describes how human beings live, adapt, become ill, recover, and heal. Rather, nursing science utilizes both physiological processes and social cognitive theories to attempt to understand individuals, families, and communities and how they experience their health, illness, and wellness.
At the same time, today there is great excitement and energy focused upon evidence-based practice and practice-based evidence as strategies for building our knowledge for effective nursing practice. Often these two models represent a quantitative and qualitative perspective, sometimes a deductive and inductive perspective on building knowledge. While the randomized controlled trial is the research methodology designated as the gold standard for building evidence-based practice, there is also growing awareness of its limitations and related ethical dilemmas, such as providing a placebo to the control group.
Practice-based evidence An earlier version of this paper was published in French. Holzemer, W. L. (2008). Theories de soins in? rmiers, un heritage pour construire notre future. Soins Issue. 724 p. 52. suggests the requirement of electronic information systems that captures the assessments, interventions, and outcomes of interest to nursing practice so that data mining can occur.
To date, few health care environments actually have the capability to build practice-based evidence empirically. However, interpretative research methodologies are actively involved in capturing practice-based evidence. Recently two Asian regions of the World Health Organization (Western Paci? c and South-East Asia) have formally adopted a new theoretical model of people-centered care. They (WHO, 2007) de? ne four domains of peoplecentered care: 1) Informed and empowered individuals, families, and communities; 2) Competent and responsive health practitioners;
3) Efcient and benevolent health care organizations; and, 4) Supportive and humanitarian health care systems. They call for a paradigm shift in health systems towards people-centered health away from the overly biomedical oriented, disease focused, technology driven and doctor dominated system of today. If we believe in the origin of the word “theory” from the Greek word “theoria” it means a vision. Peoplecentered care is a vision of health care that harmonizes the mind and body, people and systems and seeks to reestablish the health and well-being of people as the central goal of health care.
People-centered care is a rich and complex vision that has the potential to guide nursing practice as a signi? cant component of a humanized, interdisciplinary health system. William L. HOLZEMER Editor-in-Chief School of Nursing University of California, San Francisco REFERENCES Henderson, V. (1966). The Nature of Nursing. NY: Macmillan. World Health Organization (2007). People at the Centre of Health Care: Harmonizing mind and body, people and systems. South-East Asia Region and Western Paci? c Region. Geneva, Switzerland. © 2008 The Author Journal compilation © 2008 Japan Academy of Nursing Science.