Overview: Theoretical
Foundations in Nursing
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By giving nurses a sense of identity, nursing
theory can help patients, managers and other
healthcare professionals to recognize the
unique contribution that nurses make to the
healthcare service (Draper 1990). Providing a
definition of nursing theory also helps nurses
to understand their purpose and role in the
healthcare setting.
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1. Definition of Terms
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Theory
Concept
Principle
Nursing theory
Philosophy
Conceptual models
Science
Knowledge
Phenomenon
Nursing
Nursing paradigms
Paradigm
Hypothesis
Research
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 yet
decisively proven.
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A set of concepts, definitions, relationships,
and assumptions that project a systematic
view of a phenomena
It may consist of one or more relatively
specific and concrete concepts and
propositions that purport to account for, or
organize some phenomenon (Barnum, 1988)
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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 organized
perspectives serve as guides for nursing 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.
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An Example of “Theory”
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An expectation of what should happen,
barring unforeseen circumstances.
Parker (2001) A theory is an organized,
coherent set of concepts and their
relationship to each other that offers
descriptions, explanations and predictions
about phenomena.
Kozier (2008) is a supposition or system of
ideas that is proposed to explain given
phenomenon.
“A herd of buffalo can only move as fast as the
slowest buffalo. And when the herd is hunted,
it is the slowest and weakest ones at the back
that are killed first. This natural selection is
good for the herd as a whole, because the
general speed and health of the whole group
keeps improving by the regular killing of the
weakest members.
In much the same way, the human brain can
only operate as fast as the slowest brain cells.
Excessive intake of alcohol, as we all know,
kills brain cells, but naturally it attacks the
slowest and weakest brain cells first. In this
way, regular consumption of beer eliminates
the weaker brain cells, making the brain a
faster and more efficient machine. That’s why
you always feel smarter after a few beers.”
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Concept
 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.
 Examples: person, health,
environment, nursing
Principle
 A basic generalization that is accepted as true
and that can be used as a basis for reasoning
or conduct.
Nursing Theory
 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.
Philosophy
 The most basic beliefs, concepts, and
attitudes of an individual or group
 An analysis of the grounds of and concepts
expressing fundamental beliefs
 Is the next knowledge level after
metaparadigm. It specifies the definition of
metaparadigm concepts.
 A search for a general understanding of values
and reality by chiefly speculative rather than
observational means
Conceptual frameworks/models
 A set of interrelated concepts that
symbolically represents and conveys a mental
image of a phenomenon. 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 propositions that
integrate them into a meaningful
configuration (Marriner-Tomey and Alligood,
1998)
 Composed of concepts or constructs that
describe ideas about individuals, groups,
situation and events of particular interest or
discipline (e.g. Nursing)
Hypothesis
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Research
 Research comprises "creative and systematic
work undertaken to increase the stock of
knowledge, including knowledge of humans,
culture and society, and the use of this stock
of knowledge to devise new applications."
Science
 The organized body of knowledge gained
through research.
Knowledge
 Information, skills and expertise acquired by a
person through formal/informal learning.
Phenomenon
 A sets of empirical data or experiences that
can be physically observed or tangible such as
crying or grimacing when in pain.
Importance of Nursing Theory
 It helps to distinguish what should form the
basis of practice by explicitly describing
nursing.
 This can be seen as an attempt by the nursing
profession to maintain its professional
boundaries.
 Nursing theory aims to describe, predict and
explain the phenomenon of nursing (Chinn
and Jacobs 1978).
 It provides the foundations of nursing
practice, help to generate further knowledge
and indicate in which direction nursing should
develop in the future (Brown 1964).
 Theory is important because it helps us to
decide what we know and what we need to
know (Parsons1949).
2. Characteristics of a Theory
Nursing
 Nursing encompasses autonomous and
collaborative care of individuals of all ages,
families, groups and communities, sick or well
and in all settings. It includes the promotion
of health, the prevention of illness, and the
care of ill, disabled and dying people. (WHO)
Paradigm
• In science and philosophy, a paradigm is a
distinct set of concepts or thought patterns,
including theories, research methods,
postulates, and standards for what constitutes
legitimate contributions to a field.
1. Systematic, logical and coherent (orderly
reasoning, no contradictions)
2. Creative structuring of ideas mental images of
one’s experiences and create different ways
of looking at a particular event or object.
3. Tentative in nature ( change over time or
evolving but some remain valid despite
passage of time)
4. Interrelate concepts in such a way as to create
a different way of looking at a particular
phenomenon.
5. Are logical in nature.
6. Are generalizable.
7. Are the bases for hypotheses that can be
tested.
8. Increase the general body of knowledge
within the discipline through the research
implemented to validate them.
9. Are used by the practitioners to guide and
improve their practice.
10. Are consistent with other validated theories,
laws, and Principles but will leave open
unanswered questions that need to be
investigated.
3. Components of theory
 Concepts
 Definitions
 Assumptions/Proposition
 Phenomenon
Phenomenon
 A phenomenon is an aspect of reality that can
be consciously senses or experienced. (Meleis,
1997). 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.
Why on earth do we study nursing theory?
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Concepts
 A theory is composed of interrelated
concepts.
 Concepts help to describe or label
phenomena.
Everyday practice enriches theory
Both practice and theory are guided by values
and beliefs
Theory helps to reframe our thinking about
nursing
Theory guides use of ideas and techniques
Theory can close the gap between theory and
research
To envision potentialities (Gordon, Parker, &
Jester, 2001)
Take note:
Definitions
 The definition 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)
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.
“The major reason for the development and study of
nursing theory is to improve nursing practice and,
therefore, the health and quality of life of those we
serve.”
4. Purposes of Nursing Theory In Relation To:
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Education
– nursing theory was used primarily to
establish the profession’s place in the
university.
– provide a general focus for curriculum
design.
– guide curricular decision making.
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Research
– nursing research identifies the
philosophical assumptions or
theoretical frameworks from which it
proceeds.
– offer a framework for generating
knowledge and new ideas.
– assist in discovering knowledge gaps
in specific field of study.
– offer a systematic approach to
identify questions for study, select
variables, interpret findings and
validate nursing interventions.
Practice
– the primary contribution of nursing
theory when employed in a clinical
setting is the facilitation of reflection,
questioning, and thinking about what
nurses do.
– assist nurses to describe, explain, and
predict everyday experiences.
defining its own independent
functions.
5. Nursing paradigms
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Are patterns or models used to show
a clear relationship among the
existing theoretical works in nursing.
Person
Health
Environment
Uses of Theory
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serve to guide assessment,
intervention, and evaluation of
nursing care.
provide a rationale for collecting
reliable and valid data about the
health status of clients, which are
essential for effective decision making
and implementation.
help to establish criteria to measure
the quality of nursing care.
help build a common nursing
terminology to use in communicating
with other health professionals.
Ideas are developed and
words defined.
enhance autonomy (independence
and self-governance) of nursing by
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 Marriner-Tomey, 2002).
Nursing
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Theory guides and improve nursing practice.
Theory provides goal for nursing care and with
goals, nursing practice is rendered more
effective and efficient.
Theories help to focus the goals, making
nurses more confident about the practice.
Theory guides research
It validates and modifies the theory.
Theory contributes to the development of the
disciplines body of knowledge.
Theory enhances communication.
Types of Nursing Theory
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Meta-theory - the theory of theory. Identifies
specific phenomena through abstract
concepts.
Grand theories – broad and complex
Middle-range theories- address specific
phenomena and reflect practice
Practice theory - explores one particular
situation found in nursing. It identifies explicit
goals and details how these goals will be
achieved.
Descriptive theories – first level of theory
development
Prescriptive theories – address nursing
interventions and predict their consequences
Grand Nursing Theory
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These theories have the broadest scope and
present general concepts and propositions.
Theories at this level may both reflect and
provide insights useful for practice but are not
designed for empirical testing.
Grand theories consist of conceptual
frameworks defining broad perspectives for
practice and ways of looking at nursing
phenomena based on the perspectives.
Mid-Range Nursing Theories
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These theories are narrower in scope than
grand nursing theories and offer an effective
bridge between grand nursing theories and
nursing practice.
They present concepts and propositions at a
lower level of abstraction and hold great
promise for increasing theory-based research
and nursing practice strategies.
Nursing Practice Theories
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Nursing practice theories have the most
limited scope and level of abstraction and are
developed for use within a specific range of
nursing situations.
Nursing practice theories provide frameworks
for nursing interventions, and predict
outcomes and the impact of nursing practice.
6. Four ways of knowing
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Empirical
Ethical
Aesthetics
Personal