The recent Nursology.net post “What is Nursing” by Rachel Nguyen points to the all-important challenge to claim our own disciplinary identity. Our historical roots that associate nurses as task-oriented medical handmaidens partly accounts for this challenge, but as Nguyen points out in no uncertain terms, it is not our tasks, but our own disciplinary foundation of knowledge that defines our disciplinary identity. She identifies a number of nursology theories that specifically “gives us the power to provide holistic, ethical, and evidence-based care while pushing the profession forward.” This reminder, for me, brings to the fore once again the question “What makes a theory or model Nursing” that I addressed in a post on July 9, 2019. In that post, I stated:

“Unlike other disciplines, many of which focus on building knowledge as an end in itself, nursing’s mandate to act shifts the disciplinary focus so that knowledge related to a phenomena must include a focus, or point the way to “right” or “good” nursing action.  I have addressed the challenge in nursing of developing theory with this extremely complex perspective as one of the reasons for turning to theory in other disciplines, where the focus is more limited, and this complexity is typically unacknowledged and undeveloped or underdeveloped..”

This is precisely the core of a typical situation that I witness over and over again – the tendency to “drift” to the theories of other disciplines, and neglect the core that defines nursing’s own theoretical foundation. A very c ommon example involves Bandura’s theory of self-efficacy, which is rooted in the discipline of psychology. Bandura’s theory does aptly define a phenomenon that nurses often observe in practice, and one that prompts nurse action (care, intervention, therapeutics) in a general sense. But this theory falls short of what is needed when we focus on the experiences related to the challenges of health and illness. It is a phenomenon that psychologists, educators, sociologists and many other behavioral health professionals also observe, and practitioners in each of these disciplines might envision actions rooted in their disciplinary perspective.

Here is a model that shows the central concepts of Bandura’s self-efficacy theory:

This model defines self-efficacy as the  individual’s belief in their capacity to execute behaviors necessary to produce specific performance outcomes. Certainly a worthy focus for nursing care – assessment and nursing action that could include tasks, but is much more comprehensive than tasks alone. But what action? And why does it matter?

There are at least three nursing theories that fill in this essential element for nursing:

Orem’s Self-Care Framework

Orem’s theoretical perspective, begins with the practical self-care reality that people face when they experience a health challenge – one that can be concieved as some degree of compromised self-efficacy. This calls forth nursing care approaches that are needed to compensate, and further, to put into motion a path toward healing and restoration. The concepts of dependent self-care agency and self-care deficits point to the experience of limited or absent self-care capacity, and to nursing approaches that address the deficits.

Theory of self-care of chronic illness

The authors of the theory of self-care of chronic illness define self-care similarly to the concept of self-efficacy, but focus on the complexity of self-care as a process of maintaining health through health promoting practices and managing illness. They describe each of the three elements of self-care as follows:

Self-care maintenance, performed in healthy and illness states, involves all those behaviors used to keep oneself healthy – getting a good night sleep, taking prescribed medication, exercise, etc. Self-care monitoring is a process of routine, vigilant body monitoring, surveillance, or “body listening”. Self-care management involves an evaluation of changes in physical and emotional signs and symptoms to determine if action is needed. These changes may be due to illness, treatment, or the environment.

Theory of Power as Knowing Participation in Change

Barrett’s conceptualization of power as knowing participation in change brings to the fore the understanding that a person’s power – their capacity for action (which could be conceptualized as similar to self-efficacy) is grounded in the reality of what choices are actually available, and the person’s freedom to select any of the available choices. This theory focuses on power-as-freedom, in sharp contrast to power-as- control. Power-as-freedom comes from and is associated with participating knowingly in life changes. Here nursing actions are not as specifically conceptualized as in the self-care theories above; rather, Barrett’s theory turns our gaze more clearly on possibilities for action by expanding available choices, and a person’s freedom to make those choices.

These summaries certainly show both the complexities and the limitations of theory. While each theory opens possible understandings, no one theory is sufficient. But the theories of our own discipline bring us closer to the social mandate that we carry as nurses, and to our stated aim to promote health and well-bing. Our challenge as nursologists is to renew our dedication to our own discipline, and ground our work in the foundations of our discipline.

Why does it matter that we concern ourselves with the nursing actions called forth in the face of self-efficacy challenges? Would it be sufficient for us to use our advocacy skills and call in a psychologist to intervene – which we might do if we observed a person who is hallucinating? Or might we consider calling in an educator – which we might do if we determine that a person is not able to read the guidelines required to manage their diabetic symptoms? I suspect many nurses who are on the alert for self-efficacy challenges in their practice would acknowledge the value of these advocacy approaches, and they would also argue that we have disciplinary tools related to self-efficacy challenges that can be used to improve the person’s ability to achieve health and well-being. I also suspect that nurse researchers and quality assurance administrators would argue that they have questions that need to be explored in order to improve nursing actions to enhance a person’s belief in their capacity to manage their health challenges. In other words, the question goes beyond the self-efficacy variable to focus on nursing approaches that move in the direction of health and well-being.

If a research project relies only on a theory that is derived from another disciplinary perspective, it falls short of what we need as a discipline going forward. As a collective discipline, we need well designed research that is grounded in the focus of the discipline – the caring actions we put in place in response to health challenges.

My recommendation is to create a multi-theory framework in which to ground one’s own nursing care. Bandura’s theory, for example, could be included in a multi-theory framework to provide insight that defines a human capacity. But alone it is insufficient for the scholarship of our discipline. A framework that includes one or more nursing theory can point toward possible nursing approaches and ground the work in the central concerns of our own discipline. The possibilities for ongoing development of theory to inform and expand our perspective of human experience are endless! If you are a nurse engaging in nursing practice or scholarship, I invite you to take a deep dive into the wonderful world of nursing theory and ground your work where it belongs!