Chapter 4
Theoretical Foundations of
Nursing Practice
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Nursing Foundation
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Theory is the
foundation for the art
and science of
nursing.
Theory, research, and
practice are bound
together in a
continuous interactive
relationship.
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Theory
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Helps explain an event by
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Metatheory
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Defining ideas or concepts
Explaining relationships among the concepts
Predicting outcomes
That looks at the relationships of various components
that make up the knowledge of a discipline
Nursing theory
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Is a conceptualization of some aspect of nursing
Describes, explains, predicts, prescribes nursing care
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Components of a Theory
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Phenomenon
Concepts
Definitions
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Theoretical/conceptual
 Operational
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Assumptions
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The Domain of Nursing
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Domain
Paradigm
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Conceptual framework
Nursing metaparadigm
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Person
Health
Environment/Situation
Nursing
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Evolution of Nursing Theory
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First nursing theorist: Florence Nightingale
Curriculum era: 1900-1940s
Research era: 1950-1970s
Graduate education era: 1950-1970s
Theory era: 1980-1990s
Theory utilization era: 2000s-today
Theories are dynamic and responsive to the
changing environment in which we live.
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Types of Theory (1 of 2)
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Grand: Abstract, broad in scope, complex
Middle-range: Limited in scope and less abstract
Practice: Narrow in scope and focus
Descriptive: Describe phenomena and identify
circumstances in which phenomena occur
Prescriptive: Address nursing interventions for a
phenomenon, guide practice change, and
predict the consequences
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Types of Theory (2 of 2)
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Theory-Based Nursing Practice
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Nursing knowledge
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Is derived from basic and nursing sciences,
experience, aesthetics, nurses’ attitudes, and
standards of practice
Goal of nursing knowledge: To explain the practice of
nursing as different and distinct from the practice of
medicine, psychology, and other health care
disciplines
Theory generates nursing knowledge for use in
practice, thus supporting EBP
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Shared Theories (1 of 2)
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Also known as a borrowed or interdisciplinary
theory
Explain a phenomenon specific to the discipline
that developed the theory
Several nursing theories are based on systems
theory. The nursing process is a system.
Input/output
Feedback
Content
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Shared Theories (2 of 2)
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Quick Quiz 1 (1 of 2)
1. Nursing theories provide nurses with
perspectives from which to:
A. analyze patient data.
B. predict phenomena.
C. formulate legislation.
D. link science to nursing.
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Quick Quiz 1 (2 of 2)
Answer:
A. analyze patient data.
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Case Study (1 of 5)
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Susan is a new nurse who tutors a nursing
student, Bill, who has difficulty mastering good
study habits and prioritizing school assignments.
Susan is helping Bill learn the theoretical
foundations of nursing practice.
After Susan and Bill review interdisciplinary
theories, such as Maslow’s hierarchy of needs
and the developmental theories, they move on
to the topic of nursing theories.
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Select Nursing Theories (1 of 2)
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Nightingale’s Environmental Theory
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Environment as the focus of nursing care
Grand theory
Peplau’s Interpersonal Theory
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Focus on interpersonal relations between nurse,
patient, and patient’s family
Phases: preorientation, orientation, working,
resolution
Middle-range theory
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Select Nursing Theories (2 of 2)
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Orem’s Self-Care Deficit Nursing Theory
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Focuses on patient’s self-care needs
Continually assess how much self-care a patient is
able to perform.
Grand theory
Leininger’s Culture Care Theory
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Theory of cultural care diversity and universality
Integrates patients’ cultural traditions, values, and
beliefs into care plans
Middle-range theory
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Case Study (2 of 5)

Bill reads about the concept of culturally specific
nursing care. The theory that integrates patients’
cultural traditions, values and beliefs into care
plans is ______________.
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Case Study (3 of 5)
Answer:
Leininger’s theory
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Link Between Theory
and Knowledge Development
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Nursing knowledge is theoretical and
experiential.
The goals of theoretical knowledge are to
stimulate thinking and create a broad
understanding of nursing science and practice.
Experiential knowledge, or the “art” of nursing, is
based on nurses’ experiences in providing care
to patients.
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Quick Quiz 2 (1 of 2)
2. Nursing process is central to nursing
practice. Nursing practice:
A. is a theory.
B. is derived from a theory.
C. is not adaptable to all patients.
D. generates knowledge for use in practice.
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Quick Quiz 2 (2 of 2)
Answer:
B. is derived from a theory.
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Case Study (4 of 5)
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Susan quizzes Bill about the core concept of
Peplau’s theory.
Peplau’s theory has only three phases, including
orientation, working, and resolution.
A. True
B. False
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Case Study (5 of 5)
Answer:
B. False
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Relationship Between Nursing Theory
and Nursing Research (1 of 2)
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Theories provide direction for nursing research.
Nursing theory and nursing research build the
knowledge base for nursing, which is then
applied to practice.
Theory-generating or theory-testing research
refines the knowledge base of nursing.
Nurses incorporate research-based
interventions into theory-based practice.
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Relationship Between Nursing Theory
and Nursing Research (2 of 2)
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Theory-generating research
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Theory-testing research
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Uses logic to explore relationships among
phenomena.
Determines how accurately a theory describes a
nursing phenomenon.
Both theory-generating and theory-testing
research refine the knowledge base of nursing.
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Nurses incorporate research-based interventions into
theory-based practice.
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