THEORETICAL

FOUNDATION
IN NURSING
“THE JOURNEY OF A
THOUSAND MILES BEGINS
WITH A SINGLE STEP.”
LAO TZU
OBJECTIVES
At the end of the session, the learner will be
able to:
 Define Nursing Theory

 Identify the characteristics of Theory

 Demonstrate understanding on Concept,

Theory and Conceptual Framework
 Identify the 4 Essential concepts common
among Nursing Theories
 Discuss the purposes of nursing theory
NURSING THEORY
 Setof interrelated concepts that
attempts to describe/ explain the
phenomenon of nursing
CHARACTERISTICS OF THEORY
 Confirmed and became a fact
 Modified by research finding
 Developed to prepare or improve an
existing theory
DEFINITION OF CONCEPT,
THEORY AND CONCEPTUAL
FRAMEWORK
What is a
Concept?
CONCEPTS
 It
is an abstract notion or vehicle of
thoughts that involve images/word
picture

 Anabstract idea or mental image of

phenomena or reality, or a symbolic
representation of the abstract ideas
CONCEPTS

 Conceptsare able to morph and

change as the body of scientific
knowledge continues to grow
What is a
THEORY
THEORY
 Set of interrelated concepts, definitions
and propositions that present a
systematic way of viewing events or
patterns of reality
 Based on observed facts
THEORY
Aset of interpretative assumptions,
principles, or propositions that help
explain or guide action (Young, Taylor,
& Renpenning, 2001)

Akey component of a theory is that it

must be able to be tested, proved or
disproved.
CONCEPTUAL FRAMEWORK
 A group of concepts that follows an
understandable pattern

 Concepts can be thought as the individual bricks

and boards used to build a house; with the
Conceptual Framework being the blueprint that
specifies where each brick or board should go
CONCEPTUAL FRAMEWORK

 Provides an overview of the thinking

behind the theory and may demonstrate
how theory can be introduced into
practice.
WHAT IS A PRINCIPLE?
 An accepted or
professed rule of
action or conduct.
 A comprehensive
and fundamental
law, doctrine, or
assumption.
PURPOSE OF NURSING THEORY
 Defines and
enriches the practice
of nursing.
 It focuses on issues
essential to
providing care.
 It implies criteria
with which to
evaluate what
nurses do.
PURPOSE OF NURSING THEORY
 “Attempts to describe or
explain the phenomenon
(process, occurrence or event)
called nursing. “ Barnum
(1998)
 Provide a broad structure for
interpreting and using data
CHARACTERISTICS OF A USEFUL THEORY
ROBERT T. CROYLE (2005)

1. Logical
2. Consistent with everyday
observations
3. Similar to those used in previous
successful programs and
4. Supported by past research in the
same area or related ideas.
THE IMPORTANCE OF THEORY IN
NURSING

 Offers structure and organization to

nursing knowledge and provides a
systematic means of collecting data to
describe, explain, and predict nursing
practice.
THE IMPORTANCE OF THEORY IN
NURSING

 It promotes rational and systematic

practice by challenging and validating
intuition.
 In makes nursing practice more
overtly purposeful by stating not only
the focus of practice, but specific goals
and outcomes.
THE IMPORTANCE OF THEORY IN
NURSING

 It defines and clarify nursing and the

purpose of nursing practice to
distinguish it from other caring
professions by setting professional
boundaries.
 Use of a theory of nursing leads to
coordinated and less fragmented care.
(Alligood & Tomey, 2002; Chinn & Kramer, 2004; McKenna,
1993)
PURPOSES OF NURSING THEORIES
IN PRACTICE

 Assist nurses to describe,

explain, and predict
everyday experiences.
 Serve to guide
assessment,
interventions, and
evaluation of nursing
care.
 Help to describe criteria
to measure the quality of
nursing care
PURPOSES OF NURSING
THEORIES IN PRACTICE
 Help build a common
terminology to use in
communicating with
other health
professionals.
 Enhance autonomy of
nursing through
defining its own
independent
functions.
PURPOSES OF NURSING
THEORIES IN EDUCATION
 Provide a general
focus for
curriculum design
 Guide curricular
decision making.
PURPOSES OF NURSING
THEORIES IN RESEARCH
o Offer a framework
for generating
knowledge and new
ideas
o Assist in discovering
knowledge gaps in
the specific field of
study.
NURSING PHILOSOPHY
Love and pursuit of wisdom….
 DEFINITION
Philosophy is defined as follows:
• Love and pursuit of wisdom by intellectual means
and moral self-discipline.
• Investigation of the nature, causes, or principles
of reality, knowledge, or values, based on logical
reasoning rather than empirical methods.
• Statement of believes and values about human
beings and their world.
 NURSING PHILOSOPHY

• “a statement of foundational and universal

assumptions, believes and principles about the
nature of knowledge and thought and about
the nature of the entities represented in the
metaparadigm. (Reed, 1995)
 Nursing Theory & Philosophies
Theory Philosophy
Florence Nightingale’s Focuses on nursing and the patient
Legacy of caring environment relationship.
Virginia Henderson’s Patients require help towards
Definition of Nursing achieving independence.

Caring is a universal, social

phenomenon that is only effective
Jean Watson’s Philosophy
when practiced interpersonally
and Science of caring considering humanistic aspects and
caring.
APPROCHES TO NURSING
THEORIES
General System Theory –

It describes how to break whole things into

parts & then to learn how the parts work
together in “systems”. Eg: Molecules in
chemistry, cultures in sociology, and organs in
Anatomy & Health in Nursing.
Adaptation Theory –
It defines adaptation as the adjustment of living
matter to other living things & to
environmental conditions. Adaptation is a
continuously occurring process that effects
change &involves interaction & response.

Human adaptation occurs on three levels

The internal (self) , The social (others) & The
physical (biochemical reactions)
Developmental Theory –
It outlines the process of growth & development
of humans as orderly & predictable, beginning
with conception & ending with death.

The progress & behaviors of an individual within

each stage are unique.
CLASSIFICATION OF NURSING
THEORIES
 Depending On Function
• Descriptive
To identify the properties and workings of a discipline
• Explanatory
To examine how properties relate and thus affect the
discipline
• Predictive
To calculate relationships between properties and how
they occur
• Prescriptive
To identify under which conditions relationships occur.
 Depending on the Generalisability of
their principles.
• METATHEORY:
 The theory of theory. Theory about a theory.
Focuses on broader issues. Focus on generating
knowledge. (highest level of theory & the most
abstract)

 A nursing metatheory presents the most global perspective of the

nursing discipline by identifying and evaluating critical
phenomena in unique ways.
• Even though nursing metatheory is very
abstract and may not be easily tested, nursing
metatheory provides the meanings,
sentences, and structures interconnecting
situations and events observed by nurses on
a global scale.
 Depending on the Generalisability of
their principles.
• Grand theory: (Macro Theories)
Very broader in nature. Attempt to explain very
broader areas in a discipline and may include
many theories.
The broadest in scope, less abstract than
conceptual models but composed of general
concepts still relatively abstract, and the
relationships cannot be tested empirically
(Fawcett,1995)
 Depending on the Generalisability of
their principles.
• Middle range theory:
-specific and deal with a limited number of
concepts or variables (which are testable in
direct manner) and a limited aspect of real
world.
-moderately abstract, inclusive, organized
within a limited scope;
-have a stronger relationship with research and
practice.
Middle range theories provide nurses with the
“best of both worlds”---easy applicability in
practice and abstract enough to be scientifically
interesting.

Middle range theories focus on concepts of

interest to nurses, and include: pain, empathy,
grief, self-esteem, hope, comfort, dignity, and
quality of life.
 Depending on the Generalisability of
their principles.
• Practice theory: (Micro Theory)
explores one particular situation found in
nursing. It identifies explicit goals and details
how these goals will be achieved.

The first level of nursing theory, describe

prescriptions or modalities for practice.
FOUR STEPS INVOLVED IN DETERMINING
PRACTICE THEORIES
1. Factor isolating: to identify and describe a
phenomenon
2. Factor relating: to identify and describe
possible explanations or causes of the
phenomenon
3.Situation relating: to predict occurrence of
a phenomenon when the cause is present.
4.Situation producing control: to prevent
occurrence of the phenomenon by
controlling or eliminating possible causes.
 LEVELS OF THEORIES

Theory Levels of
Abstraction
Meta theory Most abstract

Grand Theory

Middle range theories

Practice theories Least Abstract

 Based on the philosophical
underpinnings of the theories
• Needs theories
These theories are based around helping
individuals to fulfill their physical and mental
needs.
• Interaction theories
These theories revolve around the relationships
nurses form with patients.
 Based on the philosophical
underpinnings of the theories
• Outcome theories
These portray the nurse as the changing force,
who enables individuals to adapt to or cope with
ill health
• Humanistic Theories
Humanistic theories developed in response to the
psychoanalytic thought that a person’s destiny
was determined early in life. Humanistic theories
emphasize a person’s capacity for self-
actualization.
 COMPONENTS OF A THEORY

CONCEPTS DEFINITIONS

NURSING
THEORY

ASSUMPTIONS PHENOMENA
 THEORIES ARE STUDIED UNDER
FOUR HEADINGS

Metaparadigm
Nursing Philosophies
Conceptual models
Theory Approach
WHAT IS A PARADIGM?
PARADIGM

 Itis a word commonly used to describe an

encapsulation of theories, methodologies,
beliefs and concepts.
 The paradigm of a specific area of science
guides and informs experiments and fact-
gathering based on the observations of
researchers within that scientific field.
METAPARADIGM
With Pattern……
 METAPARADIGM
• Metaparadigm is the most global philosophical or
conceptual framework of a profession.
• It is the ideology within which the theories,
knowledge and process for knowing find meaning
and coherence
• The word originated from two Greek words
‘meta’ meaning ‘with’ and ‘paradigm’ meaning
‘pattern’.
NURSING PARADIGM
 The nursing paradigm has developed over
time from the practices and beliefs of
professional practitioners to give structure
to the body of knowledge that is necessary
to successfully meet the goals of the
profession.
NURSING PARADIGM

Four essential concepts common

among Nursing Theories:

 Person/Individual- core of nursing

practice
 Environment- the external influences
on the target
 Health- the goal of the care
 Nursing- the care itself
FOUR ESSENTIAL CONCEPTS COMMON
AMONG NURSING THEORIES:

1. PERSON
 Recipients of nursing
care;
 They include
individuals, families,
communities & groups
FOUR ESSENTIAL CONCEPTS COMMON
AMONG NURSING THEORIES:

Environment
 theexternal influences on the
target which includes the cultural,
social, political, spiritual and
economic influences
FOUR ESSENTIAL CONCEPTS COMMON
AMONG NURSING THEORIES:

 Health
 state of well-being
 it as a harmonious connection of the
physical, psychological, social and spiritual
parts of an individual within himself, with
those around him and with his environment.
 goal of nursing
 The condition in which ALL parts & subparts
(variables) are in harmony with the whole of
the client. (Neuman, 1995)
FOUR ESSENTIAL CONCEPTS COMMON
AMONG NURSING THEORIES:

NURSING
 requires the development of a
concerned relationship between the
individual and the nurse, the use of
state-of-the-art medical knowledge,
and the exercise of good judgment to
promote good health and healing
 Central to All nursing theories.
FOUR ESSENTIAL CONCEPTS COMMON
AMONG NURSING THEORIES:

NURSING
 Definitions of nursing describe what
nursing is, what nurses do, and how
nurses interact with clients.
 It is the “diagnosis & treatment of
human responses to actual or
potential health problems” (ANA,
1995)
 the care itself
(B). EVOLUTION OF NURSING
THEORY
 The history of professional nursing began with
Florence Nightingale who envisioned nurses as a
body of educated women.
 In last century, nursing began with a strong
emphasis on practice.
HISTORICAL ERAS IN NURSING
1. Curriculum era
2. Research era
3. Graduate nursing era
4. Theory era
CURRICULUM ERA
Addressed the question of what
prospective nurses must study and
learn to become a nurse. i.e.
Courses nurses need to take, the
need to move from hospital based
nursing program to college level
education and university level
education.
RESEARCH ERA
As more and more nurses sought degrees in
higher education, research era emerged. Nurses
began to participate in research and research
course began to be included in nursing curricula.
GRADUATE NURSING EDUCATION ERA

 Masters program in nursing emerged to

meet the need for nurse with specialized
education in nursing .
 The masters education had an embedded
course in nursing research
 nearing the end of this era a course in
nursing theory or nursing conceptual
models that introduced students to the early
nursing theorists and development of
nursing theories was introduced.
THEORY ERA
 Was the natural outgrowth of research era.
 With an increased understanding of research
and knowledge development
 It became obvious that research without
theory produced isolated information,
however research and theory produced nursing
science.
OVERVIEW OF THEORY:

 The uniqueness of theories and perspectives

used by a discipline distinguishes it from other
disciplines.
 The theories used by members of a profession
clarify basic assumptions and values shared by
its members and define the nature, outcome and
purpose of practice.
 Kerlinger ---views theories as a set of
interrelated concepts that give a systematic
view of a phenomenon ( an observable fact
or event ) that is explanatory and predictive
in nature.
 Theories are composed of concepts,
definitions, models , propositions and are
based on assumptions. They are derived
through two principal methods:
1) Deductive reasoning
2) Inductive reasoning.
Nursing theorists use both of these methods.
DEDUCTIVE REASONING
 It is a form of reasoning from the general to the
specific. In deductive logic were two or more premises as
relational statements are used to draw a conclusion.
 In deductive process, an abstract theoretical
relationship is used to derive specific questions or
hypothesis.
 Theory that is developed from the applications of
deductive logical System is only as sound as premises
upon which the argument is based.
INDUCTIVE REASONING
 It is a form of logical reasoning in which a
generalization is induced from a number of specific
observed instances.
 The inductive form is based on the assumption
that members of any given class share common
characteristics. Therefore what is true for any
randomly selected members of the class is accepted
as true for all members of the class.
SO HOW DO NURSES USE THEORY IN
EVERYDAY PRACTICE?
 Organize patient data
 Understand patient data

 Analyze patient data

 Make decisions about

nursing interventions
 Plan patient care

 Predict outcomes of care

 Evaluate patient
outcomes
(Alligood, 2001)
HOW DO STUDENT NURSES BEGIN TO
USE NURSING THEORY?

 By asking yourself
two very important
questions…..
STUDENT NURSE QUESTIONS
 What is the nature of
knowledge needed for
the practice of nursing?

 What does it mean to me

to practice nursing?
NURSING ALSO UTILIZES NON-
NURSING THEORIES
COMMONLY USED NON-NURSING
THEORIES
 Systems theory
 Basic Human Needs
theory
 Health and Wellness
Models
 Stress and
Adaptation
 Developmental
Theories
 Psychosocial
Theories
WHAT IS THE LINK BETWEEN
NURSING THEORY AND THE
RESEARCH PROCESS?

 Theory provides
direction for nursing
research
 Relationships of
components in a theory
help to drive the
research questions for
understanding nursing
 Chinn and Kramer
(2004), indicate a spiral
relationship between the
two
CURRENT TRENDS THAT INFLUENCE
NURSING THEORY
 Medical science
 Nursing education

 Professional nursing
organizations
 Evolving research
approaches
 Global concerns

 Consumer demands

 Technologies
Thank you…
Enrich your
knowledge by
reading.