Chapter 3
Framework of Practice
The Theoretical Foundation of
Nursing
 Nursing theory provides the theoretical
foundation of the profession.
 Theory defines what nursing is, what it
does, and the goals or outcomes of
nursing care.
 Nursing is the synthesis of many
theories.
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Components of the Theoretical
Foundation
 A theory is a set of concepts and
propositions that provides an orderly way
to view phenomena.
 Concepts and propositions are the
structural elements of a theoretical
foundation.
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Concepts
 Building blocks of a theory
 Labels or names for
phenomena/observable facts
 Assist us in formulating a mental image
about an object or situation
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Concepts
 Theories are formed by linking concepts
together.
 A conceptual framework links global
concepts together.
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Conceptual Model
 The “symbolic representation of empiric
experience in words, pictorial, or graphic
diagram, mathematical notations or
physical material.”
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Propositions
 A proposition is a statement that
proposes a relationship between
concepts.
 Propositional statements in a theory
represent the theorist’s view of which
concepts fit together.
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Theories
 A theory helps us to organize our
thoughts and ideas.
 In science, the purpose of a theory is to
guide research, support existing
knowledge, or generate new knowledge.
 The term theory is not restricted to the
scientific world.
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Importance of Nursing Theories
 Framework for thought in which to
examine situations
 Structure for organization, analysis, and
decision making
 Structure for communicating with other
nurses and other health team members
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Importance of Nursing Theories
 Assist the nursing discipline in clarifying
beliefs, values, and goals.
 Help to define the unique contribution of
nursing in the care of clients.
 Standards of clinical practice are
developed out of nursing theories.
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Process of Knowledge
Development
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Scope of Theories
 Grand Theories
 Middle-Range Theories
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Grand Theory
 Provides an overall framework for
structuring broad, abstract ideas.
 Composed of concepts representing
global and extremely complex
phenomena.
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Middle-Range Theory
 Provides a perspective from which to
view complex situations and a direction
for interventions in three levels of
abstractness.
• High middle-range
• Middle middle-range
• Low middle-range
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Florence Nightingale’s Influence on
Knowledge Development in Nursing
 Described nursing as both an art and a
science.
 Stressed the importance of caring for the
ill person rather than the illness.
 Viewed a person’s health as the direct
result of environmental influences
(cleanliness, light, pure air, pure water,
efficient drainage).
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Florence Nightingale’s Influence on
Knowledge Development in Nursing
 The turn of the 20th century marked the
beginning of hospital-based schools of
nursing.
 Nightingale’s principles were
incorporated into modern nursing theory.
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The Evolution of Nursing
Theory
 Since the early 1950s, many nursing
theories have been systematically
developed to help describe, explain, and
predict the phenomena of concern to
nursing.
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Knowledge Development
in Nursing
 Paradigm
• A particular viewpoint or perspective
• A “worldview” about the phenomena of
concern in a discipline (Kuhn, 1970)
 Metaparadigm
• The major concepts in a discipline that
names the phenomena of concern
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Knowledge Development
in Nursing
 Metaparadigm of Nursing
• Person: Individual, family or group
• Health: Continuum of wellness to terminal
illness
• Environment: Place or community where
care is provided
• Nursing: Actions; interactions of the nurse
with the person
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Knowledge Development
in Nursing
 Two individuals with different
paradigmatic views can look at the same
phenomenon and view the phenomenon
differently.
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Knowledge Development
in Nursing
 The prevailing paradigm in a discipline
represents the dominant view of
particular concepts.
 A paradigm revolution is the turmoil and
conflict that occur in a discipline when a
competing paradigm gains acceptance
over the dominant paradigm.
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Knowledge Development
in Nursing
 A paradigm shift refers to the acceptance
of the competing paradigm over the
prevailing paradigm or a shifting away
from one worldview toward another
worldview.
 Members of a discipline cannot subscribe
to two competing paradigms at the same
time.
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Knowledge Development in
Nursing
 Four Levels of Knowing
•
•
•
•
Empirical
Aesthetic
Personal
Ethical
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Early Nursing Theorists
 Hildegard Peplau
• Defined concepts of stages of nurse-client
relationships.
 Virginia Henderson
• Defined basic human needs as the unique
focus of nursing practice.
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Maslow’s Hierarchy of Needs
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Early Nursing Theorists
 Faye Abdellah
• Identified 21 nursing problems that became
the foundation of nursing diagnoses.
 Joyce Travelbee, Josephine Paterson
and Loretta Zderad
• Emphasized the humanistic and existential
basis of nursing practice to understanding
the uniqueness of patients.
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Contemporary Nursing
Theorists
 The work of contemporary theorists form
the theoretical basis for many
interventions in current nursing practice.
• Myra Levine
• Dorothea Orem
• Sister Callista Roy
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Contemporary Nursing
Theorists
 Myra Levine’s Conservation Theory
(1969)
• Four universal principles of conservation
designed to apply concepts of nursing
practice in different environments
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Dorothea Orem
 Self-Care Deficit Theory of Nursing
• Theory of Self-Care
• Theory of Self-Care Deficit
• Theory of Nursing Systems
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Roy Adaptation Model
 Developed by Sister Callista Roy, 1976.
 Combined general systems theory with
adaptation theory.
 Goal of nursing is “promotion of
adaptation” in each of four modes of
adaptation.
 Applicable to the home setting.
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Roy Adaptation Model
 The goal of nursing is “the promotion of
adaptation” in each of four adaptive
modes.
•
•
•
•
Physiologic
Self-concept
Role function
Interdependence
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Theories for the New
Worldview of Nursing
 Describe, explain, and predict the
phenomena of concern to nursing from a
more holistic perspective.
• Jean Watson
• Martha Rogers
• Rosemarie Parse
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The Theory of Human Caring
 Developed by Jean Watson in the 1980s.
 Conceptualizes human-to-human
transactions that occur daily in nursing
practice.
 Ten carative factors are classified as
nursing actions or caring processes.
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The Science of Unitary
Human Beings
 Developed by Martha Rogers in 1990.
• The person is characterized as a human
energy field that unites all aspects of the
person into a unified whole.
• Nursing aims to repattern the rhythm and
organization of these energy fields to
heighten the integrity of the person.
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Gordon’s Functional Health
Patterns
 Influenced by Maslow’s Hierarchy of
Basic Human Needs and Von Bartlaffny’s
general systems theory.
 Offer a holistic approach to the
development of nursing diagnoses and
client care.
 Provides an appropriate method for
organization of textbook topics.
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Continuing Evolution of Nursing
Theory
 Nursing is always in a state of change.
 Nursing knowledge continues to expand
in a multiplicity of ways.
 New theories will come from a global
perspective and international nursing
leaders in the 21st century.
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