Hi Nader

an interesting question, and I think one that gives rise to a number of possible answers.  In part, I would suggest that theories, whether in nursing or any discipline, are by their nature set at the level of the ideal.  In other words, they look at the 'perfect' situation, where there are no specific limits, lack of resources, or practical problems.  In this sense, inevitably they will seem unrealistic and potential unworkable when translated into the practical reality.  But at the same time, the theory needs to remain ideal, and the challenge to the practitioner and the professional then becomes to recognise (as you are suggesting) where the barriers lie and therefore how they can be overcome.  This will vary depending on the type of theory - whether you are looking at grand theories, systems level, interpersonal etc; which will all have inherent issues depending on the level at which they are designed to work.  Similarly, the geographical, political, socio-cultural and economic environment within which the nursing situation is occurring will also give rise to specific issues and limitations which will vary. 

Overall, I suggest that there are limitations resulting from the nature of a theory driven approach - which relate to the need to strive for the ideal even when this is not immediately possible.  This is not always a bad thing though, as it provides the opportunity to maintain a goal and something to strive for.  It also helps focus and determine the profession to identify the specific issues which relate to their own area of practice.  Other barriers relate to trying to impose a theory on a situation, or into an area of practice, that it was not designed for - without considering the need to adapt or amend to address this.  Many theories are designed or developed in relation to specific circumstances, and then when practitioners attempt to use them in different ways they can become frustrated and see the problem as being integral to the theory itself, rather than the application of it.

Just some general thoughts - as I said, a very interesting question!

Dear Sandra,

Thank you for your good answer.

I think the most problem is a gap between theory and practice. Its reason can be creation a subjective theory without a sufficient attention to real environment as hospitals or clinics.

Also, theories are not absolute as reality changes over time, so we need to recognize the need for updated theories or new ones to keep abreast of current practice.

Best regards,

Debra

Dear Debra,

Do we need update some of theories or set aside them? Is not it better to create new theories based on reality in our hospitals or clinics?

Some of nursing theories are created by professors not by the nurses that work in the hospitals!

Dear Nader, thanks for your interesting question. In most western countries nurses are educated on a vocational level up to a PHD at an university. I assume that many professors in nursing have been a nurse in de past. But that might not yet be true. Dear Nader is their proof for your theorem that academics in nursing are not practical based? I would love to see that. All the best, Carl

Dear Carl,

Based on your advice, I corrected "most of" to "some of"!

Thank you.

Dear Nader,

thank you for that interesting question. Sandra already described a few of the limiting aspects. I want to add another important aspect in this discussion and this is the fact that we differ different levels of theory and their different use in daily practice:

•Grand theory

•Middle-Range theory

•Situation-specific theory

Grand theories are very abstract, broad in scope (a lot of different phenomena) so they help us to reflect nursing practice and tell us what nursing is about and what does it mean to be nurse. But this kind of theory isn’t designed for empirical testing and limited in directing, explaining and predicting nursing in specific clinical situations.

Middle-range theories offer an effective bridge between grand theories and nursing practice. They are narrower in scope and so they can describe, explain or predict a nursing phenomenon. Another hallmark of mid-range theory is that they are designed for empirical testing.

Situations-specific theories have the most limited scope of abstraction and are developed for use within a specific clinical nursing situation. The provide frameworks for specific nursing interventions to guide daily practice and predict specific outcomes. They are also developed for empirical testing but their use is limited to a specific setting or group of patients.

I always discuss this question with the undergraduate nursing students when I'm teaching nursing theories. To show them the difficulties I use the topic of "self-care". You can choose different theories about self-care to adress the different levels of abstraction and the different uses in nursing practice. All three theories can influence the nursing discipline but in a very different way:

•Grand theory (Orem‘s self-care theory)

•Middle-Range theory (Riegel‘s middle-range theory of self-care of chronic illness)

•Situation-specific theory (Riegel‘s situation-specific theory of heart failure self-care)

Just some thoughts. Hope it helped to broaden the perspective.

Best regards,

Florian.

Dear Florian,

Thank you for your comments. I want to know about the obstacles that prevent most of nursing theories to be practical?

Are there any papers about nurses perceptions of nursing theories?

it is perfect questıon,many times I ask this questıon.it can be differnt some country.

İn turkey Health System mıght be obstacle because of.Nursıng shortage,high turnover,hierarchy.

Unfortunately, most of theories have been written by the scientist without sufficient clinical experiences or the theoreticians whose believes are not related to the culture of other societies or clinical situations.

The most significant impediment to successful implementation of any nursing theory in clinical situations is attempting to use the incorrect theory or paradigm in a particular nursing situation.

Lack of a Comprehensive Philosophy

Professional nurses in all disciplines and at all positions of leadership must treat patient care in a complementary manner.

There is no way to apply a single theory to all kinds of all types of patient conditions.

Unfortunately, many nurses do not have a sufficient knowledge of understanding of the types of nursing theories to employ them effectively. This lack of comprehension may indicate a lack of educational background, resulting in poor patient care.

Misapplication of General Theories

When a nurse encounters a particular patient situation or, it may be an error, or an obstacle to successful implementation, to apply a grand theory.

Limitations of Middle-range Theories

Middle-range nursing theories are models that can be applied to professional practice. They also act as testing frameworks for researches. Middle-range theories include specific concepts and provide strategies for delivering quality patient care.

Though middle-range theories are less generalized than grand theories, the most significant obstacle to their successful application is that they do not deal with specific populations of patients and any specific problems.

As a result, while these theories can be a useful guidance for nurses, they cannot be extended to specific or special health-care problems.

Unreasonable Expectations from Practical Theories

Nurse practice theories are constructions that deal with questions that pertain to particular and specific issues, settings and communities. However, they have a flaw in that they have nothing to do with basic nursing philosophies and science. New or improvised techniques are often used to solve problems. While these techniques can be useful, such improvisation may waste a lot of time.

Often patients in emergency situations do not have time to lose.