Theoretical Foundations of Nursing

HISTORY
 began its development with Discipline vs Profession
Nightingales “Notes on Nursing”
DISCIPLINE PROFESSION
 second half of the 20th century –
specific to academia refers to specialized
transition from vocation to profession
and refers to branch field of practice
 nursing as a profession evolved in
of education ( a founded on the
different eras department of theoretical structure
learning or domain of of the science and
ERAS OF NURSING KNOWLEDGE knowledge) knowledge of a
discipline and
accompanying skills
Curriculum Era (1900-1940)
• emphasizes on courses included in
nursing programs
THEORY
• goal is to develop specialized
knowledge • organized system of accepted
and higher education knowledge that is composed of
Research Era (1950-1970) concepts, propositions, definitions and
• emphasize role of nurses and what to assumptions intended to explain a set
research of fact, event or phenomena
Graduate Education Era (1950-1970) • “A creative and RIGOROUS structuring
• emphasis is advanced role and basis for of ideas that projects a tentative,
nursing practice purposeful and systemic view of
• focus graduate education on knowledge phenomena”. (Chinn and Kramer)
development • A” theory, by traditional definition, is an
Theory Era (1980-1990) organized, coherent set of concepts and
• emphasis is many ways to think about their relationship to each other that
nursing offers descriptions, explanations and
• goal is that theories guide nursing predictions about phenomena.” (Parker
research and practice (2001
Theory Utilization Era (21st Century)
• emphasis is on nursing theory as guide
to research, practice, education and REASONS to STUDY NURSING HEORY
administration
• guidance in values and beliefs as well as
• goal is for nursing framework to
ideas and techniques in nursing practice
produce knowledge (evidence for
• reframe thinking about nursing
quality of care)
• close the gap between theory and
research
IMPORTANCE
• envision potentials

• nursing was recognized as an academic

discipline and a profession
THEORY CLASSIFICATION of THEORY (According
to Function)

• “A theory is a supposition or system of

1. Descriptive - know the properties and
ideas that is proposed to explain a given
workings of a discipline
phenomenon”. (Kozier, 2008)
2. Explanatory - examine how properties
• “It is an abstract statement formulated
relate and thus affect the discipline
to predict, explain or describe the
3. Predictive - calculate relationships
relationships among concepts,
between properties and they occur
constructs or events. It is tested by
4. Prescriptive - identify under which
observation and research using factual
conditions relationships occur
data.” (Mosby, 2006)
• “A theory is a set of concepts, DESCRIPTIVE
definitions, relationships and
assumptions that project a systematic • known to be the primary level of theory
view of phenomena.” (Potter, 2004) development.
• identify and describe major concepts of
CHARACTERISTICS of THEORY phenomena but they do not explain the
relationship of the concepts
• logical in nature • main purpose is to present a
• simple but generally broad phenomenon based on the five senses
• source of hypothesis that can be tested together with their corresponding
or elaborated meaning
• contribute in enriching the general • Example: A descriptive research about
body of knowledge through the studies the Filipino nursing practices like use of
implemented to validate them herbal medicines and other alternative
• used by practitioners to direct and forms of treatment.
enhance their, and principles practice
• must be consistent with other validated EXPLANATORY
theories, laws, and principles but will
• the type of theory that present
leave open unanswered issues that
relationship among concepts and
need to be tested.
propositions
COMPONENTS OF A THEORY • aim to provide information on how or
why concepts are related
CONTEXT Resembles environment
• cause and effect relationship are well
to which nursing act
takes place explained
CONTENT Subject of the theory • Example: A research study about the
factors affecting newborns in failing to
PROCESS Method by which nurse thrive.
acts in nursing theory
explaining, predicting, or prescribing
PREDICTIVE nursing care (Meleis ,1991)
PURPOSE/S:
• achieved when the relationships of
concepts under a certain condition are Education
able to describe future outcomes • establish nursing as a profession
consistently Research
• generated and tested using • identifies the philosophical assumptions
experimental research or theoretical framework
• Example: A Theoretical model based on Practice
the observation of the effects of • facilitate reflection, questioning and
unsanitary environmental condition on thinking
the recovery of the post-operative -guides nursing practice and generates
patients. knowledge
-helps to describe or explain nursing
PRESCRIPTIVE (Situation-Producing) -enables nurses to know WHY they are doing
WHAT they are doing

• deal with nursing actions, and test the

HOW NURSES USE THEORY in
validity and certainty of a specific
PRACTICE
nursing intervention
• organizing patient data
• commonly used in testing new nursing
• understanding patient data
interventions
• analyzing patient data
• Example: Laurente’s (1996) theory
• decision and interventions
validates and explains the different
• plan patient care
nursing management in the emergency
• predict outcomes of care
room in relieving anxiety among its
• evaluate patient outcome
clients post-operative patients.
ASSUMPTIONS
NURSING THEORY
• Is a statement that specifies the
 a group of interrelated concepts that relationship or connection of factual
are developed from various studies of concepts or phenomena
disciplines and related experiences • Act of faith in which it does not have an
 aims to view the essence of nursing empirical evidence of support
care • Example:
 a complete nursing theory is one that - It is assumed that the theory of
has context, content and process Leininger supports theory of Roy’s Adaptation
(Barnum, 1994) Model
 articulated and communicated
conceptualization of invented or PHENOMENA/PHENOMENON
discovered reality (central phenomena
and relationships) in or pertaining to • aspects of reality that can be
nursing for the purpose of describing, consciously sensed or experienced
• sets of empirical data or experiences • directly observable objects, events or
that can be physically observed or properties, which can be seen, felt or
tangible such as crying or grimacing heard
when in pain • e.g. color of the skin, communication
• concerned with how an individual skill, presence of lesion, wound status
person reacts using the human senses etc.
concerning their surrounding and • are limited by time and space (it can be
assessing the different behaviors and viewed/ measured only specific period
factors that affect such behaviors and specific setting and variables.
Nursing, phenomena can be: 2. INFERENTIAL CONCEPTS
• are indirectly observable concepts
• Clinical or environmental setting of
• e.g. pain, dyspnea and temperature.
nurses – health center
3. ABSTRACT CONCEPTS
• Disease process – stomach ulcer
• concepts are not clearly
• Client’s behavior – guarding behavior at
observable directly or indirectly (known
the pain site
as “directly non-observable concepts”)
• Interventions – care of the client in pain
• Unaffected by time and space
• Practices that are utilized in nursing
• e.g. social support, personal role, self-
theories and metaparadigms (person,
esteem, etc.
nursing, health and environment)

CONCEPT

• an idea formulated by the mind or an

experience perceived and observed

such as justice, love, war, and disease • composed of various descriptions which
convey a general meaning and reduces
• Concept is an idea of an object. the vagueness in understanding a set of
• Concepts are basically vehicles of concepts
thought involving mental images. • OPERATIONAL DEFINITION – meaning
• In Nursing, concepts have been of a word based on how it was
borrowed from other discipline measured on or used (e.g. – significance
(adaptation, culture, homeostasis) as of pain and intervention)
well as developed directly from nursing
practice and research (maternal-infant
bonding, health-promoting behaviors)
• Concepts are building blocks of theory.

TYPES of CONCEPT

1. EMPIRICAL OR CONCRETE CONCEPTS

CONCEPTUAL VS OPERATIONAL
DEFINITION • theoretical works that address one or
more metaparadigm concepts (person,
CONCEPTUAL OPERATIONAL
environment, health and nursing)
definition from a how the concept is
literature such as a being used • address questions about the following
dictionary, stated by Alligood (2005):
encyclopedia, and
journal  nursing
Example 1: Hospital Stay  nature of human caring
time during which a total of days as a  nature of nursing practice
person is a registered patient, beginning with  social purpose of nursing
patient in a certain admission day and practice
hospital finishing with discharge
CONCEPTUAL MODELS OF NURSING
Example 2: Ambulation (PARADIGMS/FRAMEWORKS)
to walk from one taking 6 steps without
place to another or assistance • composed of abstract and general
to move about concepts and propositions that provide
a frame of reference for members for
PROPOSITION the discipline

- Explains the relationships of different • frame – determines how it is viewed by

concepts members

Example: CONCEPTUAL MODEL – set of concepts and

statements that integrate the concepts into
“An increase in student intelligence meaningful configuration
causes an increase in their academic
achievement.” This declarative statement does • are representations of an idea or body
not have to be true, but must be empirically of knowledge based on the own
testable using data, so that we can judge understanding or perception of a
whether it is true or false. person or researcher on a certain topic,
phenomena or theory.
STRUCTURAL LEVEL OF NURSING • can be represented thru a diagram or in
KNOWLEDGE: narrative form which shows how
concepts are interrelated
 Philosophies
 Conceptual Models
 Theories CONCEPTUAL MODELS
 Middle Range Theories
 Nursing Theories and Grand Theories

PHILOSOPHIES
THEORETICAL MODELS • typically stem from a nurse theorist's
own experience
Nursing Philosophies
• highly established set of concepts that
are testable. The following is a
• Nightingale
theoretical framework as proposed by
• Watson
Lydia Hall
• Roy
• Benner
• Martinsen
• Erikson

Nursing Conceptual Model

• Levine
• Rogers
• Orem
• King
• Neuman
• Roy
• Johnson
CONCEPTUAL VS THEORETICAL
Nursing Theories and Grand Theories
CONCEPTUAL THEORETICAL
• Boykin and Schoenhoefer
a structure of concepts It is a structure of
or theories which are concepts which exist • Meleis
pulled together as a or tested in the • Pender
map for the study literature, a ready- • Leininger
made map for the • Newman
study. • Parse
• Erickson, Tomlin and Swain
• Husted and Husted
MIDDLE RANGE THEORY
Middle-Range Nursing Theories
 theories that include fewer concepts
and propositions that represent a
limited or atrial view of nursing reality • Mercer
• Mischel
GRAND THEORY • Reed
• Wisner and Dodd
 are based on broad, abstract, and • Eakes, Burke and Hainsworth
complex concepts • Barker
• provide the general framework for • Kolcaba
nursing ideas pertaining to components • Beck
such as people and health • Swanson
• Ruland and Moore
Accessibility – (empirical precision) addresses
the extent to which indicators can be identified
METAPARADIGM and what extent the purpose can be attained;
how accessible is it
• most global conceptual or philosophical -Importance
framework of a discipline or profession
Importance – (derivable consequences)
• basis of Conceptual models and
answers the question: Does this create
theories in nursing
understanding that is important to nursing?
• defines and describes relationships
among major ideas and values
• guides the organization of theories and
models for a profession HISTORY OF NURSING THEORY
• (metaparadigms Greek “meta” – with Florence Nightingale is founded the
and paradeigma – pattern): history of professional nursing. In her
"Environmental Theory," Florence Nightingale
NURSING METAPARADIGM described nursing as "the act of utilizing the
• patterns or models used to show a clear patient's environment to support him in his
relationship among the existing recovery" in 1860.
theoretical works in nursing At a time when women either were
• are focused on relationships among educated or engaged in public service,
four major concepts: Nightingale envisioned nurses as a group of
educated women. After organizing and caring
1. Person – the recipient of nursing care like for the injured in Scutari during the Crimean
individuals, families and communities. War, Florence Nightingale saw the need for a
2. Environment – the external and internal school of nursing and established one at St.
aspects of life that influence the person. Thomas' Hospital in London, which marked the
beginning of modern nursing.
3.Health – the holistic level of wellness that the
person experiences. At the start of the twentieth century,
Nightingale's invention in nursing practice and
4.Nursing – the interventions of the nurse education and her following writings served as a
rendering care in support of, or in cooperation manual for the establishment of nursing schools
with the client. and hospitals in the United States.

Nightingale recognized the special focus

Analysis and Evaluation of Theoretical
of nursing in the middle of the 1800s and
Knowledge in Nursing
distinguished nursing knowledge from medical
Clarity – consistency in terms of terminology knowledge at that time. She stated that a
and structure; how clear it is nurse's primary role is to prepare the patient so
Simplicity – sufficient and comprehensive; how that nature or God can work on them. She
simple it is stated the following: "Knowledge of people is
Generality – scope, concepts and purpose; how the foundation for caring for the sick." a distinct
general is it knowledge base than that used by doctors in
their practice—and their surroundings
(Nightingale, 1859/1969). Despite this early ideas to explain the evidence is important for
instruction from Nightingale in the 1850s, the formulating a differential diagnosis.
nursing community didn't start to seriously
consider the necessity to build nursing
knowledge separate from medical knowledge to A METAPARADIGM is the point of view that
guide nursing practice until 100 years later, in characterizes a discipline's topic of study.
the 1950s.
PERSON
The necessity for developing nursing
theory became evident as a result of this - The first metaparadigm concept is person. The
beginning, and among nurse leaders, person is the specific patient that the nurse is
administrators, educators, and professionals caring for. The nursing client is an open system,
who pursued higher education, theory constantly changing in mutual process with the
development formed as a process and changing environment. The person can refer to
consequence of professional scholarship and not only the patient but also to the patient's
growth. These individuals worked to create a family and friends. Nursing has the ability to
scientific foundation for nursing management, nurture and empower the patient in the hopes
education, practice, and research because they that the patient will manage their own health to
realized the limits of theory from other the best of their ability. The person is the most
disciplines to describe, explain, or predict crucial concept in the nursing profession since
nursing outcomes. The growth and application there would be no profession without them.
of theory gave nursing procedures significance, ENVIRONMENT
resulting in the period now known as the
nursing theory era. - The term "environment" refers to one's
surroundings. The idea of an environment
should include both internal and external
components because the interaction between
RATIONALISM is the belief that reason is
these two factors has an impact on a person's
beneficial of knowledge or, more significantly,
health. Nightingale, a theorist, once mentioned
that reason is the only way to learn.
that the nurse's job is to "put the patient in the
- Example: Using nursing as an example, one best condition for nature to act upon him"
may claim that a lack of social support (cause) (Nightingale, 1992). When I was a child, I
will lead to hospital readmission (effect). Until it adored watching tv programs with hospital
is disproven, this logical reasoning is just a scenes. I would watch patients arrive from
theory. extremely unsanitary environments, their
health in danger, and once inside the hospital's
clean environment, it began to improve. The
EMPIRICISM holds that the fundamental combination of a clean environment and
means of acquiring knowledge is through the treatment is the cause of their improvements.
senses (and sense experiences). HEALTH
- Example: Formulating differential diagnoses is - The main factors that influence health can be
one of the best ways to show this kind of an inner and outer state of wellness, integrity,
reasoning in nursing. Creating a list of possible and wholeness as well as consideration of
illness and disease from both a personal and a
social and cultural point of view. The As a result, nurses must be aware from out
metaparadigm concept of health is strongly ideas and practices or they risk meeting the
connected with the metaparadigm of person same fate.
because the experience of health, or lack
HYPOTHESIS
thereof, is seen as a reflection of the whole
person. A person's overall wellness condition,
whether it be physical, mental, spiritual, or
emotional, is what I consider their health.
NURSING

- The study of human health and illness

processes is what I believe to be nursing.
Nursing is a profession that can improve a
person's health outcomes.

PHILOSOPHY

CONCEPTUAL METHOD

THEORY

- Nursing theory can help us establish our

professional objectives and give us a framework
for how we approach the nursing profession.
Nursing theory is a comprehensive investigation
into every aspect of anatomy and physiology,
making it crucial because this is where
interactions between care, medication, and
therapy occur. It aids in the definition of a
nurse's professional goals and forms the basis
for their career growth. It serves as a guidance
for nurses on how to order goals and
interventions.

ASSUMPTION

- Making decisions or taking the wrong steps in

nursing practice could be readily caused by false
assumptions. The effect of assumptions in
nursing is that they can result in the wrong
diagnosis, the wrong treatment, and can drive
people away from those we are trying to help.