Theoretical Foundation of Nursing
A. Introduction to Nursing Theory
1. History of Nursing Theory
The first nursing theories appeared in the late
1800s when a strong emphasis was placed on
nursing education.

In 1860, Florence Nightingale defined
nursing in her “Environmental Theory” as
“the act of utilizing the patient’s
environment to assist him in his recovery.”

In the 1950s, there is a consensus
among nursing scholars that nursing
needed to validate itself through the
production of its own scientifically tested
body of knowledge.

In 1952, Hildegard Peplau introduced
her Theory
of
Interpersonal
Relations that emphasizes the nurseclient relationship as the foundation of
nursing practice.

In
1955,
Virginia
Henderson conceptualized the nurse’s
role as assisting sick or healthy
individuals to gain independence in
meeting 14 fundamental needs. Thus
her Nursing Need Theory was developed.

In 1960, Faye Abdellah published her
work “Typology of 21 Nursing Problems,”
which shifted the focus of nursing from a
disease-centered approach to a patientcentered approach.

In 1962, Ida Jean Orlando emphasized
the reciprocal relationship between
patient and nurse and viewed nursing’s
professional function as finding out and
meeting the patient’s immediate need
for help.

In 1968, Dorothy Johnson pioneered
the Behavioral
System
Model and
upheld the fostering of efficient and
effective behavioral functioning in the
patient to prevent illness.

In 1970, Martha Rogers viewed nursing
as both a science and an art as it provides
a way to view the unitary human being,
who is integral with the universe.

In 1971, Dorothea Orem stated in her
theory that nursing care is required if the
client is unable to fulfill biological,
psychological, developmental, or social
needs.

In 1971, Imogene King‘s Theory of Goal
attainment stated that the nurse is
considered part of the patient’s
environment
and
the nurse-patient
relationship is for meeting goals towards
good health.

In 1972, Betty Neuman, in her theory,
states that many needs exist, and each
may disrupt client balance or stability.
Stress reduction is the goal of the system
model of nursing practice.

In 1979, Sr. Callista Roy viewed the
individual as a set of interrelated systems
that maintain the balance between these
various stimuli.

In 1979, Jean Watson developed the
philosophy of caring, highlighted
humanistic aspects of nursing as they
intertwine with scientific knowledge and
nursing practice.
2. Significance for the:
Discipline
- is a specific to academia and a branch
of education, a department of learning
or a domain/field of knowledge.
Profession
- refers to a specialized field of practice,
founded upon the theoretical structure
of the science or knowledge of that
discipline and accompanying practice
abilities.
B. History and Philosophy of Science
- To formalize the science of nursing,
basic questions must be considered,
such as “What is science, knowledge,
and truth?” and “What methods
produce scientific knowledge?” These
are philosophical questions. The
term epistemology is concerned with
the theory of knowledge in philosophical
inquiry. The particular philosophical
perspective selected to answer these
questions will influence how scientists
perform scientific activities, how they
interpret outcomes, and even what they
regard as science and knowledge (Brown,
1977). Although philosophy has been
documented as an activity for 3000
years, formal science is a relatively new
human pursuit (Brown, 1977; Foucault,
1973). Scientific activity only recently
has become the object of investigation.
- Nursing science has been
characterized by two branching
philosophies of knowledge as the
discipline developed. Various terms are
utilized to describe these two stances:
empiricist, and interpretive, mechanistic and
holistic, quantitative and qualitative, and
deductive and inductive forms of science.
1. Rationalism
- Rationalist epistemology (scope of
knowledge)
- emphasizes the importance of a priori
reasoning as the appropriate method
for advancing knowledge.
- is the knowledge that is derived from
reason and logic.
- is the search for and emphasis on
basic mechanisms of disease, which
then color all clinical decisions.
- about intuition.
- Theory-then-research strategy
(Reynolds)
2. Empiricism
- is the knowledge deprived from
experience and experimentation.
- about visual concepts.
- is complementary to nursing ethics,
which emphasizes patient dignity and
care.
- consists of collecting data and
observation and using what was
learned to explain nursing concepts.
- Research-then-theory
- the power of sensory experience
- that scientific knowledge was
discovered through the generalization
of observed facts in the natural world
(Bacon)
3. Early Twentieth Century Views of Science
and Theory
- Philosophers focused on the analysis
of theory, structure, whereas scientist
focused on empirical research.
- Positivism (imposed on the mind by
experience) is the philosophy of
science that information is derived
from logical and mathematical
treatments and reports of sensory
experience is the exclusive source of
all authoritative knowledge.
4. Emergent Views of Science and Theory in
the late 20th Century
- Empiricists argue that for science to
maintain its objectivity, data
collection and analysis must be
independent of a theory.
- Brown argues that the new
epistemology challenged the
empiricists view of perception by
acknowledging that theories play a
significant role in determining what
the scientist will observe and how it
will be interpreted. He identified 3
different views of the relationship
between theories and observation:
I. Scientists are merely passive observers
of occurrences in the empirical world.
Observable data are objective truth
waiting to be discovered.
II. Theories structure what the scientists
perceived in the empirical world.
III. Presupposed theories and observable
data interact in the process of scientific
investigation.
C. Structure of Nursing Knowledge
1. Structure Level
Structure Level
Example
Metaparadigm
Person,
environment,health and
nursing
Philosophy
Nightingale
Conceptual models
Neuman’s system model
Theory
Neuman’s theory of
optimal client stability
Middle-range theory Maintaining
optimal
client stability with
structured activity (body
recall) in a community
setting
for
healthy
aging.
2.Metaparadigm
- the most general statement of
discipline and functions as a framework
in which the more restricted structures
of conceptual models develop. Much of
the theoretical work in nursing focused
on articulating relationships among four
major concepts: person, environment,
health, and nursing.
 Person
- (also referred to as Client or Human
Beings)
- the recipient of nursing care and mat
include individuals, patients, groups,
families, and communities.
 Environment
- (or situation)
- defined as the internal and external
surroundings that affect the client. It
includes all positive or negative
conditions that affect the patient, the
physical environment, such as families,
friends, and significant others, and the
setting for where they go for their
health care.
 Health
- defined as the degree of wellness or
well-being that the client experiences. It
may have different meanings for each
patient, the clinical setting, and the
health care provider.
 Nursing
- The nurse’s attributes, characteristics,
and actions provide care on behalf of or
in conjunction with the client. There are
numerous definitions of nursing, though
nursing scholars may have difficulty
agreeing on its exact definition. The
ultimate goal of nursing theories is to
improve patient care.
3. Philosophy
- It is the most abstract type and sets
forth the meaning of nursing
phenomena through analysis, reasoning,
and logical presentation. Works of
Nightingale, Watson, Ray, and Benner
are categorized under this group.
4. Conceptual Methods
- These are comprehensive nursing
theories that are regarded by some as
pioneers in nursing. These theories
address the nursing metaparadigm and
explain the relationship between them.
Conceptual models of Levine, Rogers,
Roy, King, and Orem are under this
group.
5. Middle Range Theory
- Are precise and answer specific nursing
practice questions. They address the
specifics of nursing situations within the
model’s perspective or theory from
which they are derived. Examples of
Middle-Range theories are that of
Mercer, Reed, Mishel, and Barker.
Nursing Philosophies (Theory, Theorist and
Application Only)
1. Nightingale’s Environmental Theory
 Founder of Modern Nursing and Pioneer
of the Environmental Theory.
 Defined Nursing as “the act of utilizing
the environment of the patient to assist
him in his recovery.”
 Stated that nursing “ought to signify the
proper use of fresh air, light, warmth,
cleanliness, quiet, and the proper
selection and administration of diet – all
at the least expense of vital power to
the patient.”
 Identified five (5) environmental factors:
fresh air, pure water, efficient drainage,
cleanliness or sanitation, and light or
direct sunlight.
 Watson’s Theory of Human Caring
 She pioneered the Philosophy and
Theory of Transpersonal Caring.
 “Nursing is concerned with promoting
health, preventing illness, caring for the
sick, and restoring health.”
 Mainly concerns with how nurses care
for their patients and how that caring
progresses into better plans to promote
health and wellness, prevent illness and
restore health.
 Focuses on health promotion, as well as
the treatment of diseases.
 Caring is central to nursing practice and
promotes health better than a simple
medical cure
2. Benner’s Stages of Nursing Expertise
Nursing Philosophies
 Caring, Clinical Wisdom, and Ethics in
Nursing Practice
 “The nurse-patient relationship is not a
uniform, professionalized blueprint but
rather a kaleidoscope of intimacy and
distance in some of the most dramatic,
poignant, and mundane moments of
life.”
 Attempts to assert and reestablish
nurses’ caring practices when nurses are
rewarded more for efficiency, technical
skills, and measurable outcomes.
 States that caring practices are instilled
with knowledge and skill regarding
everyday human needs.
3. Erickson’s Caritative Caring Theory
 Theory of Carative Caring
 “Caritative nursing means that we take
‘caritas’ into use when caring for the
human being in health and suffering […]
Caritative caring is a manifestation of
the love that ‘just exists’ […] Caring
communion, true caring, occurs when
the one caring in a spirit of caritas
alleviates the suffering of the patient.”
 The ultimate goal of caring is to lighten
suffering and serve life and health.
 Inspired many in the Nordic countries
and used it as the basis of research,
education, and clinical practice.