Chapter 5
Theories of
Nursing Practice
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Science and Theory

Science
 A method of bringing together facts and giving them
coherence and integrity
 Scientific inquiry involves five aspects:
• Hypothesis
• Method
• Data collection
• Results
• Evaluation
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Science and Theory

Theory
 A group of related concepts that explain existing phenomena
and predict future events
 Criteria for theory acceptance involve six factors:
• Inclusiveness
• Consistency
• Accuracy
• Relevance
• Fruitfulness
• Simplicity
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Nursing Science

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Collection of data related to nursing that may be applied to the
practice of nursing
Guides the practice of nursing to better serve clients
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Theories, Models,
and Frameworks

Theory
 An abstract generalization that presents a systematic
explanation about how phenomena are interrelated
 Must include at least two concepts that are related in a way
that the theory explains
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Theories, Models,
and Frameworks

Conceptual model or framework
 Deals with concepts that are assembled because of their
relevance to a common theme
 Conceptual framework is used interchangeably with
conceptual model.
 More loosely structured than theories
 Four concepts basic to nursing that are included in models are
nursing, person, health, and environment.
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Nursing Theory

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Guides research and practice
Basic ingredients are concepts.
Examples of nursing concepts include health, stress, and
adaptation.
Language of nursing theory:
 Concept
 Construct
 Conceptual model
 Philosophy
 Theory
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Schematic Models

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Demonstrate concepts, usually through a picture or visual
representation of ideas
Clarify and show relationships between complex concepts
Illustrate the layout and features specific to a theory—similar to
the blueprint of a building
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Levels of Theory

Range from a broad scope to a smaller, more specific scope
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Theory of Unpleasant Symptoms
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Florence Nightingale:
The First Nursing Theorist

Influences that directed her toward nursing theory:
 Classic education
 Upper class life
 Religion and spirituality
 Era of reform throughout England
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Canons of Nursing

Theory of practice “Canons of Nursing”—foundation for the
promotion of health and guidance for the practice of professional
nursing
 Ventilation and warming
 Noise
 Variety
 Diet
 Light
 Chattering hopes and advice
 Cleanliness
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Nursing Theorists

Peplau (1952)

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Explored interpersonal relationship of the nurse and the client
Identified the client’s feelings as a predictor of positive
outcomes related to health and wellness
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Nursing Theorists

Rogers (1970)

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Science of unitary man: energy fields, openness, pattern, and
organization
Nurse promotes synchronicity between human beings and their
universe/environment.
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Nursing Theorists

Newman (1979, revised 1986)

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Defines health as "expanding consciousness," or increasing
complexity
Theory stimulated by concern for those whom health as the
absence of disease or disability is not possible
Nurse’s role is to recognize the person’s unique pattern of life
and to work within that pattern to achieve the person’s goals.
Every person in every situation, no matter how disordered and
hopeless it may seem, is part of the universal process of
expanding consciousness.
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Nursing Theorists

Orem (1971)

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Facilitates client self-care by measuring the client’s deficit
relative to self-care needs
Nurse implements appropriate measures to assist the client in
meeting needs by matching with an appropriate supportive
intervention.
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Nursing Theorists

Roy (1974)
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Nurse will be the change agent in assisting the individual with
adaptation when an insult renders him or her in need of
environmental modification.
Adaptation will occur by assisting the “biopsychosocial” client in
modifying external stimuli.
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Roy’s Adaptation Model
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Nursing Theorists

Watson (1978)

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Caring among nurse, environment, and client is essential to
healing.
Holistic outlook addresses the impact and importance of
altruism, sensitivity, trust, and interpersonal skills.
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Nursing Theorists

Mishel (1981, revised 1997)
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Uncertainty in illness is a stress-producing incident that is
capable of contributing to negative physical and/or
psychologic outcomes.
Uncertainty exists when the client is unsure about a
diagnosed illness.
Four-step framework assists nurses in working with clients:
stimuli frame, appraisal stage, initiation of coping
mechanisms, and adaptation.
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Future of Nursing Theories
and Theorists

Health care concerns in the 21st century
 Primary focus of federal and state legislative agendas
 Major concerns: uninsured population, patient safety, nursing
shortage, rising health care costs, technology, confidentiality
issues, advanced practice nursing
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Future of Nursing Theories
and Theorists

Nursing theories in the 21st century
 Established nursing theories will be reevaluated and modified to
answer important health care questions.
 Will embrace complex issues such as genetics, computers,
noninvasive surgery, robotics, decreasing energy sources,
increasing pollutants under a thinning ozone layer,
environmental hazards, new diseases, and antibiotic-resistant
illness
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