LESSON 1
Theoretical Foundation of Nursing
Introduction to Nursing Theories
What is a theory?
● Is an organized system of accepted knowledge that is composed of concepts,
propositions, definitions and assumptions intended to explain a set of fact, event
or phenomena.
● “a creative and rigorous structuring of ideas that projects a tentative, purposeful and
systemic view of phenomena” (Chinn and Kramer, 1991)
Definition of Terms
Concept – an idea formulated by the mind or experience perceived and observed.
Proposition – explains the relationships of different concepts. (ex. Children do not want to
stay in the hospital because of their fear of injections.)
Definition – is composed of various descriptions which convey a general meaning and reduces
the vagueness in understanding a set of concepts.
Assumptions – is a statement that specifies the relationship or connection of factual concepts
or phenomena.
Phenomenon – Describes an idea or responses about an event, a situation, a process, a group
of events or a group of situations.
The following diagram explains the relationships of concepts, propositions, assumptions and
definitions with theory and phenomena.
How other Authors DEFINE THEORY:
Parker
(2001)
Blackwell
(2005)
Delaune &
Ladner
(2006)
Mosby
(2006)
Kozier
(2008)
“A theory, by traditional definition, is an organized, coherent set of concepts
and their relationship to each other that offers descriptions, explanations and
predictions about a phenomena.”
“[It is] a reasoned proposed explanation of an occurrence, or of something
that will occur or be produced, for which absolute proof is lacking
“A theory is a set of concepts and propositions that provide an early way to
view phenomena.”
“[It is] an abstract statement formulated to predict, explain or describe the
relationships among concepts, constructs or events. It is tested by
observation and research using factual data.”
“A theory is a supposition or system of ideas that is proposed to explain a
given phenomenon.”
Potter and
Perry
(2014)
Smith and
Parker
(2015
“A theory helps explain an event by defining ideas or concepts, explaining
relationships among the concepts and predicting outcomes.”
“A theory is a notion or an idea that explains experiences, interprets
observation, describes relationships and projects outcomes.”
Characteristics of a THEORY
● Theories can correlate concepts in such a way to generate a different way of looking at a
certain fact or phenomenon.
● Theories must be logical in nature.
● Theories should be simple but generally broad in nature.
● Theories can be the source of hypotheses that can be tested for it to be elaborated.
● Theories contribute in enriching the general body of knowledge through the studies
implemented to validate them.
● Theories can be used by practitioners to direct and enhance their practice.
● Theories must be consistent with other validated theories, laws and principles but will
leave an open unanswered issues that need to be tested.
What is Nursing?
American Nursing
Association (ANA)
Nursing is the “diagnosis and treatment of human responses to actual or
potential health problem.”
International Council of
Nurses (ICN)
Nursing encompasses “autonomous and collaborative care of individuals of
all ages, families, groups and communities, sick or well and in all settings.
Nursing includes the promotion of health, prevention of illness, and the care
of ill, disabled and dying people. Advocacy, promotion of a safe environment,
research, participation in shaping health policy and in patient and health
systems management, and education are also key nursing roles.
To assist clients in the performance of activities contributing to health, its
recovery or peaceful death that clients would perform unaided, if they had
the necessary will, strength or knowledge.
Nursing is a “dynamic discipline. It is an art and a science of caring for
individuals, families, groups and communities geared toward promotion and
restoration of health, prevention of illness, alleviation of suffering and
assisting clients to face death with dignity and peace. It is focused on
assisting the client as he or she responds to health-illness situations, utilizing
the nursing process and guided by ethico-legal moral principles.
Virginia Henderson
Association of Deans of
Philippine Colleges of
Nursing (ADPCN)
*Focused in supporting communities, families and individuals in maintaining, restoring or
achieving a state of optimum health and functioning. It is both a science and an art that is
concerned with the quality of life as defined by the clients.
What about a Nursing Theory?
●
Nursing theory is a group of interrelated concepts that are developed from various
studies of disciplines and related experiences.
•
An articulated and communicated conceptualization of invented or discovered reality
(central phenomena and relationships) in or pertaining to nursing for the purpose of
describing, explaining, predicting, or prescribing nursing care. (Meleis, 1991)
*Another theorist, Barnum (1994), stated that a complete nursing theory is one that has context,
content and process.
Components of a Theory By Barnum (1994)
Context
Content
Process
Resembles environment to which nursing act takes place.
Subject of the theory.
Method by which nurse acts in using nursing theory.
Nursing theories and models provide information about:
1.
2.
3.
4.
Definitions of nursing and nursing practice.
Principles that form the basis for practice.
Goals and functions of nursing.
Clarifies the scope of nursing practice.
Nursing theories and models are derived from concepts
1. Concept is an idea of an object, property, or event.
2. Concepts are building blocks of theories.
3. In Nursing, concepts have been borrowed from other discipline (adaption, culture,
homeostasis) as well as developed directly from nursing practice and research
(maternal-infant boding, health-promoting behaviors).
Types of concepts:
1. Empirical or concrete concepts: These are directly observable objects, events, or
properties, which can be seen, felt or heard e.g. color of the skin, communication skill,
presence of lesion, wound status etc., These are limited by time and space (it can be
viewed/measured only specific period specific setting and variable).
2. Inferential concepts: These are indirectly observable concepts, e.g. pain, dyspnea and
temperature.
3. Abstract Concepts: These concepts are not clearly observable directly or indirectly
(known as “Non-observable concepts directly”) E.g. social support, Personal Role,
Self-esteem etc.
Types of Definition of Concepts
CONCEPTUAL
OPERATIONAL
Comparable to definition from a literature
such as a dictionary, encyclopedia, and
journals.
Specifies exactly how the concept will be
determined and assess, it also identifies
procedures and operations significant to
determine concepts.
Example 1: Hospital Stay
The time during which a person is a
The total of days as patient, beginning with
registered patient in a certain hospital.
admission day and finishing with discharge.
Example 2: Ambulation
To walk from one place to another or to move Taking 6 steps without assistance.
about.
Conceptual Models and Theoretical Models
Theoretical models or frameworks are highly
established set of concepts that are testable.
Conceptual models or frameworks are
representations of an idea or body of knowledge based
on the own understanding or perception of a person or
researcher on a certain topic, phenomena or theory.
They can be represented thru a diagram
or in narrative form which shows how concepts
are interrelated.
PERSON – PHYSICAL FITNESS & EXERCISE – LOWERED BLOOD PRESSURE
CONCEPTUAL FRAMEWORK VS. THEORETICAL FRAMEWORK
CONCEPTUAL
It is a structure of concepts or theories which
are pulled together as a map for the study
THEORETICAL
It is a structure of concepts which exist or
tested in the literature, a ready-made map for
the study.
What are Nursing Paradigms?
Nursing paradigms are patterns or models
used to show a clear relationship among
the existing theoretical works in nursing
1. Person
2. Environment
3. Health
4. Nursing
1. Person/Client
- The recipient of nursing care.
- It is important to know that a person is multidimensional, thus, care provided is individualized
according to the needs of the patient.
2. Environment (or Situation)
- Internal and external surroundings that affect the person.
- Includes all possible conditions affecting the client and the setting in which health care needs
occur.
- There is continuous interaction between the client and the environment.
3. Health
- Goal of Nursing care
- The degree of wellness or well-being that the client experiences.
- Dynamic and continuously changing.
4. Nursing
- The interventions of the nurse rendering care in support of, or in cooperation with the client.
- The diagnosis and treatment of human responses to actual or potential health problems (ANA,
1995).
- The attributes, characteristic, and nature of the nurse providing care in conjunction with the
client.
PHILOSOPHY IN NURSING
•
•
Specifies the definition of metaparadigm concepts in each of the conceptual models
of Nursing.
Sets forth the meaning of phenomena through analysis, reasoning, and logical
argument.
•
Philosophies have contributed to the knowledge development in Nursing by forming
a basis for subsequent developments especially in area of human science.
SCIENCE
Any systematic knowledge or practice in a discipline of study. In a more casual sense, science
refers to a system of acquiring knowledge based on the scientific method. It is also the organized
body of knowledge gained through research.
The scientific method includes several steps:
SCIENTIFIC METHOD
Observation
Gathering Information/Data
Forming Hypothesis
Experimental Investigation
Conclusion or Theoretical Explanation
Integration of knowledge and/or
phenomenon by a rational/sentient being
Recognition and collecting data for a
particular scientific problem or inquiry.
An attempt to explain or suggest a nature of a
phenomenon.
A set of examinations done to solve the
particular query raised through the
hypothesis process.
A statement explaining a set of natural
phenomena or a scientific query derived from
Experimental Investigation.
What is Knowledge?
Knowledge can be defined as:
• Information, skills and expertise acquired by a person through various life experiences, or
through formal/informal learning such as formal education, self-study, vocational
• The abstract or workable understanding of a subject or idea.
• What is known in a particular field of discipline or study.
• Facts and information or awareness or familiarity gained by experience of a fact or situation.
Knowledge acquirement involves several cognitive processes.
Types of Cognitive Process
Perception
Association
Learning
Reasoning
Communication
Achieving understanding of sensory data.
Combining two or more concepts/ideas to
form a new concept, or for comparison.
Acquiring experience, skills, information and
values.
Mental process of seeking conclusions
through reason.
Transferring data from sender to receiver
using different mediums or tools of
communication.
What are the sources?
⮚Traditional Knowledge is a nursing practice which is passed down from generation to
generation. When asked about the basis of the nursing practice the answer would be as
simple as “It’s always been practiced this way.”
⮚Authoritative knowledge is an idea by a person of authority which is perceived as
true because of his or her expertise.
⮚Scientific knowledge is a type of knowledge which came from a scientific method
through research. These new ideas are tested and measured systematically using
objective criteria.
Types of Knowledge
TRADITIONAL and
AUTHORITATIVE
Advantage
•
Disadvantage
•
•
•
Practical to implement
Based on subjective data
Limited use in a variety of
practice setting
In nursing practice, scientific
knowledge through
evidenced-based practice and
research serves as the main
focus.
SCIENTIFIC
•
•
•
Systematic and accurate
Theories it creates are les
subjective than knowledg
gained by other methods
Requires time and effort
produce credible results
Phenomenon
A phenomenon can be defined as sets of empirical data or experiences that can be
physically observed or tangible.
It is concerned with how an individual person reacts using the human senses
concerning their surrounding and assessing the different behaviors and factors that
affect such behaviors.
In Nursing, phenomena can be:
✔
✔
✔
✔
Clinical or environmental setting of nursing
Disease process
Client’s behavior
Interventions
✔
Practices that are utilized in nursing theories and metaparadigms (person,
nursing, health and environment)
PURPOSES OF NURSING THEORY
Nursing Theory Development
Education
•
Nursing theories were primarily used to develop and guide nursing education in
universities and institutions.
•
They were once known to be more strongly established in the field of academics rather
than in clinical practice.
•
In 1970s and 1980s, a number of nursing programs recognized the major concepts of
some nursing models, structured these concepts into a conceptual framework, and build
the complete curriculum around that framework (Kozier, 2018).
✔
✔
✔
✔
●
●
Program objectives
Course objectives
Course description
Clinical performance criteria
Prepare students for practice as members of the professional community.
To ensure adequate quality nursing delivery and to clarify and improve the status of the
Nursing as a profession.
Research
●
●
To help us identify gaps in the way we approach specific fields of study such as symptom
management, quality of life
Different theoretical perspectives also help create new ideas, research questions and
interpretations
●
●
●
●
●
Grand theories "occasionally" direct nursing research.
Based on Middle-range theories which focus on the discovery of concepts such as pain,
self-esteem and learning.
Theoretical concepts from social sciences served as one of the foundations in
qualitative nursing research.
Critical theory is used in the academe to describe theories that clarify how social
structures influence a wide variety of human experiences from art to social practices.
In nursing, critical theory research helps elaborate more on how structures such as race,
gender, sexual orientation, and economic class affect experiences and health outcomes of
the patients (Kozier, 2018).
Clinical Practice
Theories thoroughly guide critical thinking and decision-making in clinical nursing
practice.
● Nurses will have a better understanding on the basis and nature of their work and be
able to express it clearly in collaboration with other professionals.
● Nursing Theories strengthen professional independence by guiding the deepest and most
important part of their practice.
● Nursing Theories are always critical in assisting nurses to facilitate questions, reflections,
and critical thinking in every aspect of care.
Example: The application of Leininger’s Transcultural Nursing Theory for developing culturally
similar strategies that is useful to nurses working with suspected child maltreatment cases.
●
Interdependence of Theory and Research
‣
The relationship between nursing theory and nursing research helps in building nursing
knowledge!
Nursing Knowledge-derived from basic and
nursing sciences, experience, aesthetics, nurse’s
attitudes, and standards of practice.
(Potter and Perry, 2018)
Composition of Nursing Knowledge
●
●
Theoretical knowledge aims to stimulate thinking and broaden understanding of the
science and practice of the Nursing discipline.
Practical knowledge is referred to as the art of Nursing because it is gained through
personal experience and learned during practice.
Nursing Research
1. Theory-generating research is designed to discover and describe relationships and
phenomena without imposing predetermined notions on the nature of the phenomena.
2. Theory-testing research is utilized to determine how accurate a theory describes a
phenomenon.
*The end result of theory-generating and theory-testing research is to enhance nursing
knowledge.
Contributions of Nursing Theorists
Theorist
Practice
Florence Nightingale
(Environmental Theory)
⮚ Environmental
Hildegard Peplau
(Psychodynamic Nursing)
Education
Research
⮚ Development of
excellent training
system in St. Thomas
Hospital and King’s
College Hospital in
London.
⮚ Scientific principles
and practical
experience in
mastery of skills.
⮚ Invented the “polar
⮚ Provides clear
design for the
practice of
psychiatric nursing
⮚ Emphasized the
development of
interpersonal
relationship
between the patient
and the nurse.
⮚ Author of
“Interpersonal
Relations in
Nursing” which aids
nurses
⮚ Formulated effective
psycho-therapeutic
methods.
⮚ Formulated
Virginia Henderson (14
components of Basic
Nursing Care)
⮚ Nurses as direct
⮚ Nurse’s education
demands universal
understanding of
diverse human
being.
⮚ Designed three
phases of curriculum
development
⮚ Recommended
library research.
⮚ Advocated research
as a way to improve
practice.
Joyce Travelbee (Human to
Human Relationship
Model)
⮚ Hospice is one of
her essential
contributions
⮚ The focus of Nursing
Education has
shifted from a
disease-oriented
⮚ Utilized by various
aspects as integral
part of nursing care:
✔ Good
Ventilation
✔ Proper disposal
control of noise
✔ Sanitation
✔ Water
treatments
caregiver help
patients to become
independent.
diagrams” to
analyze and gather
data.
concepts of anxiety
as a means to
constructively
resolve angry
feelings through
experiential
learning within the
nurse-patient
relationship.
authors in their
study of recently
finding meaning in
illness and suffering
enables the patient
not only to accept
illness but it will
also served as a
self-actualizing
experience.
approach to holistic
care approach.
⮚ Stated that nursing
programs need to
offer a much broader
background in
communication
techniques, values
clarifications, and
care of the dying.
Betty Neuman (Systems
Model)
⮚ Goal-directed,
integrated and
holistic approach to
client care
⮚ Formulated
Neuman Nursing
Process Format:
✔ Nursing Diagnosis
✔ Nursing Goals
✔ Nursing Outcomes
⮚ Holistic curriculum
⮚ Provides an effective
framework in
conceptual evolution
among levels of
education of nursing
students from
diploma to associate
to baccalaureate
programs.
⮚ Additional
clarification and
generation of
testable nursing
theories
⮚ Guide model to
enhance the nursing
care of clients with
specific
physiological
stressors.
Dorothy Johnson
(Behavioral System Model)
⮚ Used assessment,
disorders, treatment
and evaluation
instead of Nursing
Process
⮚ “The behavioral
system is said to
determine and limit
the interaction
between the patient
and his
environment.
⮚ Focuses on the
⮚ Stated that nursing
patient as a
behavioral system
and its dysfunction.
research would:
“Identify and
explain the
behavioral system
disorders which
arise in connection
with illness, and
develop the
rationale for the
means of
management.”
Imogene King (Goal
Attainment Theory)
⮚ Utilized by
⮚ Nursing curriculum
⮚ Her work served as
development and
practice application
in Ohio State and
other universities.
a theoretical basis
for various studies.
⮚ Asserted that
professionals in
most specialty
areas.
⮚ Developed the Goal
Oriented Nursing
Record (GONR)
which is used to
record goals and
diagnosed cancer
patients and their
personal search for
meaning.
outcomes in patient
settings.
Dorothea Orem (Self Care
Deficit Theory in Nursing)
⮚ Described nursing
⮚ Came up with the
⮚ Developed a
management of
Pertussis.
⮚ Teaching self-care
to diabetic patients
and End-Stage
Renal Failure.
⮚ Pain assessment
and control
idea of a need for a
nursing-specific
knowledge structure.
⮚ Author of “Guides
for Developing
Curriculum for the
Education of
Practical Nurses”
and “Foundations of
Nursing and Its
Practice”.
number of
instruments for
research.
⮚ The 1st instrument
developed named
Exercise Self-Care
Agency (ESCA)
which is used to
determine the
capacity of patients
to care for their
selves.
Faye Abdellah (Typology of
21 Nursing Problems)
⮚ Organized and
⮚ The typology
⮚ Believed that
Sr. Callista Roy (Adaptation
Model)
⮚ Manipulating the
systematic basis of
nursing practice.
⮚ Typology helps in
efficient
assessment, nursing
diagnosis and
planning
interventions.
⮚ Uses scientific basis
in problem-solving
process.
stimuli and not the
patient.
⮚ Nurses enhance the
interaction of
person and their
environment thus
improving health.
provided scientific
body of knowledge
and filled-in the gaps
of weaknesses in
nursing education.
⮚ Development of
⮚
✔
✔
✔
⮚
✔
curriculum
development in
various institutions.
Three vertical
strands in the
curriculum:
The adapting person
Health-Illness
Nursing
Management
Two horizontal
strands in the
curriculum:
Nursing Process
evidenced-based
practice on
scientific data has a
great impact in
nursing research.
⮚ Development and
testing of theories.
⮚ Practice-based
research.
⮚ Development of
programs of
research.
⮚ Development of
adaptation research
instruments.
✔ Student Adaptation
and Leadership
Madeleine Leininger
(Transcultural Nursing)
⮚ Prepares nurses to
⮚ Helps produce a
⮚ Focused on culture
prevent culture
shock and conflicts
as they practice in
different places with
different cultures
⮚ Provides human
care and health
behaviors as
background
knowledge to
understand nursing
phenomena.
well-qualified faculty
prepared in
Transcultural
Nursing to teach and
guide students.
⮚ Education in
Transcultural
Nursing leads to
culturally competent
nursing care.
care.
⮚ With research
method of
(ethno-nursing) to
examine theories.
Jean Watson (Philosophy
and Science of Caring)
⮚ Caring as an
⮚ Author of “Nursing:
⮚ Research must
essential field in
nursing.
⮚ Example in clinical
setting (Intensive
Care Units,
Neonatal Intensive
Care Units,
Pediatric and
Gerontological
Units)
Human Science and
Human Care- a
theory of “Nursing”
⮚ Described the Core
of Nursing as aspects
of the nurse-patient
relationship
resulting in a
therapeutic result.
focus on both
subjective and
objective patient
outcomes in
knowing that caring
is important in
nursing.
Patricia Benner (From
Novice to Expert:
Excellence and Power in
Clinical Nursing Practice)
⮚ Formulated the
⮚ Learning needs at an
⮚ Extended the study
1.
2.
3.
4.
MARTHA ROGERS
(Science of Unitary Human
Being)
Levels of
Competency in
Nursing Practice:
Novice
Advance Beginner
Competent
Proficient
Expert
⮚ Nursing
intervention is
always focused on
unitary human
being and change
the energy field
early stage of clinical
knowledge are
different from those
needed in later stage.
⮚ Seminars and
trainings for nurses
should focus more
on teaching
non-invasive
interventions such as
meditation,
of formal models
which direct care
and substitute
knowledge used in
nursing practice.
⮚ The theory has been
used by various
researchers as it is
applicable and
found testable in
different settings
and studies.
between human and
environment.
⮚ Nursing
interventions
include all the
noninvasive actions
such as guided
imagery, humor,
therapeutic touch,
music therapy, etc.
which are used to
increase the
potential of human
being
ERNESTINE
WIEDENBACH
(Prescriptive Theory)
IDA JEAN ORLANDO
(Deliberative Nursing
Process Theory)
⮚ Provides foundation
for assessing or
explaining client
conditions.
⮚ Influenced many
core concepts in
nursing today,
including nursing
assessment, nursing
process and nursing
diagnosis such as
self-care deficits.
⮚ The theory stresses
the reciprocal
relationship
between the client
and the nurse.
⮚ The dynamic
concept of the
nurse-client
interaction is seen
through
collaboration
therapeutic touch,
and service
education programs.
⮚ Wiedenbach
proposed that
nursing education
serves the practice in
the following ways:
1. Future practitioners of
nursing
2. To gain experience in
clinical areas of hospital
3. Its representatives may
function in the clinical area
and may work closely with
the staff
4. Validation that need for
help was met
5. Educational opportunities
to the nurse
⮚ The theory is used in
the academe by
focusing on
individual learning
needs of the students
and by addressing
them together with
student’s active
participation.
⮚ In her model, the
focus of nursing
research is to be
related to the
client’s response to
the health care
experience. Her
model promotes
family relationships,
control factors that
disable conditions,
and use healthcare
practices, such as in
the care of clients
with cancer.
⮚ The theory provided
a framework on how
to produce
improvement in the
client’s behavior.
Evidence of
relieving the client’s
distress shows
positive changes in
the client’s
condition.
⮚ Serves as an
evidence-based
between the nurse
and the client.
practice in deciding
and helping
whether nursing
action solve client’s
problems.
ROSEMARIE RIZZO
PARSE (Theory of Human
Becoming)
⮚ Provides an
alternative nursing
approach to solving
client’s problem by
focusing on how the
client perceives
them.
⮚ Provides nurses
with emphasis that
actions should focus
on valuing the
client’s experiences.
understanding of
the nursing
education which
focused on personal
meaning and
experiences of the
clients rather than
the traditional
theoretical
frameworks.
LYDIA HALL (Care, Core,
Cure Theory in Nursing)
⮚ Creation of the Loeb
⮚ Her theory supports
Center for Nursing
and Rehabilitation
at Montefiore
Medical Center. The
center’s major
orientation was
rehabilitation and
subsequent
discharge to home
or to a long-term
care
⮚ The center’s guiding
philosophy was
Hall’s belief during
the rehabilitation
phase of an illness
experience,
professional nurses
were the best
prepared to foster
the rehabilitation
process, decrease
complications and
recurrences, and
promote health and
the model of
primary care
nursing and
delineates definite
ideas on
professional
nursing practice
and education in
terms of screening,
monitoring and
evaluating academe
staff and mentors.
It has contributions
on the development
on the concepts of
care in the
following areas:
Critical care,
Geriatrics, Dialysis,
Perioperative
⮚ Creates a deeper
⮚ The theory is applied
in crisis to change
situations clients go
through by conducting
qualitative research.
⮚ Focuses on lived
experiences of the
client which are the
foundation of
phenomenological
research.
⮚ In addition to case
study research by
nurses who worked at
Loeb, an 18-month
follow-up study of the
outcomes of care was
funded by the
Department of Health,
Education and
Welfare. The purpose
of the longitudinal
study was to compare
selected outcomes of
two groups of patients
exposed to different
nursing environments
(the Loeb program
and a control group).
Outcomes examined
were cost of hospital
stay, hospital
readmissions, nursing
home readmissions,
mortality, and return
to work and social
activities. Overall
findings suggested
prevent new
illnesses.
that the Loeb group
achieved better
outcomes at less
overall cost.