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Theoretical Foundations of Nursing

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									The development of a
   Shu-Fang Vivienne Wu
     Assistant professor
   Define theory and list characteristics of a theory
   Describe the components of a theory and its use
   Trace the development of a nursing theory
   Theory Development in Nursing: Historical
   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 ,
Definitions of theory
  Defining theory is the first step towards developing a
   set of criteria for the evaluation of theory.
 Many of the early definitions of theory in the nursing
   literature were influenced by the Logical Positivistic
   Received View (Suppe, 1977), where the focus was
   on structure and process.
Ex.1.McKay (1969) defines theory as “a logically
   interrelated set of confirmed hypotheses” (p. 394)and
   Jacox (1974) defines it as “a systematically related
   set of statements including law-like generalizations
   that are empirically testable” (p. 324).
 These definitions are consistent with the Received
   View philosophy on theory at the time.
Definitions of theory
   Chin and Jacobs (1983) define theory as “a set
    of concepts, definitions, and propositions that
    projects a systematic view of phenomena by
    designating specific interrelationships among
    concepts for purposes of describing,
    explaining, predicting, and/or controlling
    phenomenon” (p. 70).
   This definition begins a departure from the
    Logical Positivistic Received View, in that it
    does not emphasize the structure of the theory.
Problem in nursing:lack of agreement
on the definition of theory
   Many authors have used the term theory as
    interchangeable with such terms as conceptual
    framework, conceptual model, model, and paradigm.
   Fawcett (1989) clearly states that “conceptual models
    and theories are clearly distinguished by their levels
    of abstraction and thus must be used in different
    ways” .
   She defines nursing theory as “a relatively specific
    and concrete set of concepts and propositions that
    purports to account for or characterize phenomena of
    interest to the discipline of nursing” (p. 23).
A conceptual model vs. A theory
   A conceptual model is an abstract and general
    system of concepts and propositions.
   A theory deals with one or more relatively
    specific and concrete concepts and
    propositions”(Dudley-Brown p.77) .
Distinguish a conceptual model from a
   If the purpose is to describe, explain, or predict
    specific phenomena, the work is most likely a theory.
    Ex. the works of Peplau (Alligood & Tomey Ch 5,
    p.54) and Orlando.
   If the purpose of the work is to articulate a body of
    distinct knowledge for the discipline of nursing, the
    work is most likely a conceptual model. Ex. the
    works of Johnson, King, Levine, Neuman, Orem,
    Rogers, and Roy.
Distinguish a conceptual model from a
   Most of these theorists have been described by
    others as proposing a nursing theory, not a
    conceptual model.
   Failure to distinguish a conceptual model from a
    theory, Fawcett (1989) states, leads to
    misunderstandings and inappropriate expectations of
    the work.
   However, according to Meleis (1985), the use of
    different labels (theory, paradigm, model, and
    framework) corresponds to differences in emphasis
    rather than substance.
Definitions of theory
•   Pinnel and Menesis (1986)
    Systematic set of interrelated concepts,
    definitions and deductions that describe,
    explain or predict interrelationships
Definitions of a theory
   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
Definition of a theory
   Chinn and Krammer
    creative and vigorous structuring of ideas that
    project a tentative, purposeful and systematic
    view of phenomena
Definitions of a theory
   Meleis,2005
    Theory is an organized, coherent, and
    systematic articulation of a set of statements
    related to significant questions in a discipline
    that are communicated in a meaningful whole.
Some commonalities
Structured ideas
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
•    Systematic, logical and coherent
    (orderly reasoning,no contradictions)
•    Creative structuring of ideas
    mental images of one’s experiences and create
     different ways of looking at a particular event or
•    Tentative in nature ( change over time or evolving
     but some remain valid despite passage of time)
Theory Development
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.
- 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
   Philosophy
-   Knowledge level which specifies the
    definitions of the metaparadigm concepts in
    each of the conceptual models of nursing.
-   Nightingale is considered philosophical
-   Out of these philosophies theory maybe
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
   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
   Nursing theory is defined as a conceptualization of
    some aspect of nursing reality communicated for the
    purpose of describing phenomena, explaining
    relationships between phenomena, predicting
    consequences, or prescribing nursing
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
4. Theory enhances communication
Theory Development in
Nursing: Historical
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
 1969 first conference on nursing theory
Historical Development
   Role of nurses where questioned; what
    they do, for whom where and when were
   purpose of nursing, process of theory
    development was 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.
Types of theories
   According to range
   Grand theory
   Middle range theory
   Micro theory
Types of theories: Grand Theory
     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
     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-
  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.
 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
   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
    Deals with specific and narrow defined
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

Client centered theory
   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 :
    er, Roy, Levine, Hall.
Nurse – client dynamics
   Focus on interaction between the nurse and
   This category includes theories developed by
    the following: Peplau, Watson, King and
Client Nurse Environment Dynamics
   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
   Theories of Neuman and Leininger are
    discussed under this category.
Framework to Analyze the Nursing
1.What are the major concepts?
  Person, nursing, health and environment
2. 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
3. Key concepts unique to the theory. Some theories have
   several key concepts and it may have sub-concepts.
Analysis of theory
   Clarity-How clear is this theory?
   Simplicity-How simple is this theory?
   Generality-How general is this theory?
   Empirical precision
           -How accessible is this theory?
   Derivable consequences
           -How important is this theory?
   Theory development and evaluation are cyclical,
    continuous, and dynamic process. One can not exist
    without the other.
   Theory evaluation including description, concept
    analysis, theory critique, testing and support.
   These process are based on the view that science is a
    human process that includes not only valid findings but
    also observation, agreements, useful solutions to
   Theory evaluation is central to the development of
    theory; it is the responsibility of each clinician,
Please see the attachment: Adaptation model of nursing
1.Define theory and list characteristics of a theory
2.Describe the components of a theory and its use
3.Trace the development of a nursing theory
4.Theory Development in Nursing: Historical Overview

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