GUEVARRA, Angela M.
Concept
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A mental idea of a phenomenon
A comprehensive idea or generalization
An idea that brings diverse elements into a
basic relationship
A unit of knowledge abstracted from a set of
characteristics attributed to a class of objects,
relations or entities
A unit of thought
A general idea formed in the mind
Something understood or retained in the mind,
from experience, reasoning, and/or
imagination: a generalization or abstraction of a
particular set of instances or occurrences
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A set of interrelated concepts that symbolically
represents and conveys a mental image of a
phenomena. Conceptual models of nursing
identify concepts and describe their
relationships to the phenomena of central
concern to the discipline: person, environment,
health and nursing (Power and Knapp, 1995)
A set of concepts and the prepositions that
integrate them into a meaningful configuration
(Marriner – Tomey and Alligod, 1998)
Composed of concept or constructs that
describe ideas about individuals, groups,
situations and events of particular interest or
discipline (e.g. Nursing)
Theory
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A set of statements that tentatively describe,
explain, or predict relationships among
concepts that have been systematically selected
and organized as an abstract representation of
some phenomenon (Power and Knapp, 1995).
These systematic organize perspectives serve as
guides for nursing in action in administration,
education, research and practice.
A well – substantiated explanation of some
aspect of the natural world; an organized
system of accepted knowledge that applies in a
variety of situations / hypotheses.
An explanation of what should happen, barring
unforeseen circumstances.
A coherent statement or set of statements that
attempts to explain observed phenomena.
An explanation for some phenomena that is
based on observation, experimentation, and
reasoning.
A comprehensive explanation of a given set of
data that has been repeatedly confirmed by
observation and experimentation and has
gained general acceptance within the scientific
community but has not been decisively proven
A construct (the way to put together the “parts”
of something) that accounts for or organizes
some phenomena (Barrum, 1998)
Nursing Theory
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Conceptual Framework / Model
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1st semester
Theoretical Foundation of Nursing
A body of knowledge that describes or explains
nursing and is used to support nursing practice.
An organized and systematic articulation of a
set of statements related to questions in the
discipline of nursing
Is a set of concepts, definitions, relationships,
and assumptions or propositions derived from
nursing models or from other disciplines and
project a purposive systematic view of
phenomena by designing specific interrelationships among concepts for the purposes
of describing, explaining, predicting and / or
prescribing.
Principle
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A basic generalization that is accepted as true
and that can be used as a basis for reasoning or
conduct.
Characteristics of a Theory
A theory is
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Interrelating concepts in such a way as to create
a different way of looking at a particular
phenomenon.
Logical in nature
Generalizable
Basis for hypotheses that can be tested
Increasing the general body of knowledge
within the discipline through the research
implemented to validate them.
Used by the practitioners to guide and improve
their practice.
Consistent with other validated theories, laws
and principles but will leave open unanswered
questions that need to be investigated.
Concepts of a Theory
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4.
Concepts
Definitions
Assumptions
Phenomenon
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Concepts
Definitions
Phenomenon
Assumptions or
propositions
GUEVARRA, Angela M.
Theoretical Foundation of Nursing
1. Concepts – a theory is composed of interrelated
concepts.
Concepts help to describe or label phenomena.
Using Levine’s Conservation Model in Nursing
Practice as an example, there are concepts that
affect the nursing practice – the “why’s of
nursing actions” the three major concepts that
form the basis of the model and its assumptions
are as follows:
a) Conservation
b) Adaptation
c) Wholeness
Another examples is King’s theory of Goal
Attainment in Nursing Practice. According to
this model, the concepts that are critical to goal
attainment in nursing practice are as follows.
a) Personal systems
b) Interpersonal systems
c) Social systems
2. Definitions. The definitions within the
description of a theory convey the general
meaning of the concepts in a manner that fits
the theory. These definitions also describe the
activity necessary to measure the constructs,
relationships or variables within a theory (Chinn
and Kramer 2004)
3. Assumptions are statements that describe
concepts or connect two concepts that are
factual. Assumptions are the “taken for
granted” statements that determine the nature
of the concepts, definitions, purpose,
relationships and structure of the theory.
4. Phenomenon. a phenomenon is an aspect of
reality that can be consciously sensed or
experienced. Nursing theories focus on the
phenomena of nursing and nursing care.
Examples of phenomena in nursing include
caring, self-care, and client responses to stress
Types of Theories
1. Metatheories. Are theories whose subject
matters are some other theories. These are
theories about theories.
2. Grand Theories. Are broad in scope and
complex and therefore require further
specification through research before they can
be fully tested ( Chinn and Kramer, 1999). These
are intended to provide structural framework
for broad, abstract ideas about nursing
(Fawcett,1995)
3. Middle – Ranged Theories. Have more limited
scope, less abstraction, address specific
phenomena or concepts and reflect practice
(administration, clinical or teaching). The
phenomena or concepts tend to cross different
nursing fields, and reflect a wide variety of
1st semester
nursing care situations. E.g.; quality of life,
uncertainty in illness, social support,
incontinence, caring.
4. Descriptive Theories. Are the first level of
theory development. They describe
phenomena, speculate on why phenomena
occur and describe consequences of
phenomena. They have the ability to explain,
elate, and in some situations predict nursing
phenomena (Meleis,1997) example: theories of
growth and development
5. Prescriptive Theories address nursing
interventions and predict the consequence of a
specific nursing intervention. Prescriptive
theories are action oriented, which test the
validity and predictability of a nursing
intervention.
Importance of Nursing Theories
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Aim to describe, predict and explain the
phenomenon of nursing (Chinn and Jacobs,
1978)
Provide the foundations of nursing practice,
help to generate further knowledge and
indicate in which direction nursing should
develop in the future (Brown, 1994)
Help to distinguish what should form the basis
of practice by explicitly describing nursing
Help provide better patient care, enhanced
professional status for nurses, improved
communication between nurses and guidance
for research and education (Nolan,1996)
The main exponent of nursing -caring- cannot
be measured. It is vital to have the theory to
analyze and explain what nursed do.
Establish a unique body of knowledge
Maintain professional boundaries in nursing
Purposes of Theories
a) In practice
b) In education
c) In research
Nursing Paradigm
Nursing has a model or paradigm that explains
the linkages of science, philosophy, and theory that is
accepted and applied by the discipline. The elements of
nursing paradigm direct the activity of the nursing
profession, including knowledge development,
philosophy, theory educational experience, research,
practice and literature identified with the profession
(Alligood and Marinner – Tomey, 2002)
Nursing identified its domain in a paradigm that
includes four linkages; the person, health, environment/
situation, and nursing.
GUEVARRA, Angela M.
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Nursing
Person
Health
Environment
Four Major Concepts of Nursing Theories
1. Person – Refers to all human beings. People are
the recipients of nursing care; they include
individuals, families, communities and groups
2. Environment – includes factors that affect
individuals internally and externally. It means
not only everyday surroundings but also
settings where nursing care is provided.
3. Health – addresses the person’s state of well –
being.
4. Nursing – is central to all nursing theories.
Definitions of nursing describe what nursing is,
what nurses do, and how nurses interact with
clients. It is the “diagnosis and treatment of
human responses to actual or potential health
problems” (ANA, 1995). Example; the nurse
establishes nurses diagnoses of fatigue, change
in body image, and altered coping based on the
medical diagnosis of heart condition.
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b)
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Von Bertalanffy (1969, 1976) developed general
systems theory which has the following
assumptions:
All systems must be goal directed
All system is more than the sum of its part
A system is everchanging and any change in one
part affects the whole
Boundaries are implicit and human systems are
open and dynamic
INPUT
Client interaction
with the
environment:
- Psychological
- Physiological
General Systems Theory
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Includes purpose, content and process,
breaking down the “whole” and analyzing the
parts
The relationships between the parts of the
whole are examined to learn how they work
together
A system is made up of separate components.
The parts rely on one another, are interrelated,
share a common purpose, and together form a
whole.
Input is the information that enters the system
Output is the product of the system
Feedback is the process through which the
output is returned to the system
OUTPUT
Assessment
Nursing
Diagnosis
- Developmental
- Sociocultural
Environmental
- Spiritual
Planning
Client heath
status for
returning to
the
environment
Implementation
Evaluation
FEEDBACK
Client successfully or unsuccessfully
function in the environment
Nursing theories are often based on and
influence by broadly applicable processes and theories.
The following theories are basic to many nursing
concepts.
General systems theory
Change theory
Developmental theory
Adaptation theory
SYSTEM
Nursing
Process
Different Views on non-nursing Theories used in
Nursing
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Theoretical Foundation of Nursing
NURSING PRACTICE AS A SYSTEM
2. Change Theory
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People grow and change throughout their lives.
This growth and change are evident in the
dynamic nature of basis human needs and how
they are met
Change happens daily. It is subtle, continuous
and manifested in both everyday occurrences
and more disruptive life events.
Reactions to change are grounded in the basic
human needs for self – esteem, safety and
security.
Change involves modification or alteration. It
may be planned or unplanned.
Kurt Lewin (1962) developed the change theory,
which identifies the following components;
Recognition of the are where change is needed
Analysis of a situation and what forces are
working to change it
Identification of methods by which change can
occur
Recognition of the influence of group mores or
customs on change
GUEVARRA, Angela M.
Theoretical Foundation of Nursing
5. Identification of the methods that the reference
group uses to bring about change
6. The actual process of change
• Lewin identified 3 states of change: unfreezing.
Movement, refreezing
a) Unfreezing. Is the recognition of the need for
change and the dissolution of previously held
patterns of behavior
b) Movement. Is the shift of behavior toward a
new and more healthful pattern
c) Refreezing. Is the long – term solidification of
the new pattern of behavior.
Stage 3. Phallic or Oedipal (3 to 6 years)
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3. Developmental Theory
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Human growth and development is an orderly
predictive process begins with conception and
continues through death
• The four main areas of developmental theory
are as follows:
a) Biophysical development. Attempts to describe
the way our physical bodies grow and change
b) Psychoanalytic / psychosocial development.
Attempts to describe the development of the
human personality, behavior and emotions. This
development is thought to occur with varying
degrees of influence from internal biological
forces and external societal / cultural forces.
Example 1: Sigmund Freud’s Psychoanalytic Model
of Personality Development which has five
psychosexual developmental stages associated with
different pleasurable zones. This theory believes
that two internal forces essentially drive
psychological change in the child: sexual (libido) and
aggressive energies.
Stage 1. Oral (birth to 18 months)
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Initially, sucking and oral satisfaction is not
only vital to life, but also very pleasurable in
its own right
Later, the infant begins to realize that the
mother/parent is something separate from
self
Disruption in the availability of parent (e.g.
inadequate bonding or chronic illness) could
have an impact on the infant’s
development.
Stage 2. Anal (12 to 18 months to 3 years)
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The focus of pleasure is the anal zone.
The children become increasingly aware of
the pleasurable sensations of this body
region with interest in the products of their
effort
Through the toilet – training process, the
child is asked to delay gratification in order
to meet parental and societal expectations.
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The genital organs become the focus of
pleasures. The boy becomes interested in the
penis; the girl becomes aware of the absence of
the penis known as the penis envy.
This is the time of exploration and imagination
The child fantasizes about the parent of the
opposite sex as his or her first love interest,
known as Oedipal or Electra Complex.
By the end of this age, the child attempts to
reduce this conflict by identifying with the
parent of the same sex in a way to win
recognition and acceptance.
Stage 4. Latency (6 to 12 years)
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Sexual urges, from the earlier Oedipal stage are
repressed and channeled into productive
activities that ae socially acceptable
Within the educational and social worlds of the
child, there is much to learn and accomplish.
This is where the child places energy and effort.
Stage 5. Genital (puberty through adulthood)
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This is the time of turbulence when earlier
sexual urges awaken and are directed to an
individual outside the family circle
Unresolved prior conflicts surface during
adolescence.
Once the conflicts are resolved, the individual is
then capable of having a mature adult sexual
relationship.
Example 2.
Erik Erikson’s Psychosocial Model. According to
Erikson’s eight stages of life, individuals need to
accomplish a particular task before successfully
completing the stage. Each task is framed with opposing
conflicts, such as the adolescent’s need to develop a
sense of personal identity challenged by many
confusing choices.
1. Trust vs mistrust (birth to 1 year)
• Starting with oral satisfaction, the infant
learns to trust the caregiver as well as
self
• Trust is achieved when the infant let the
caregiver out of sight without undue
distress. Very crucial to this stage is
consistent caregiving.
2. Autonomy versus Sense of Shame and Doubt
(1 to 3 years)
• The child is now becoming
accomplished in some basic self – care
activities, including walking feeding and
toileting.
GUEVARRA, Angela M.
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Theoretical Foundation of Nursing
This newfound independence is the
result of maturation and imitation
• The toddler develops his/her autonomy
by making choices. Choices typical for
the toddler include activities related to
relationships, desires, and playthings.
• There is also opportunity to learn that
parents and society have expectations
about these choices
• Parents should be guided that limiting
choices and/or harsh punishment can
lead to feelings of shame and doubt.
3. Initiative vs Guilt (3 to 6 years)
• Children like to pretend and try out new
roles
• Fantasy and imagination allow children
to further explore their environment.
• Also, at this time, children are
developing their superego or
conscience
• Conflicts often arise between the child’s
desire to explore and the limits placed
on his/her behavior. These conflicts
may lead to feelings of frustrations and
guilt.
• Guilt may also occur if the caregiver’s
responses are too punitive.
4. Industry vs Inferiority (6 to 11 years)
• School age children are eager to apply
themselves to leaning socially
productive skills and tools
• They learn to work and play with their
peers.
• School – age children thrive on their
accomplishments and praise.
• Without proper support for learning of
new skills or if skills are too difficult
children may then develop sense of
inadequacy and inferiority.
• Erikson believed that adult’s attitude
toward work can be traced to successful
achievement of this task
5. Identity vs Role Confusion (puberty /
adolescence)
• Dramatic physiological changes
associated with sexual maturation
highlight this stage
• There is marked preoccupation with
appearance and body image
• It is during this stage that the individual
is able to seek for the answer to the
question, “who am I?”
• Acquiring sense of identity is essential
for making adult decisions such as
choice of vocation or marriage partner.
1st semester
6. Intimacy vs Isolation (young adult)
• Young adults, after developing sense of
identity deepen their capacity to love
and care for them
• This is the time to become fully
participative in the community,
enjoying adult freedom and
responsibility.
• If the individual has not developed send
of identity, he/she may experience
feelings of isolation from others and the
inability to form meaningful
attachments
7. Generativity vs Self – Absorptions and
Stagnation (middle age)
• Following the successful development
of an intimate relationship, the adult
can focus on supporting future
generations
• The individual pursues expansion of
personal and social involvement.
He/she should be able to see beyond
his/her needs and accomplishments to
the needs of society.
• Dissatisfaction with one’s place and
achievement often leads to self –
absorption and stagnation.
8. Integrity vs Despair (old age)
• as the aging process creates physical
and social losses the adult may also
suffer loss of status and function, such
as through retirement or illness. These
external struggles are also met with
internal struggles, such as search for
meaning in life.
• Meeting these challenges creates the
potential for growth and wisdom.
• If the elderly has achieved integrity,
he/she views life with a sense of
wholeness and derives satisfaction from
past accomplishments; views death as
an acceptable completion of life;
accepts one’s one and only life cycle.
• Despair is experienced when the elderly
views himself/herself as a failure;
believes that he/she made poor choices
during life; and sense that his/her life
has been worthless.
c. Cognitive Development. Is focused on
reasoning and thinking processes, including the
changes in how people come to perform
intellectual operations.
Jean Piaget’s Theory of Cognitive Development
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This theory includes four periods and recognizes
that children move through these specific
GUEVARRA, Angela M.
Theoretical Foundation of Nursing
periods at different rates but in the
development according to Piaget’s are as
follows.
Period I. Sensorimotor (birth to 2 years)
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The infant develops action pattern for dealing
with the environment. This includes hitting,
looking, grasping or kicking
As the infant learns that sucking achieves a
pleasing result, he/she generalizes the action to
suck fingers, blanket or clothing. Successful
achievement leads to greater exploration
Toward the end of this age, infants are able to
make primitive mental images as thy acquire
object permanence. Before this, they do not
realize that objects out of sight exist.
At 18 months, the child can understand that
even if it cannot be seen, it still exists and will
search for it
Period II. Preoperational (2 to 7 years)
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Children learn to think with the use of
symbols and mental images
Still egocentric, the child sees objects and
persons from only one point of view, the
child’s own
Play is the initial method of non-language
use of symbols
This is the time for parallel play – children
engaging in activities side – by – side
without a common goal. Imitation and
make – believe plays are ways to represents
experience
Later, language develops and broadens
possibilities for thinking about the past or
the future. Children can now communicate
about events with others
Period III Concrete Operational (7 to 11 years)
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Children at this time, achieve the ability to
perform mental operations
The child can count and at the same time
understand what each number represents
Children can now describe a process without
actually performing it
Reversibility is the primary characteristics of
concrete operational thought. Children can
mentally reverse the direction of their thoughts.
Children can now classify objects according to
their quantitative dimensions, known as
seriation
Another accomplishment of this stage is
conservation or the ability to see objects or
quantities as remaining the same despite a
change in their physical appearance
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Period IV Formal Operations (11 years to adulthood)
The individual’s thinking moves to abstract and
theoretical subjects
Thinking can venture into such subjects as achieving
world peace, finding justice and seeking meaning in life
Adolescents can organize their thoughts in their minds.
They have the capacity to reason with respect to
possibilities
New cognitive powers allow the adolescents to do more
far – reaching problem solving, including their futures
and that of other. This thinking matures and the depth
of understanding increases with experiences.
d. Moral Development . focuses on the description of
the moral reasoning. Moral reasoning is how people
think about the rules of ethical and moral conduct but
does not predict what a person would actually do in a
given situations. Moral development is the ability of an
individual to distinguish right from wrong and to
develop ethical values on which to base his or her
actions.
Example: Lawrence Kohlberg’s Theory on Moral
Development
4. Adaptation Theory
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It defines adaptation as the adjustment of living
matter to other living things and to the
environmental conditions
Adaptation is a continuously occurring process
that affects change and involves interactions
and response
Human adaption occurs on three levels
o The internal (self)
o The social
o The physical (biochemical reactions)