Chapter One Notes:
Definition of a theory:
 Represents a theorist’s thoughtful examination of a phenomenon, defined as a
concrete situation, event, circumstance, or condition of interest.
 In Nursing, theory represents a well-defined view of professional , which
differentiates its focus and activities from those of other professions
 Nurses use theoretical frameworks to describe, explain, predict and prescribe
nursing practice
o Descriptive theory frameworks describe the properties and components of
nursing as a professional discipline
o Explanatory theory identifies the function of nursing and how the
components relate to each other
o Predictive theories foretell the relationship between the components
o Prescriptive theories focus on Nursing therapeutics and identify what will
happen if a particular intervention is used
Role of Theory:
 Provide professional nurses with a systematic way to view client situations and a
logical way to organize and interpret health data
o The client is the focus, and the goal is to promote and maintain the health
and well-being of individuals, families and communities
 Establish the boundaries and domain of professional nursing
Development of Nursing Theory
 The first Nursing theorist was Florence Nightingale, with her classic work Notes
on Nursing, published in 1859
o Nightingale believed that nurses could create environments beneficial to
the restoration and preservation of health
 Nursing theories are classified according to their levels of abstraction
o Grand theories encompass thinking about nursing as a whole and are the
most abstract of theoretical knowledge
o Mid-range theories cover more discrete aspects of phenomenon specific to
professional nursing, exploring them in depth. The concept must be
applicable to many nursing situations and easily recognized and
operationalized in nursing theory and the basic assumptions must fit the
theory. These can derive from a grand theory.
o Practice theories present situation producing guidelines for evidence based
practice. Practice theories may be as simple as a single concept that is
operationalized, and may be linked to a specific population or situation
Nursing Meta-paradigms
 A paradigm is defined as a worldview with global concepts underlying the
theories and methodology of a particular discipline
 Nursing’s consists of four concepts:
o Person:
 the recipient of nursing care, whom must be considered as a
functional whole with unique dimensions. This may encompass the
family, community, or a target population.

Preserving and protecting the clients basic integrity and health
rights as a unique individual are the ethical responsibilities of a
nurse to a client
o Environment:
 Refers to the internal or external context of the client in the health
care situation
 The nurse considers the cultural, developmental, physical, and the
psychosocial conditions that influence the clients perceptions,
behavior, growth and development
o Health:
 Multidimensional
 Quality of life is an important dimension of health
o QOL is a personal experience having to do with “life
satisfaction” or well-being that includes, but is not limited
to physical health
o Nursing:
 ICN defines Nursing as: “Nursing encompasses autonomous and
collaborative care of individuals of all ages, families, groups and
communities, sick or well in all settings. Nursing includes the
promotion of health, prevention of illness, and care of the ill,
disabled or dying people. Advocacy, promotion of safe enviro,
research, participation in shaping health policy and in patient and
health systems management, and education are also key nursing
roles.”
 Caring:
o Giving of self
o Involved presence
o Intuitive knowing and empathy
o Supporting the patients integrity
o Professional competence
Four Patterns of Knowing:
 Empirical ways of knowing- grounded in science and evidenced in the scientific
principles that a nurse consistently incorporates in all phases of the nursing
process
 Personal ways of Knowing- helps nurses understand the humanness of others.
Personal knowing occurs when a nurse is able to intuitively understand and treat
individual clients as unique human beings because of their own awareness.
 Aesthetic ways of knowing- allow for creative applications in the relationship
designed to connect with clients in another more meaningful way
 Ethical ways of knowing- moral aspects. Encompass the knowledge of what is
right and wrong, attention to standards and codes in making moral choices, and
taking responsibility for one’s actions.
Evidence Based Nursing Practice:

The conscientious explicit and judicious use of current best evidence in making
decisions about the care of individual patients.
 Four components are required:
o Best practices, derived from consensus statements developed by expert
clinicians and researchers
o Evidence from scientific findings in research based study. The “evidence”
is found in published journals .
o Clinical nursing expertise of professional nurses, including knowledge of
pathophysiology, pharmacology and psychology
o Preferences and values of client and family members.
Hildegard Peplau:
 Shifted the focus from what nurses do to clients to what nurses do with clients
 Viewed nursing as a “developmental educational instrument” designed to help
achieve changes in health status.
 As participant-observers nurses must actively engage with their clients,
simultaneously observing clients behaviors and their own responses and providing
assistance, info and encouragement
 Described four developmental phases of a relationship:
o Orientations phase
o Working phase- composed of identification and exploitation
o Termination/ Resolution phase
Contributions from other disciplines:
 Sigmund Freud
o Transference- client projects irrational attitudes and feelings from the past
on to people in the present.
o Countertransference- feelings refer to unconscious attitudes or
exaggerated feelings a nurse may develop towards a client
o Focused on the role of anxiety in explaining problematic behaviors and
identified ego-defense mechanisms ( methods people use to protect
themselves from anxiety.)
 Carl Jung
o Examined the complex dimensions of a person
 Harry Stack Sullivan
o Introduced idea of the therapeutic relationship as a healing human
connection
 Martin Buber
o I-thou relationship- neither is an object of study. Each individual responds
in a respectful manner
 Carl Rogers
o Identified three helper characteristics in the development of a clientcentered relationship: unconditioned positive regard, empathetic
understanding and genuineness
 Aaron Beck
o Identified three variables instrumental in maintaining dysfunctional
thinking:
 Cognitive distortion- automatic thoughts to stressful situations
 Cognitive triad- negative view of self
 Schemata- cognitive biases
 Abraham Maslow
o Hierarchy of Needs
 Erik Erikson
o Development as a linear process
Communication
 Linear Theory
o Sender- the source or initiator of the message. Encodes the message.
o Message- verbal or non-verbal expression of the of thoughts
o Receiver-recipient of the message. Decodes the message
 Circular Transactional Theoretical Models
o Expands the linear model to include communication, feedback loops, and
validation
 Symmetrical relationships are equal
 Complementary roles typically operate with one person holding a
higher position
 Metacommunication is a non-verbal message about how a message
should be interpreted
 Feedback is the response the receiver gives to the sender.
 Validation is a form of feedback that provides confirmation
 Therapeutic Communication
o A purposeful form of communication used in the helping relationship