Running Head: HOW CAN I THINK DIFFERENTLY?

How Can I Think Differently?

Nursing Theories Applied to Practice Scenario
Roscel Stephanie Yap Ferrer
Athabasca University
HOW CAN I THINK DIFFERENTLY? 2

Abstract
Nursing theories guide nursing practice in improving nursing care by allowing nurses to

communicate what they do for their clients and provide rationale for their actions (Ahtisham and

Quennell, 2019). The utilization of both classic and contemporary nursing theories in practice is

significant in collecting useful information that can be applied in everyday nursing care. As a

nurse practicing in women’s health, I have selected Virginia Henderson’s Need Theory and Afaf

Meleis’ Transition Theory in describing my actions as the nurse in a scenario to be discussed in

this paper. The concepts, application, strengths and limitations of both theories will be compared

and contrasted. Identifying the similarities and differences of these nursing theories further

strengthen critical thinking, strategies of approach and care design amongst nurses, therefore,

improving client outcomes.

Keywords: nursing, theories, practice, concept, outcomes

HOW CAN I THINK DIFFERENTLY? 3

How Can I Think Differently? Nursing Theories Applied to Practice Scenario

Several nursing theories have influenced my practice and have helped improved client

outcomes. The two main nursing theories that highlights my area of practice are Virginia

Henderson’s Need Theory and Afaf Meleis’ Transition Theory of Nursing. Utilizing both

theories, this paper is based on a scenario that is common in my workplace and has helped me

develop the most effective care strategies I use in my practice. T. L. is 34 years old and is 37

weeks pregnant with her first baby. She is scheduled to undergo a caesarean section due to

breech presentation. She was placed under spinal anesthesia but still recognizes sensation during

multiple pinprick and cold tests. She was then converted to general anesthesia intubated.

Concepts and Key Elements

Similarities

In Henderson’s and Meleis’ theories, the goal is for clients to undergo a healthy process

of achieving positive health outcomes (Im, 2014; see also Ahtisham & Jacoline, 2015). To

achieve this, T. L. requires thorough perioperative and post-operative care including assessment

and management of pain and postpartum hemorrhage.

Virginia Henderson’s Need Theory “focuses on the importance of increasing the patient’s

independence to hasten their progress in the hospital. Henderson’s theory emphasizes on the

basic human needs and how nurses can assist in meeting those needs” (Gonzalo, 2019, p.1). Two

of the Need Theory’s fundamental needs that are noted in childbirth are: (a) Communicate with

others in expressing emotions, needs, fears, or opinions and (b) Work in such a way that there is

a sense of accomplishment (Ahtisham & Jacoline, 2015). These are related to the Transition

Theory’s concept that developmental changes such as childbirth may trigger emotions and fears

that need to be communicated to caregivers (Meleis, 2015). In facilitating a sense of

HOW CAN I THINK DIFFERENTLY? 4

accomplishment, assisting T. L. with tasks like proper bathing is an example. The Transition

Theory’s seeking and receiving support as a pattern of response and the Need Theory’s basic

need of learning to use health resources inspire me in providing information on discharge

instructions, lactation support and family support programs. Meleis’ Transition Theory

illustration (2015) is available to be viewed in my presentation as a separate attachment (Ferrer,

2020).

Differences

The Need Theory focuses on the individual’s physiological and psychological needs

while the Transition Theory integrates conditions in the community and society that exacerbate

or improve transition responses (Johnston & Webber, 2005; see also University of Pennsylvania,

n.d.). According to the Transition Theory, care is provided before, during and after the transition

experience (Meleis, 2015). I combine both concepts in ensuring that T. L’s basic needs are

satisfied in the hospital including normal breathing patterns, elimination of body wastes and

adequate sleep and rest. Care is then extended by educating T. L. of what to expect during

postpartum home visits after discharge.

Application to Practice

Similarities

The application of the nursing process particularly assessment, setting of goals,

intervention and evaluation is significant according to the Need and Transition Theories

(Johnston & Webber, 2005; see also Meleis, 2015). The care T. L. receives also implies the use

of research to inform my nursing practice and promote healthy transitions. Use of journal articles

appropriate for her situation, provision of postpartum care information sheets and consultation of

policy procedure manuals promote application of research.

HOW CAN I THINK DIFFERENTLY? 5

Differences

The Need Theory has been very influential for decades. Mariner Tomey (1994)

emphasizes Henderson’s argument that the role and function of the nurse must be the foreground

of nursing education. Virginia Henderson published the Basic Principles of Nursing Care in

1960 and has successfully guided nursing education and practice through the years (Johnston,

2005). As the circulating nurse in the scenario, my application of a disposable warming unit

during and after surgery is an example of an intervention based on Henderson’s concept of

maintaining body temperature as a fundamental need.

On the other hand, Meleis’ Transition Theory continues to evolve in advancing nursing

practice (Im, 2014). This theory is used in education to examine the effectiveness of the nurse-

client relationship (Meleis, 2015). In the scenario, I consider developing rapport with T. L. and

her family to increase their trust in the health care system. The care and education I provide

become easily received by the client by doing so. In Meleis’ Women’s Health and the World’s

Cities (2011), for example, Mwangangi (2011) writes: “Health education can improve women’s

perception of the benefits of the health-care system” (p. 234).

Strengths and Limitations

Virginia Henderson’s Need Theory

Strengths. Johnston and Webber (2005) acknowledge the concepts of Henderson as

having a strong definition of nurses’ role boundaries. For example, I am responsible for the

nursing interventions provided to T. L. with guidance from doctor’s orders.

HOW CAN I THINK DIFFERENTLY? 6

The Need Theory is “stable, uncomplicated and self-explanatory” (Kaur, 2014, slide 27).

Due to the above characteristics, there are14 Fundamental Needs diagrams available that I can

share to T. L. for educational purposes.

Limitations. Johnston and Webber (2015) cited the discussion of George (1995) of the

Need Theory’s limitation of not being able to “explore the holistic nature of being a person” (p.

200). This theory is then only applicable during T. L.’s hospital stay in ensuring that her

immediate physiological and psychological needs are met.

Afaf Meleis’ Transition Theory

Strengths. The research studies on this theory have been conducted in diverse groups

undergoing several types of transitions (Im, 2014). Concepts have been applied to the

formulation of situation-specific transition theories. Valuable research has been done on

women’s health making it more relevant to T. L.’s care. It helps me to better understand T. L.’s

first childbirth experience by identifying the triggers, conditions, interventions and pattern of

responses surrounding the transition.

Limitations. Meleis, et al. (2000) recognize that “transitions theory is an emerging

framework that needs to be further developed, tested, and refined” (as cited in Im, 2014, p. 273).

In my area of practice, I find it beneficial to see further studies done on women’s health across

different cultures as well. The Need Theory has been around for so long that a many evidence-

based studies have been done in relation to it.

Conclusion
HOW CAN I THINK DIFFERENTLY? 7

The Need and Transitions Theories have supported my critical thinking and decision-

making approach to T. L.’s scenario. The concepts and key elements of each theory reinforce T.

L.’s goals of an uneventful recovery from a cesarean section with general anesthesia and

successful assumption of her role as a new mother. The use of nursing process in effective

postpartum management is suggested by both theories. The combination of both theories’

contribution to education and research provides guidelines to the roles of nurses in client care,

their relationship to the client and the benefits of the support that can be acquired through their

families and communities. The strengths of these theories have substantiated their benefits in

supporting the plan of care for T. L. Fortunately, their limitations vary making it easier to fill the

gaps of each theory respectively.

References

Ahtisham, Y. & Jacoline, S. (2015). Integrating nursing theory and process into practice;

Virginia’s Henderson need theory. International Journal of Caring Sciences, 8(2),

443-450. Retrieved from http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?

vid=4&sid=e711a60a-26cc-408c-9beb-759e891669ff%40pdc-v-sessmgr04

Ahtisham, Y. & Quennell, S. (2019). Usefulness of nursing-theory guided practice:

An integrative review. Scandinavian Journal of Caring Sciences, 33(3), 540-555.

Retrieved from http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?

vid=2&sid=e711a60a-26cc-408c-9beb-759e891669ff%40pdc-v-sessmgr04

Ferrer, R. S. Y. (2020). Afaf I.Meleis transition theory of nursing and expertise in women’s

health [Powerpoint slides]. See separate attachment.

Gonzalo, A. (2019). Virginia Henderson: Nursing need theory. Retrieved from

HOW CAN I THINK DIFFERENTLY? 8

https://nurseslabs.com/virginia-hendersons-need-theory/#:~:text=Henderson%20states

%20that%20individuals%20have,maintaining%20physiological%20and%20emotional

%20balance.

Im, E. (2014). Theory of transitions. In Smith, M. J. & Liehr, P. R. (Eds.), Middle range theory

for nursing (pp. 253-276). Retrieved from

http://eds.b.ebscohost.com/eds/ebookviewer/ebook/bmxlYmtfXzU4MTQ5OV9fQU41?

sid=ba35eeb1-bdab-443d-86c4-2aa0577d4cdb@pdc-v-

sessmgr03&vid=3&format=EB&rid=3

Johnston, B. M. & Webber, P. B. (2005). In Duffy, T., Donnell, A. & Snowden, A. (Eds.),

Pioneering theories in nursing (pp. 189-205). Retrieved from

http://eds.b.ebscohost.com/eds/ebookviewer/ebook/bmxlYmtfXzg0NjEzNV9fQU41?

sid=65a69f3d-318e-4afc-8c3c-d216ea67fcb0@pdc-v-

sessmgr06&vid=2&format=EB&rid=1

Kaur, M. (2014). Class presentation on Virginia Henderson’s nursing theory [Powerpoint

slides]. Retrieved from https://www.slideshare.net/MandeepGill1/virginia-hendersons-

theory-of-nursing

Meleis, A. I. (2015). Transitions theory. In Smith, M. C. & Parker, M. E. (Eds.), 

Nursing theories and nursing practice (pp. 361-380). Retrieved from

http://docshare03.docshare.tips/files/26827/268274013.pdf

Mwangangi, F. M. (2011). Accessibility to health care in urban environments. In Meleis, A.,

HOW CAN I THINK DIFFERENTLY? 9

Birch, E. L.& Wachter, S. M. (Eds.), Women’s health and the world’s cities (pp. 229-

239). Retrieved from https://0-ebookcentral-proquest-

com.aupac.lib.athabascau.ca/lib/athabasca-ebooks/reader.action?docID=3441959

University of Pennsylvania. (n.d.). Transitions theory [PDF file]. Retrieved from

https://www.nursing.upenn.edu/live/files/552-transitions-theory