Theories of Nursing
Practice
What is a theory?
 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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What are the components of a
theory?
 Concepts – ideas and mental
images that help to describe
phenomena (Alligood and
Marriner-Tomey, 2002)
 Definitions – convey the
general meaning of the
concepts
 Assumptions – statements
that describe concepts
 Phenomenon – aspect of
reality that can be consciously
sensed or experienced
(Meleis, 1997).
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What is a paradigm?
 A model that
explains the linkages
of science,
philosophy, and
theory accepted and
applied by the
discipline (Alligood
and Marriner –
Tomey, 2002)
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What is a domain?
 The view or
perspective of the
discipline
 It contains the
subject, central
concepts, values and
beliefs, phenomena
of interest, and the
central problems of
the discipline
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How does domain relate to
nursing theory?
 Nursing has
identified its domain
in a paradigm that
includes four
linkages:
1) person/client
2) health
3) environment
4) nursing
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Purposes of nursing theory
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What are the purposes of nursing
theory?
 It guides nursing
practice and
generates knowledge
 It helps to describe
or explain nursing
 Enables nurses to
know WHY they are
doing WHAT they
are doing
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Types of nursing theories
 Grand theories – broad
and complex
 Middle-range theoriesaddress specific
phenomena and reflect
practice
 Descriptive theories –
first level of theory
development
 Prescriptive theories –
address nursing
interventions and predict
their consequences
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Why on earth do we study
nursing theory?
 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)
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“The study and use of
nursing theory in nursing
practice must have roots in
the everyday practice of
nurses (Gordon, Parker, and
Jester, 2001).
So how do nurses use theory in
everyday practice?




Organize patient data
Understand patient data
Analyze patient data
Make decisions about
nursing interventions
 Plan patient care
 Predict outcomes of care
 Evaluate patient
outcomes
(Alligood, 2001)
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How do student nurses begin to
use nursing theory?
 By asking yourself
two very important
questions…..
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Student nurse questions
 What is the nature of
knowledge needed for
the practice of nursing?
 What does it mean to me
to practice nursing?
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Nursing also utilizes non-nursing
theories
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Commonly used non-nursing
theories
 Systems theory
 Basic Human Needs
theory
 Health and Wellness
Models
 Stress and
Adaptation
 Developmental
Theories
 Psychosocial
Theories
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What is the link between nursing
theory and the research process?
 Theory provides direction
for nursing research
 Relationships of
components in a theory
help to drive the research
questions for
understanding nursing
 Chinn and Kramer
(2004), indicate a spiral
relationship between the
two
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Current trends that influence
nursing theory
 Medical science
 Nursing education
 Professional nursing
organizations
 Evolving research
approaches
 Global concerns
 Consumer demands
 Technologies
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“ Practicing nurses who despise
theory are condemned to
performing a series of tasks either at the command of a
physician or in response to
routines and policies.”
Leah Curtin, RN, MS, FAAN
(1989)
Former Editor, Nursing
Management
Objectives
Define theory
and list
characteristics
of a theory
Trace the
development
of a nursing
theory
Describe the
components
of a theory
and its use
Describe the
different types
of theories
and examples
of each.
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Some commonalities
Purpose
Concepts
Definitions
Propositions
Structured ideas
Tentative
Describe a phenomenon or occurrence
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Components/Elements of
theory
1.Purpose “Why is the theory
formulated”
2.Concepts are building blocks of
theory – ideas, mental images of a
phenomenon, an event or object that
is derived from an individual’s
experience and perception
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Components/Elements of
theory
3.Has a major concept like nursing,
person, health or environment.
4. Definitions give meaning to
concepts which can either be
descriptive or procedural (stipulateuse of term within the theory)
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Components/Elements of
theory
Propositions are
expressions of
relational statements
between and among
the concepts. It can
be expressed as
statements,
paradigms or figures
. AKA as theoretical
assertions
Assumptionsaccepted “truths”
that are basic and
fundamental to the
theory. Or value
assumptions where
what is good or right
or ought to be.
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Characteristics of a Theory
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)
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How does a theory develop?
Four
strategies of
theory
development
• Theory
practice theory
( theory
developed in
other discipline
and used in
nursing
situations)
• Practice – theory
evolved from
clinical practice
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How does a theory develop?
3. Research theory or inductive method
Must evolve from research findings or
empirical evidence.
4. Theory research theory
theories developed by other disciplines
are utilized but given unique nursing
perspective. Original theory examined
and given a new research findings.
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TERMINOLOGY
METAPARADIGM
- Most abstract level of knowledge. In
nursing this is main concepts that
encompasses the subject matter and the
scope of the discipline
- Central concepts of person, environment,
health and nursing
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TERMINOLOGY
 Philosophy
- Knowledge level which specifies the
definitions of the metaparadigm concepts
in each of the conceptual models of
nursing.
- Nightingale is considered philosophical
approach
- Out of these philosophies theory maybe
formalized
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Conceptual models
 Frameworks or paradigms that provide a
broad frame of reference for the
systematic approaches to the
phenomena with which the discipline is
concerned.
 -different views nursing like Roy focuses
on adaptation, King on interaction and
Abdellah on interventions
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theory
Group of related concepts
that propose actions that
guide practice
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Nursing theory
Group of related concepts that derived
from the nursing models. Some derive
from other nursing discipline like
LEininger which comes from
anthropology
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Uses of theory
1. 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.
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Uses of theory
2. Theory guides research
according to Meleis, primary use of
theory is to guide research. It validates
and modifies the theory.
3. Theory contributes to the development
of the disciplines body of knowledge
4. Theory enhances communication
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Historical Development
 Role of nurses where
questioned; what
they do, for whom
where and when
were determined.
 purpose of nursing,
process of theory
development was
discussed
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First Conference in Nursing theory
Brought leading scholars and theorists to discuss
and debate on issues regarding nursing
science ad theory development.
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Historical Development
 Writings of Dickoff,
James and Wiedenbach
“Theory in a Practice
Discipline” influenced
the theoretical thinking in
nursing . They presented
a definition of nursing
theory and goals for
theory development in
nursing, approaches
where discussed
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Categories of nursing theories
client
nurse
`
environment
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Process of Knowledge
Development
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Scope of Theories
 Grand Theories
 Middle-Range Theories
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Maslow’s Hierarchy of Needs
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