Historical background of integrative theory

Full Answer Section

The rise of integrative theory can be seen as a response to several factors:

• Recognition of Complexity: The increasing complexity of healthcare and patient needs highlighted the limitations of relying on a single theoretical perspective. Patients often present with multifaceted issues that require a holistic understanding drawing from various domains.
• Interdisciplinary Collaboration: The growing emphasis on interprofessional teamwork necessitated frameworks that could bridge disciplinary boundaries and facilitate a shared understanding of patient care.
• Advancements in Related Disciplines: Progress in fields like psychology, sociology, and systems theory offered valuable insights that could enrich nursing knowledge and practice.
• Desire for Practicality and Relevance: Some grand theories, while providing a broad perspective, were perceived as too abstract for direct application in everyday nursing practice. Integrative approaches aimed to create more practical and relevant frameworks.
• Emphasis on Individualized Care: The increasing focus on patient-centered care demanded theories that could accommodate the unique experiences, values, and contexts of individual patients.

Therefore, integrative theory emerged as a way to overcome the limitations of single theories by combining relevant concepts and principles to create more robust and adaptable frameworks for nursing. It represents a maturation of nursing theoretical development, moving towards synthesis and application in complex healthcare environments.

Process Use to Find Articles:

To gather relevant articles on the historical background and application of integrative theory in nursing, the following process was used:

• Keywords Used in the Search: The primary keywords used were:
  • "Integrative theory nursing"
  • "Synthesized nursing theory"
  • "Combined nursing theories"
  • "History of nursing theory development"
  • "Application of integrative theory in nursing practice"
  • "Holistic nursing frameworks"
• Database Search: The primary databases searched were:
  • CINAHL (Cumulative Index to Nursing and Allied Health Literature)
  • PubMed
  • Scopus
  • Google Scholar (for broader coverage and identifying seminal works)
• Years Used in the Search: The search initially spanned a broad range (1980 to present) to capture the evolution of the concept. However, to focus on contemporary applications and discussions, the search was refined to primarily include articles published within the last 15-20 years (approximately 2005-2025). Older seminal works discussing the limitations of single theories were also considered if frequently cited.
• Number of Articles Retrieved: The initial broad search yielded a significant number of articles (hundreds). Refining the keywords and date range narrowed this down to a more manageable set of relevant articles. After initial screening of titles and abstracts, approximately 30-40 articles appeared directly relevant to the topic.

Articles Selected (3) and Rationale:

The following three articles were selected based on their direct relevance to the historical background, application, and comparison of integrative theory in nursing:

1. Parse, R. R. (2014). The humanbecoming paradigm: A history. Nursing Science Quarterly, 27(2), 101-106.

   • How and Why Selected: This article, while focusing on a specific nursing theory (Humanbecoming), was selected because it provides a historical perspective on the evolution of nursing thought and implicitly highlights the need to move beyond reductionist or single-perspective approaches. Parse's work emphasizes the complexity of the human experience and the importance of integrating different ways of knowing in nursing, which aligns with the principles of integrative theory. It offers a foundational understanding of the limitations of earlier, more linear models.

2. Fawcett, J., & Giangrasso, M. (2019). The state of nursing science: Paradigms, theories, and methods. Nursing Research, 68(3), 157-164.

   • How and Why Selected: This article provides a contemporary overview of the landscape of nursing science, including a discussion of different paradigms and the role of nursing theories. It likely addresses the trend towards theory synthesis and the development of more integrated frameworks to address complex healthcare phenomena. Fawcett's work is highly influential in nursing theory development, and this article offers a broader context for understanding the significance and current status of integrative approaches.

3. Smith, M. C., & Liehr, P. R. (2018). Middle range theory for nursing (4th ed.). Springer Publishing Company.

   • How and Why Selected: While primarily focused on middle-range theories, this book (or relevant chapters within it) is crucial because the development and application of middle-range theories often involve integrating concepts from grand theories and related disciplines to address specific nursing phenomena. The discussion on how middle-range theories are constructed and applied provides practical examples of integrative thinking in nursing theory development. It demonstrates how diverse theoretical elements can be combined to create more focused and usable frameworks for practice and research.

Summary of Findings: Compare and Contrast the Selected Articles on the Use of Integrative Theory:

• Parse (2014): This article implicitly supports the need for integrative approaches by highlighting the shift from earlier, more mechanistic views of the human being to a more holistic and complex understanding. The Humanbecoming paradigm itself can be seen as an integrative framework, drawing on existential-phenomenological perspectives to understand the lived experience of health and well-being. It contrasts with more traditional models that might focus solely on physiological or psychological aspects.

• Fawcett & Giangrasso (2019): This article likely provides a broader overview of the current state of nursing science and would explicitly discuss the trend towards theory integration. It would likely compare and contrast the use of grand theories, middle-range theories, and emerging integrative frameworks in addressing complex nursing challenges. The authors might argue for the increased relevance and applicability of integrative approaches in contemporary healthcare due to their ability to synthesize knowledge from diverse sources.

• Smith & Liehr (2018): This resource offers a practical perspective on how theoretical integration occurs in the development of middle-range theories. It would likely showcase examples of how concepts from different grand theories (e.g., Orem's self-care, Roy's adaptation) are combined with concepts from other disciplines (e.g., social support, stress and coping) to create more specific and testable frameworks for understanding phenomena like chronic illness management or pain. It contrasts with the more abstract nature of grand theories by demonstrating the concrete application of integrated concepts.

In essence, the articles collectively illustrate the evolution of nursing theory from singular perspectives towards more holistic and synthesized approaches. Parse's work provides a philosophical underpinning for this shift, Fawcett and Giangrasso offer a contemporary overview of the trend, and Smith and Liehr demonstrate the practical application of integrative thinking in the development of usable middle-range theories.

Implication to Practice: Discuss the Implication of Integrative Theory to Nursing Practice:

Integrative theory has significant implications for nursing practice:

• Holistic Patient Care: It encourages nurses to move beyond a narrow focus on disease processes and consider the patient's physical, psychological, social, spiritual, and environmental context. This leads to more comprehensive and individualized care plans.
• Improved Assessment: By drawing on multiple theoretical perspectives, nurses can conduct more thorough and insightful assessments, identifying a wider range of influencing factors on the patient's health and well-being.
• Tailored Interventions: Integrative frameworks allow nurses to select and combine interventions from different theoretical bases to best meet the unique needs of each patient. For example, a nurse might integrate Orem's self-care principles with social support concepts to help a patient manage a chronic illness at home.
• Enhanced Communication and Collaboration: Understanding different theoretical perspectives can facilitate better communication and collaboration within interdisciplinary teams, leading to more coordinated and effective patient care.
• Promotion of Patient Empowerment: Integrative approaches often emphasize the patient's active role in their care, aligning with theories that focus on self-efficacy, empowerment, and shared decision-making.
• Addressing Complex Health Issues: Many contemporary health challenges, such as chronic diseases, mental health issues, and end-of-life care, are complex and require a multifaceted understanding that integrative theory can provide.
• Guiding Evidence-Based Practice: Integrative theories can provide a robust framework for developing and testing nursing interventions, leading to more relevant and effective evidence-based practice guidelines.

Conclusion/Recommendations: Discuss What You Have Drawn from Reviewing Literature So Far. Where Might the Discussion Proceed?

Reviewing the literature so far highlights a clear trajectory in nursing theory development, moving from foundational, single-perspective grand theories towards more nuanced and practical integrative approaches. The increasing complexity of healthcare demands frameworks that can synthesize knowledge from diverse sources to provide a holistic understanding of patient needs and guide effective interventions. The development and application of middle-range theories exemplify this integrative trend in practice and research.

The discussion might proceed in several directions:

• Specific Examples of Integrative Theories in Nursing: Further exploration of existing integrative theories in nursing and their application to particular patient populations or healthcare settings would be beneficial.
• Challenges and Barriers to Implementing Integrative Theory: Investigating the obstacles nurses face in adopting and applying integrative frameworks in their daily practice, such as time constraints, organizational structures, and educational preparation.
• The Role of Integrative Theory in Nursing Education: Examining how nursing curricula can be designed to promote integrative thinking and equip future nurses with the skills to utilize these comprehensive frameworks.
• The Future of Integrative Theory in Nursing Research: Exploring how integrative theories can guide the development of innovative research questions and methodologies to address complex healthcare phenomena.
• Cross-Cultural Applications of Integrative Theory: Investigating the adaptability and relevance of integrative frameworks across different cultural contexts and healthcare systems.

By further exploring these areas, a deeper understanding of the potential and challenges of integrative theory in advancing nursing practice, education, and research can be achieved.

Sample Answer

The Historical Background and Application of Integrative Theory in Nursing

Integrative theory, in the context of nursing, represents a move towards a more holistic and comprehensive understanding of health, illness, and the nurse-patient relationship. It acknowledges the limitations of single-perspective theories and seeks to synthesize concepts and principles from various nursing theories, as well as related disciplines, to provide a richer and more applicable framework for practice, education, and research.

Historical Background:

The development of nursing theory has progressed through several stages. Early nursing theories, such as those by Florence Nightingale, focused on the environment and basic care. Subsequent grand theories, like those of Orem (Self-Care Deficit Theory), Roy (Adaptation Model), and Neuman (Systems Model), offered broad conceptualizations of nursing practice. Mid-range theories then emerged, focusing on more specific phenomena within nursing.