Table of Contents
The philosophy of nursing has to begin with a prayer in memory of the famous Florence Nightingale whose rich heritage and writings made the profession an indispensable one in society (Kim and Kollak, 2006). Theories and philosophies are creative products of various nursing researchers. The theories which have been classified into philosophies, grand theories ad middle range theories facilitate the nursing practice; they have become experts in their field based on the theories. It is debatable whether the theories are mature enough or are rigorously developed; however, they have undoubtedly contributed to the guiding of nursing practice.
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Numerous theories are present, unique with assumptions, philosophies, values, perspectives and scope (Kim and Kollak, 2006). The diversity of nursing is addressed in the many theories. Faults have been found with the concept of precision, constituents and logic in structure. However, the perspectives are correctly assumed. Categorization of the theories is varied by different researchers (Kim and Kollak, 2006). Meleis found theories as having “systems, holistic, adaptation and behavioral orientations” (1996 cited in Kim and Kollak, 2006).
The grand theories of nursing include Roy’s adaptation model, Orem’s self-care model, Neuman’s systems framework, Parse’s human-becoming theory and Watson’s theory of human care. Initially, the grand theories were significant but recently the middle-range theories are gaining significance. The examples of middle-range theories are Engerbretson and Littletons’ theory of cultural negotiation (2001), Kelly’s commitment to health theory (2001), Leininger’s culture care theory and Kolkaba’s comfort theory (1992).
The transtheoretical model of behavior change of Prochaska and DiClemete was first developed when work was being done to motivate the cessation of smoking. Five stages of change are proposed in the theory (Prochaska and DiClemente, 1983). The stages are pre-contemplation, contemplation, preparation, action and maintenance.
Pre-contemplation is the stage where the patient has not even thought about changing (Prochaska and DiClemente, 1983). This is the stage he is first approached in. The next two stages find him thinking about it and then planning for change. Action begins when he has started the change of behavior. Maintenance begins when his behavior becomes permanent and the new behavior becomes a habit and gets incorporated into his daily routine (Prochaska and DiClemente, 1983). The decisional balance scale refers to the decision-making process by the patient where he weighs the pros and cons. When the pros are more, the change is evident. In the event of more cons, change does not take place or if it takes place, it gets quickly reverted. This is the strong and weak principle. The patient does not attain health. Self-efficacy and the processes of change are catalysts for behavior change (Prochaska and DiClemente, 1983).
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Kelly thought out the commitment to health theory after indicating a few negative points about the Transtheoretical Model (TTM). It could be applied to only one unhealthy behavior (Kelly, 2008). Biological, environmental and social issues are not addressed in the TTM. A difference is not observed about the people who do not make the change possible. Change is the aim of all health behavior interventions. Kelly chose the commitment-to-health theory, a middle-range theory which is taken from Prochaska and DiClemente’s Transtheoretical Model of Behavior change (1983). The promotion of health is the main theme. Health interventions include healthy eating, physical activity and abstinence from smoking (CDC, 1996). The possibility of behavior change between the action and the maintenance of change is predicted with this theory (Kelly, 2008)… Here “commitment is defined as a freely chosen internal resolve to perform health behaviors, even when encumbered or inconvenienced by difficulties” and “health as the optimal level of well-being” (Kelly, 2008). The more the commitment, the greater is the possibility for adoption of behavior change.
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