Book Review: Nursing Theory: Utilization & Application

In my experience, nursing students enroll in graduate level programs with grand ideas of becoming more autonomous and more highly respected for their talents. Few students seem to come to graduate education looking to stretch their minds with visions of nursing theory. As an instructor in graduate level theory, I am sometimes amazed by the response that I get from new graduate students when asked to disclose their personal framework for nursing. This happens to be one of the first graduate level assignments that many students encounter. How different would the student response be if we asked them to look back on this personal framework after studying nursing theory throughout the curriculum? With the advent of Doctorate of Nursing Practice (DNP) programs, theory becomes even more important and serves to guide their education and capstone projects. In today’s world of nursing research, evidence-based practice, and advanced roles, it is vital that nurses have an understanding of nursing theory and how theory guides research and practice. Alligood’s fourth edition Nursing Theory Utilization & Application is a text for our time in nursing: going beyond the explanation of nursing theory to the ethical underpinnings of nursing theory and ultimately to help students and nurses actually use theory to undergird their practice on all levels.

Chapter 4 of this text is one that is very interesting from both the educator’s and the bedside nurse’s perspectives. As I read this chapter, I was somewhat overwhelmed by the idea that nurses at the bedside providing direct care could possibly employ a nursing theory so consistently and correctly as to meet all moral obligations of that theory. At the end of the chapter the author addressed this point in discussing the hardship of subscribing totally to a nursing theory while working in less than ideal conditions. The literature is filled with studies explicating the nature of the workplace for nurses. With the economic downturn well into the pockets of many healthcare organizations, nurses find themselves working in situations where they can hardly do the basic tasks of caring for the acutely ill patients assigned to them. How is it that nurses must also have to consider the moral obligations of practice directed by a specific nursing theory? The author of this chapter, Pamela Grace, acknowledged this issue stating “it is pointless to urge actions facilitative of health for individuals . . .if conditions are such that what is postulated as necessary cannot possibly be accomplished” (p. 91). The content of this chapter does provide clear links between a nurse’s personal belief system, nursing theory, and nursing practice. As most nurses work for healthcare institutions, information regarding the nurses search for a fit between their framework for practice and the institution’s stated framework is certainly important especially to student nurses or graduate students who will be making their way into the workforce. Understanding how to work within frameworks established as the institution’s policy is valuable. Also the idea that some healthcare facilities may have a framework that is non-functional is interesting and allows graduates the possibility of forging a new path within the institution. Moral obligations implied within nursing theories seem to be a topic that has not been well developed, therefore, this chapter of the reviewed text is a welcomed insight. Added to the content of this chapter are examples that provide further explanation and assist the student in the utilization and application of nursing theory with regard to ethics or moral obligations.

It is stated in this text that nursing is in the era of theory utilization. One area specifically noted in this text is the utilization of theory to guide nursing research. A quick literature search revealed multiple studies using nursing theory as a basis for research. The theories of Roy, Rogers, Orem, and Parse were readily used as foundations to nursing research concerning multiple populations and problems. Roy’s adaptation model is evaluated as a framework for assisting nurses to understand posttraumatic stress disorder (Nayback, 2009). Rogers’ science of unitary human beings is used in an oncology case study to guide the nurses caring for a breast cancer patient through treatment and survivorship (Farren, 2009). Wu and Volker (2009) concluded that theory should be incorporated into qualitative research. An example of theory integration in seen in a qualitative study concerning the meaning of health in older women was viewed through a Rogerian lens (Shearer, Fleury, & Reed, 2009). Multiple qualitative inquiries studying concepts such as risk-taking (Bunkers, 2009) and the lived experiences of feeling unsure (Morrow, 2010) and misunderstood (Condon, 2010) used Parse’s theory of humanbecoming as a guiding foundation. These are just a few of the many examples found in recent literature. As we prepare graduate students to be well-versed in research findings and to participate in developing and implementing research projects, utilization of nursing theory as a basis for nursing research, and as a lens through which findings may be viewed should be taught.

As a result of using nursing theory as the foundation for research, nurses should be prepared for the theory utilization era as evidenced-based practice has become the standard. This text’s primary focus is leading the student or nurse to use nursing theory to guide practice. Within each chapter concerning a specific theory, the author provided case histories along with narrative plans of care that linked the theory to practice situations. These examples will help students to link the theories to their own nursing practice as they see similar situations arise. Students could also use these scenarios and care plans to further evaluate whether or not the theory is one that they would use to guide their practice. Nurses are often more concrete in their thought process and these case studies will assist them in understanding how they can apply the theory to practice. Another portion of the chapter is on critical thinking exercises. These questions at the end of each chapter provide students with opportunities to expand their ability to critically think about situations from a theoretical perspective. Together the case histories, care planning, and critical thinking exercises provide students with tools to survive in the theory utilization era of nursing practice.

In conclusion, although many students just beginning graduate level nursing work would not look forward to this book as a text they would enjoy, I certainly think that after study they would find the book incredibly useful. The book is divided primarily by theorist making it a straightforward reference to find specific information. It also provides an interesting outlook on ethics within the use of nursing theory to guide practice. The book is written to assist the student or nurse in the utilization and application of nursing theory and provides tools to ensure the goal is met.