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									Theoretical Foundations of
Nursing

        Prof. Dawn Capaque
       MIT, San Lorenzo Ruiz
      School of Health Sciences
Objectives

 Define theory and list characteristics
 of a theory
 Describe the components of a theory
 and its use
 Trace the development of a nursing
 theory
 Describe the different types of
 theories and examples of each.
Introduction to Theory
 Nursing as a profession
 There has been questions about whether
 nursing is a profession or an occupation.
 An occupation is a job a career.
 A profession is a learned vocation or
 occupation that has status of superiority and
 precedence within a division of work. It needs
 widely varying levels of training or education,
 skills and variable knowledge base. All
 professions are occupations but not all
 occupations are professions (Logan,Franzen,
 Butcher,2004;Schwiran , 1998)
Characteristics of a profession
1. Utilizes in its practice a well-defined
   and well organized body of
   specialized knowledge on the
   intellectual level of the higher
   learning.
2. Constantly enlarges the body of
   knowledge it uses and improves its
   techniques of education and service
   by the use of scientific method.
Characteristic of a profession
3) Entrusts the education of its
  practitioners to institutions of higher
  education.
4) Applies its body of knowledge in
  practical services that are vital to
  human and social welfare.
5) Functions autonomously in the
  formulation of professional policy and
  in the control of professional activity.
Characteristics of a profession
   6. Attracts individuals of intellectual and
   personal qualities who exalt service above
   personal gain and who
  recognize their chosen occupation as a life
   work.
7. Strives to compensate its practitioners by
   providing freedom of action, opportunity for
   continuous professional growth and
   economic security.
Definitions of theory

1. Pinnel and Menesis (1986)
    Systematic set of interrelated
   concepts, definitions and deductions
   that describe, explain or predict
   interrelationships
Definitions of a theory

2. Walker and Avant (1983)
Internally consistent group of relational
  statements (concepts, definitions and
  propositions) that presents a
  systematic view of phenomenon and
  which is useful for description,
  explanation, prediction and control
Definition of a theory

3. Chinn and Krammer
  creative and vigorous structuring of
  ideas that project a tentative,
  purposeful and systematic view of
  phenomena
Definitions of a theory

 Ellis
 coherent set of hypothetical,
 conceptual and pragmatic principles
 forming a general frame of reference
 for a field of inquiry
Some commonalities

Purpose
Concepts
Definitions
Propositions
Structured ideas
Tentative
Describe a phenomenon or occurrence
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
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 (stipulate-use of term
  within the theory)
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
Assumptions- accepted “truths” that are
  basic and fundamental to the theory.
  Or value assumptions where what is
  good or right or ought to be.
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)
Theory Development


     Prof. Dawn M. Capaque
      MIT, School of Health
             Sciences
How does a theory develop?

   Four strategies of theory
   development
1. Theory practice theory ( theory
   developed in other discipline and
   used in nursing situations)

2. Practice – theory
   evolved from clinical practice
 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.
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
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
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
theory

 Group of related concepts that
 propose actions that guide practice
Nursing theory

 Group of related concepts that derive
 tfrom the nursing models. Some
 derive from other nursing discipline
 like LEininger which comes from
 anthropology
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.
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
Uses of theory




    4. Theory enhances
       communication
Theory Development in
Nursing: Historical Overview

          DMCAPAQUE
Where do I begin?
Florence Nightingale
- Considered first modern nursing theorist
- First one to delineate what is considered
  the nursing goal and practice domain.
- “ placing the client in the best condition for
  nature to act upon him”
- Taught about symptoms and what they
  indicate, rationale for actions and trained
  powers of observation and reflection
Historical Development of Nursing
Theories: Significant Events
 Nightingale until the 50’s
 Florence Nightingale Notes on Nursing
 control of the environment to care for the
 individual (ventilation, light, warm , noise
 absence or reduction, cleanliness & diet )

1952 Nursing Research Journal publication

1960’s nature of nursing practice was
  debated, defined nursing practice, or
  develop nursing theory, and created a
  substantive body of knowledge
Historical development

 1960-1970 proliferation of conceptual
 models and frameworks, and
 philosophy of nursing.
 Examples: Abdellah 21 nursing
 problems and Hall’s Core, care and
 cure (person,body,disease)
 1969 first conference on nursing
 theory
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
First Conference in Nursing theory

Brought leading scholars and theorists to
  discuss and debate on issues regarding
  nursing science ad theory development.
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
Historical Development

1980’s characterized by acceptance of
  the significance of theory in nursing.
  Less debates on whether or not to
  use theory, practice theory or
  borrowed ones.
 More and more publication up to the
  present.
Stages of Theory Development
according to Kidd and Morrison
1. Silent Knowledge stage
- Blind obedience to medical authority
- Training schools were hospital based,
  emphasis on carrying out physicians
  orders and few books, depended on
  physicians diagnosis, exploited as
  workers and as students.
- Persisted for more than 80 years
2. Received Knowledge Stage
  Learning through listening to others
- Nursing now challenged to be in the
  university as opposed to
  apprenticeship that happens to most
  hospital programs.
- Nurses acquired non nursing degrees
  relying on the authority of educators,
  sociologist, psychologists,
  physiologists, and anthropologists to
  provide answers to nursing problems.
3. Subjective Knowledge stage

  Authority was internalized and a new
  sense of self emerged.
- Negative attitude toward borrowed
  sciences or theories
- Defining on nursing and developing
  theories about and for nursing
- Research focused on the nurse rather
  on he clients and clinical situations.
4.Procedural Knowledge
  Includes both separate and
  connected knowledge
- Proliferation of approaches to theory
  development applying theory in
  practice was frequently
  underemphasized
- Emphasis was on procedures used to
  acquire knowledge, with over
  attention to appropriateness of
  methodology the criteria for evolution
  and statistical procedures
5. Constructed Knowledge

 Integration of different types of
 knowledge ( intuition, reason and self-
 knowledge)
 Nursing theory based on empirical
 studies theoretical literature client
 reports, clinical experiences and
 nurses scholar intuition.
Types of theories

 According to range
 - Grand theory
 Middle range theory
 Micro theory
Types of theories
 Grand Theory consist of broad conceptual
 frameworks that reflect wide and expansive
 perspectives for practice and ways of
 describing, explaining, predicting and
 looking at nursing phenomena. They are
 the most complex and broadest in scope.
 Henderson’s The Nature of Nursing ;
 Levine’s The Four Conservation Principles
 of Nursing, Roy’s Adaptation Model, and
 Orem’s Self-Care (Marriner-Tomey)
Types of Theories
 Mid Range- less complex and narrower in
 scope than grand theory and micro theory.
 A more workable level is the middle
 range.more limited in scope and less
 variables, and testable.
Types of Theories
Mid range Example: grand theory on stress
  and adaptation might not yield any
  interpretable guidelines on practice but if
  the theory is focused on chronic lingering
  illness as the stressor on family, the stress
  theory becomes operational for both
  research and practice purposes. Ex.
  Peplau’s Psychodynamic Nursing and
  Orlando’s Nursing Process Theory
Types of theories

 Micro theories- are the least complex.
 They contain the least complex
 concepts and are narrowest in scope.
 They deal with a small aspect of
 reality, generally a set of theoretical
 statements
 - Deals with specific and narrow
 defined phenomena
According to Orientation or focus of
the theory
1. Client centered: Nightingale,
   Henderson
2. Client-nurse dynamics: Watson
3. Client-nurse environment :
   Leininger
Categories of nursing theories



        client           nurse




                        `
                 environment
Client centered theory

1. Client centered theories are those
   focused on the needs and problems
   of clients which are met, resolved or
   alleviated by nursing interventions
   This category includes theories
   developed by the following :
   Nightingale,Abdellah,Henderson,Or
   em,Pender, Roy, Levine, Hall.
Nurse – client dynamics

2.Nurse-client-dynamics focus on
  interaction between the nurse and
  client. This category includes theories
  developed by the following: Peplau,
  Watson, King and Orlando
Client Nurse Environment
Dynamics
3. CLIENT NURSE ENVIRONMENT-
  focus on the interaction between
  nurse and client in an environment
  that includes broader dimensions of
  time and space. As well as culture,
  cultural diversity, and universality.
  Theories of Neuman and Leininger
  are discussed under this category.
Framework to Analyze the Nursing
theory
I What are the major concepts?
- Person, nursing, health and
   environment
II Based on Focus
- Client centered, nurse-client
   dynamics, nurse client-environment
   dynamics
   How similar and how different are
   their concepts of persons, nursing,
   health, environment
Framework to Analyze the Nursing
theory
III Key concepts unique to the theory.
   Some theories have several key
   concepts and it may have sub-
   concepts.

								
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