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The ongoing development of nursing knowledge is essential for advancing both nursing practice and research. Nursing grand theories, such as Orem’s Self-Care Deficit Theory and Roy’s Adaptation Model, have historically provided comprehensive frameworks for addressing complex patient needs across diverse clinical settings. These theories guide nursing practice by emphasizing the importance of holistic care, which integrates the physical, emotional, and psychological needs of patients. However, as the healthcare landscape evolves, the relevance of these grand theories in contemporary nursing practice has been called into question due to the shift toward evidence-based practice (EBP), which is more focused on actionable and measurable outcomes (Schultz et al., 2022).

             Supporters of the ongoing use and development of nursing grand theories argue that they provide an overarching structure for understanding the complexity of human health and behavior. For example, Roy’s Adaptation Model has been applied to a wide range of healthcare settings to guide nurses in assessing patients’ ability to adapt to illness and other health challenges (Roy et al., 2021). Recent evidence shows that the use of grand theories can lead to improved outcomes in nursing practice. In a study by Zhang et al. (2021), the application of Roy’s Adaptation Model in the care of elderly patients in long-term care facilities enhanced patient satisfaction, improved care coordination, and led to better health outcomes. This indicates that grand theories still offer valuable guidance in certain contexts, particularly when addressing holistic patient care.

              Despite this, critics argue that the abstract nature of grand theories makes them difficult to implement in today’s highly specialized and dynamic clinical environments. With the increasing reliance on technology and data-driven approaches in modern healthcare, nurses are often expected to apply evidence-based guidelines that provide specific, targeted interventions for particular conditions. For example, clinical practice guidelines for diabetes management and wound care are evidence-based and grounded in research, providing nurses with concrete tools for improving patient outcomes (Melnyk et al., 2020). Studies have shown that evidence-based practices lead to more effective, measurable patient outcomes compared to theoretical models alone (Fitzpatrick & Wallace, 2020).

         Furthermore, the shift toward EBP is supported by research that emphasizes the need for clinical decisions to be based on the best available evidence rather than abstract theories. Melnyk et al. (2020) found that EBP improves nursing care by reducing complications, decreasing healthcare costs, and enhancing overall patient outcomes. This research highlights the importance of a practical, evidence-driven approach to nursing care, which often contrasts with the broad, generalized nature of grand theories.

              In conclusion, while nursing grand theories have historically contributed to the development of nursing knowledge, the growing emphasis on evidence-based practice suggests that these theories must evolve or be complemented by more specific, evidence-driven approaches. Nurses should continue to integrate grand theories into their practice where applicable, but also embrace evidence-based practices to ensure that patient care is both effective and measurable in today’s fast-paced healthcare environment.

References:

Fitzpatrick, J. J., & Wallace, M. (2020). Nursing theories and nursing practice: An exploration of evidence-based applications. Journal of Nursing Education and Practice, 10(7), 85-93. https://doi.org/10.5430/jnep.v10n7p85

Melnyk, B. M., et al. (2020). Evidence-based practice in nursing and healthcare: A guide to best practice. Wolters Kluwer. https://shop.lww.com/evidence-based-practice-in-nursing-healthcare/p/9781975185725?srsltid=AfmBOorgWDRWOYJaWdiNaRm0GSt9iBfMCWs4-U1du6rOcgraid67kvF1

 Roy, C., et al. (2021). The Roy Adaptation Model: A framework for patient-centered care. Nursing Science Quarterly, 34(3), 261-269. https://doi.org/10.1177/08943184211002917

 Schultz, D., et al. (2022). The evolution of nursing theories and the role of evidence-based practice. Journal of Clinical Nursing, 31(11-12), 1237-1244. https://doi.org/10.1111/jon.16135

 Zhang, X., et al. (2021). Application of Roy’s Adaptation Model to improve outcomes in elderly long-term care patients. Geriatric Nursing, 42(1), 87-92. https://doi.org/10.1016/j.gerinurse.2020.08.008