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INTRODUCTION
TO
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THEORETICAL NURSING
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onal Association ofAfter
Long
Term this
Care
Administrator
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completing
chapter
the student should
be able to
1. Identify and define terminology related to theoretical thinking
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2.NOT
Identify
and SALE
describe OR
several
types of theoretical works in nursing
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3.National
Identify and
explain the fourof
metaparadigm
concepts
nursing
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Long Term
CareofAdministrator
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e y T e rLearning,
ms
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Assumptions
Clarity
Concept
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Health
Human being (person)
Metaparadigm
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Conceptual
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Derivable consequences
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Nursing
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Philosophies
of nursing
precision
Proposition
of Empirical
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Environment
Simplicity
Generality
Theory
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N ursing T heories : A F ramework for P rofessional P ractice
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A
lthough the beginning of nursing the-
oryTerm
development
can be traced to Florence
National Association of Long
Care Administrator
Boards
Night­in­gale, it was not until the second half
of the twentieth century that nursing theory caught the
© Jones &BACKGROUND
Bartlett Learning, LLC
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attention of nursing as a discipline. During the decades
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of the 1960s and 1970s, theory development was a
topic
of discussion andBoards
publication. During the
National Association of Long Termmajor
Care
Administrator
1970s, much of this discussion related to the development of a single global theory for nursing. However,
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Jones
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Learning,
in the©
1980s,
attention
turned away
from the LLC
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ment of a global theory for nursing, as schol­­ars began to recognize the
validity
of Administrator
multiple approachesBoards
to theory development in nursing.
onal Association of Long Term
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Because of the plurality in nursing theory, this information must be
organized to be mean­­ingful for practice, research, and further knowl­­edge
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& BartlettThe
Learning,
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goal of this LLC
chapter is to present an organized
and pracNOT
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tical overview of the major concepts that are essential to understandingSALE OR DISTR
perspective in professional nursing practice. Definitions of key
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terms are included throughout the discussion.
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T
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NOTtheory
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o apply nursing
in practice,
the
nurse must have some knowledge of the theoretical works of the nursing profession. Theoretical
STRUCTURE
works in nursing are generally categorized either as
philosophies,
conceptual
models,
theories, orLLC
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The most abstract of these theoretical works are the
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of nursing, followed by the conceptual
models, theories, and middle-range theories. However,
the metaparadigm
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Metaparadigm
Nursing
Before discussing the metaparadigm concepts that are important to nurs© JonesA&concept
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define the term “concept.”
is aLearning,
term
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ing, it is important
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chapter 1 Introduction to Theoretical Nursing Knowledge
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3
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or label that describes a phenomenon or group of phenomena (Meleis,
2007). National
The label may
be a word or phrase
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Careideas,
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vations, and experiences so as to provide a mental image for the purpose
of facilitating communication and understanding about the phenomenon
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(Fawcett, 2005). The phenomenon described by a concept may be either
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empirical or abstract. An empirical concept is one that can be either
or experienced
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An abstract concept
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that is not observable, such as hope or caring (Hickman, 2002).
A metaparadigm is the most global perspective of a discipline. A
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disciplines
metaparadigm
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that identify the phenomenon of central interest to a discipline, the global
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gles out phenomena of interest that it will deal with in a unique manner. models. Multiple
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The concepts
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nomena are even more abstract in the metaparadigm than those found in NOT allow
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discipline
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allows members of the discipline to identify and communicate the bound- the phenomena
aries of the subject matter specific to the discipline (Kim, 2000). Most of interest in
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different ways.
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the central concepts of the©discipline
as person
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❖❖ Health: human processes of living and dying
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N ursing T heories : A F ramework for P rofessional P ractice
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National
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outcomes of nursing actions; the process of which encompasses
activities that
referred
to asCare
assessment,
diagnosis (labeling),
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ofare
Long
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Administrator
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planning, intervention, and evaluation (Fawcett, 2005, p. 6)
BecauseLLC
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Sub­­­sequently, multiple theories have been developed from each concepphenomena
within the model. These conceptual models and theories of nursing reprefrom the
meta­­paradigm
of the discipline
nes & Bartlett Learning, LLCsent various paradigms derived
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nursing. There­fore, although
of the
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theories may link and define the four metaparadigm concepts somewhat
onal Association of Long Term
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differently,
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ent and
defined either implicitly or explicitly in each of the models and theories.
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an effort
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predict the
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Philosophies
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of nursing
set forth
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general
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and
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nursing phenomena through reasoning and the logical presentation of
ideas. Phi­los­o­phies are broad and address general ideas about nursing.
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Because of their
contribute
to the discipline
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been categorized as philosophies of nursing will be presented in Chapters
3 through 6 of this book.
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Conceptual Models ofNOT
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propositions that provide a frame of reference for members of a discipline.
This frame of reference determines how the world is viewed by members
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guides theLLC
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make
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that integrate the concepts into a meaningful configuration (Lippitt,
1973; as cited in Fawcett, 1994). Assumptions are accepted as truth and
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represent the
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or conceptual
framework.
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chapter 1 Introduction to Theoretical Nursing Knowledge
5
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Assumptions form the basis for defining concepts and framing propositions (Meleis,
2007).
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is aLong
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about
a concept
or a
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statement of the relation between two or more concepts (Fawcett, 2005).
Conceptual models of nursing are models containing abstract con© Jones & Bartlett Learning, LLC
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ticular type of patient, situation, or event (Fawcett, 2005, p. 16). At the
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described in a manner unique to the model, with the model providing an
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pline. The definitions
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model are formal and explicit. Thus they identify the purpose and scope
nurses,
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In addition, they provide a framework for recording the effects of nursing.
Using a conceptual model or framework also helps to provide consistency
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Nursing Theories
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A nursing theory is more specific than
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a conceptual model (Alligood,
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a set of statements
significant
in a discipline
that
are communicated in a meaningful whole . . . discovered or invented
for describing, predicting, or prescribing events, situations, conditions, or
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relationships” (Meleis, 2007, p. 37). More specifically, nursing theory is
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defined by Meleis (p. 41) as “a conceptualization
of some
aspectOR
of reality
or Term
discovered)
pertains to nursing.
The conceptualization
onal Association(invented
of Long
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is articulated for the purpose of describing, explaining, predicting, or prescribing nursing care.” According to Fawcett (1994), “The primary distinc© Jones
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tion between
a conceptual
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and a theoryLLC
is the level of abstraction. The
distinction
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between a
linking statements. A theory, in contrast, deals with one or more specific,
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concrete concepts and propositions.”
and a theory
Theories vary in their scope and level of abstraction. The theory that is the level of
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abstraction.
in scope
and highly
abstract conceptually may ©
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6
N ursing T heories : A F ramework for P rofessional P ractice
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as a grand theory, whereas the theory that has a narrow scope and is
concrete or practical
may
be referred
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theory
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CaretoAdministrator
(Fawcett, 2005, p. 19). Middle-range theories also generally include fewer
concepts and propositions (Fawcett, 2005), represent a limited or partial
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view of nursing reality and are more appropriate for empirical testing
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& Smith, 1999), and are more applicable to practice (Smith, 2008).
theoriesCare
may be
derived from existing
conceptual models
National Association ofNursing
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Administrator
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of nursing. Such theories evolve from nursing reality as perceived by the
theorist. Nurse theorists, like other nurses, are affected by both historical
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their lives.Learning,
Nursing theories
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also evolve from a perception of ideal nursing practice. As a consequence,
various
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theories represent
different realities and address different
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aspects of nursing (Meleis, 2007). For this reason, the multiplicity of nursing theories presented in the following chapters should not be viewed as
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& Bartlett
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theories,
but ratherLLC
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vide insight into different ways to describe, explain, and predict nursingSALE OR DISTR
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Curley (2007, p. 3) describes this understanding in an interesting way
by comparing the multiplicity of nursing theories to a collection of maps
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& Bartlett
Learning,
LLC
of the sameLLC
region. Each map may display
a different
characteristic
of
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the region, such as rainfall, topography, or
air currents.
Although
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needed or the question being asked. This is precisely the case with the
nurse’s choice of nursing theories for practice.
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S
everal authors have devised criteria for
onal Association of Long Term Care Administrator
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the analysis
and evaluation of nursing concep-
ANALYSIS AND
tual models and theories. In general, the criteria that areLLC
used for analysis include examination
EVALUATION
OF
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the origins of the model relative to logic and reasoning
THEORETICAL
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as well as the work of other scholars who have influKNOWLEDGE
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enced
the thinking
the theorist,
the unique focus
of
NURSING
the model, and the definitions of the metaparadigm
concepts (Fawcett, 2005, p. 52–53). Other authors sug-
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gest that the criteria for analysis should include clarity,
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C R I T I C A L
simplicity, generality, empirical precision, and derivable consequences
T H I N K I N G
(ChinnNational
& Kramer, 2008,
p. 237). Clarity
refers to
consistency
terms of
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terminology and structure—or put simply, “How clear is the theory?” (p.
237). Simplicity is highly valued in nursing model and theory develop© Jones & Bartlett Learning, LLC
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ment: “How simple is this theory?” (p. 237). Generality refers to the scope
think of
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of the concepts and the purpose of the theory (Alligood, 2010, p. 12)
additional
is reflected in of
theLong
question,
“How
general
is this theory?” (Chinn
&
Nationaland
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Administrator
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criteria that
Kramer, 2008, p. 237). The fourth criterion in analytic schema is empiri- should be
cal precision, which is linked to the testability and usability of the theory added to the
nes & Bartlett Learning,
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(Alligood, 2010,
(2008, p.&237)
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notion by asking, “How accessible is this theory?” Finally, the last cri- and evaluation
is “How
important
this theory?” (p.237)—that
onal Associationterion
of Long
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CareisAdministrator
Boardsis, the derivable of models and
theories? If so,
consequences of the theory.
Suggested evaluation criteria include an explanation of the origins of what are they?
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cal claims of the theorist. This step is followed by an exploration of the
adding these
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the depth and the breadth of the model to ascertain, for example, if definitions of the metaparadigm concepts of the discipline are included. The
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and social significance.
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whether
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special
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of social congruence considers whether the model will lead to nursing
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Finally, in step 6 of the evaluation process, a determination is made
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the expectation is that the model will enhance understanding of the pheof interest rather than being based up any type of comparison of
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one model to another (Fawcett, 2005, p. 54–57).
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A combination of these criteria will be used in the brief analysis of
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chapters
that follow in this
book.
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While some of the theories will fare better than others based on the way
they satisfy these criteria, in the final analysis all of the theorists whose
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work is included in the subsequent chapters of this book have made subNOT FOR SALE OR stantial
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contributions to the discipline of nursing.
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chapter 1 Introduction to Theoretical Nursing Knowledge
9
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C l as s r o o m A c t i v i t y 1 - 1
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Select one nursing model or theory for review. Review the chapter
in this book that pertains to this model or theory, and conduct an
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Jones &
andLearning,
evaluation ofLLC
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in Bartlett Learning, LLC
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fellow students, and discuss areas of agreement and disagreement.
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REFERENCES
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Alligood, M. R. (2006). Philosophies, models, and theories: Critical thinking structures. In M. R. Alligood & A. M. Tomey (Eds.), Nursing
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LLC
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theory: Utilization and application (3rd ed., pp. 43–65). St. Louis:
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Mosby.
M. R.
(2010).
Introduction
to nursing theory:
Its history, signifiNational AssociationAlligood,
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cance, and analysis. In M. R. Alligood & A. M. Tomey (Eds.), Nursing
theorists and their work (7th ed., pp. 3–15). Maryland Heights, MO:
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Mosby.
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Chinn, P. L., & Kramer, M. K. (2008). Integrated knowledge development
in nursing
(7th ed.). St. Louis,
MO: Elsevier-Mosby.
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Administrator
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Curley, M. A. Q. (2007). Synergy: The unique relationship between nursing
and patients. Indianapolis, IN: Sigma Theta Tau International.
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& Bartlett
Learning, LLC
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J. (1994). Analysis and evaluation conceptual models of nursing.
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Philadelphia: F. A. Davis.
J. (2005). Contemporary
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evaluNationalFawcett,
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ation nursing models and theories (2nd ed.). Philadelphia: F. A. Davis.
Hickman, J. S. (2002). An introduction to nursing theory. In J. B. George
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ed., pp. 1–20). Upper Saddle River, NJ: Prentice Hall.
S. (2000).
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Liehr, P., & Smith, M. J. (1999). Middle range theory: Spinning research
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Lippitt, G. L. (1973). Visualizing change: Model building and the change
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process. Fairfax, VA: NTL Learning Resources.
Meleis, A. I. (2007). Theoretical nursing: Development and progress (4th
Philadelphia:
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