TFN: CHAPTER 1


GINA S. CUENCA
 Evolution of Nursing
 This course explores the philosophies, theories and history
of the science of nursing. Nursing theory and other theories
are applied to practice using evidence-based innovations
with focus on global setting.
 The roles of educator, clinician, and manager are
investigated with emphasis on the contributions of the
theorists. Nursing theories and other theories are evaluated
and analyzed for their usefulness and applicability to
nursing practice, education, and administration.
 Nursing theory is concerned with the practical application
and it is determining by the understanding of nurses to use
theory in their clinical practice along with knowledge and
psychomotor skills required to operationalize practically.
GENERAL OBJECTIVES
 is to introduce
The aim of this module
the student to the nature of nursing and
the role of the nurse by exploring the
concepts underlying the practice of
nursing. The module will also
introduce the student to different
theorist, their theory and model as
framework in the practice of nursing.
 Integrated relevant concepts and metaparadigm

of theories on Person, Health, Environment and
Nursing in Nursing Practice.
 Applied appropriate nursing concepts and
actions holistically and comprehensively
 Appreciated the value of evidence-based nursing
practice in the application of nursing and related
model theories
 Ensured a working relationship utilizing
relevant concepts/ theories of effective
communication and interpersonal relationship in
nursing practice.
Nursing Theories: An Overview


A theory is a group of related concepts that propose
action that guide practice.
Theory refers to “a coherent group of general
propositions used as principles of explanation.
” A nursing theory is a set of concepts, definitions,
relationships, and assumptions or propositions
derived from nursing models or from other
disciplines and project a purposive, systematic view
of phenomena by designing specific inter-
relationships among concepts for the purposes of
describing, explaining, predicting, and /or
prescribing.
Kerlinger - theories as a set of interrelated concepts
that give a systematic view of a phenomenon (an
observable fact or event) that is explanatory and
predictive in nature.

Theories are composed of:
1. Concepts
2. Definitions
3. models
4. propositions
5. based on assumptions.
 They are derived through two principal methods:
1. Deductive reasoning
2. Inductive reasoning
Nursing theorists use both of these methods.

 Nursing theories are "attempts to describe or exp ain
the phenomenon (process, occurrence and
nursing"
l - Barnum(1998) .Theories are for professional
event) called
nursing. Theory is "a creative and rigorous structuring
of ideas that projects a tentative, purposeful, and
systematic view of phenomena"

 A theory makes it possible to "organize the relationship

among the concepts to describe, explain, predict, and
control practice".
Inductive reasoning is a method of reasoning
in which the premises are viewed as
supplying some evidence, but not full

assurance, for the truth of the conclusion.

Ex. The coin I pulled from the bag is a penny.

That coin is a penny. A third coin from the
bag is a penny. Therefore, all the coins in the
bag are pennies."
 Lesson1: A. Introduction to Nursing
Theory

1. Discuss about Theory and Nursing Theory
2. Analyze the Components of the Theory and define
each of the components
3. Define Paradigm
4. How does DOMAIN relate to Nursing Theory
5. Assess the importance of Nursing Theory to
nursing practice.
6. Identified the types of theories and concepts
 Definitions of theory
1. Pinnel and Menesis (1986)

Systematic set of interrelated concepts,
definitions and deductions that describe,
explain or predict interrelationships

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
3. Chinn and Krammer
Creative and vigorous of ideas that
structuring project a tentative, systematic view
of phenomena
purposeful and

4. Albert Ellis
coherent set of hypothetical, conceptual and
pragmatic principles forming a general frame of
reference for a field of inquiry

( Copyright 2004 by Delmar Learning, a division of

Thomson Learning, Inc.)
 HISTORY OF NURSING
THEORY

The history of professional nursing began with Florence
Nightingale. It was Nightingale who envisioned nurses
as a body of educated women at a time when women
were neither educated nor employed in public service.
Following her service of organizing and caring for the
wounded in Scutari, during the Crimean War, her
vision and establishment of a School of Nursing at St.
Thomas’ Hospital in London marked the birth of
modern nursing.
Nightingale’s pioneering activities
in nursing practice and subsequent
 nursing
writings describing
education became a guide for
establishing nursing schools in the
United States at the beginning of
the twentieth century.
(Kalisch & Kalisch, 2003; Nightingale, 1859/1969).
 Nursing began with a strong emphasis on practice,
but throughout the century, nurses worked toward
the development of nursing as a profession through


successive periods recognized as historical eras
(Alligood, 2006a)

 By the mid-1930s, a standardized curriculum had

been published. However, it was also in this era that
the idea of moving nursing education from hospital-
based diploma programs into colleges and
universities emerged. (Kalisch & Kalisch, 2003).
 As nurses increasingly sought degrees in
higher education, a research emphasis era, as

it is deemed, began to emerge. This era came
about as more and more nurses embraced
higher education and arrived at a common
understanding of the scientific age, that is,
that research is the path to new nursing
knowledge. Nurses began to participate in
research, and research courses began to be
included in the nursing curricula of many
developing graduate programs (Alligood,
2006a).
 The research era and the graduate education era
developed in tandem. Master’s degree programs in
nursing emerged to meet the public need for nurses

with specialized clinical nursing education. Many of
these programs included a nursing research course.
It was also in this era that most nursing master’s
programs began to include courses in concept
development or nursing models that introduced
students to early nursing theorists and the
knowledge development process (Alligood, 2006a).
 MID 1800’S AND 1960’S


MID 1800”s- Nursing Knowledge is
distinct from medical knowledge(
Nightingale)
Nursing Practices was based on
principles and traditions passed on
through apprenticeship education and
common sense wisdom.
Nursing as a Vocational heritage more
than professional vision.
KEY CONCEPTS




 TYPES OF THEORIES
 categories when
There are three major
classifying nursing theories based on
their level of abstraction:
1. grand theory
2. middle-range theory
3. practice-level theory.
 Grand Nursing Theories
 Grand theories are abstract, broad in scope, and complex,

therefore requiring further research for clarification.
 Grand nursing theories do not provide guidance for
specific nursing interventions but rather provide a
general framework and ideas about nursing.
 Grand nursing theorists develop their works based on
their own experiences and the time they were living
explaining why there is so much variation among
theories.
 Address the nursing metaparadigm components of
person, nursing, health, and environment.
 Middle-Range Nursing Theories
More limited in scope (as compared to grand

theories) and present concepts and propositions
at a lower level of abstraction. They address a
specific phenomenon in nursing.
Due to the difficulty of testing grand theories,
nursing scholars proposed using this level of
theory.
Most middle-range theories are based on the
works of a grand theorist but they can be
conceived from research, nursing practice, or the
theories of other disciplines.
 Practice-Level Nursing Theories

Practice nursing theories are situation specific
theories that are narrow in scope and focuses on a
specific patient population at a specific time.
Practice-level nursing theories provide
frameworks for nursing interventions and suggest
outcomes or the effect of nursing practice.
Theories developed at this level have a more
direct effect on nursing practice as compared to
more abstract theories.
These theories are interrelated with concepts from
middle-range theories or grand theories.
 By Goal Orientation
Theories can also be classified based on their goals, they

can be descriptive or prescriptive.
 Descriptive theories are the first level of theory
development. They describe the phenomena and
identify its properties and components in which it
occurs.
 Descriptive theories are not action oriented or
attempt to produce or change a situation.
 There are two types of descriptive theories: factor-
isolating theory and explanatory theory.
 Types of descriptive theory

1. Factor-Isolating Theory
 Also known as category-formulating or labeling
theory.
 Theories under this category describe the properties
and dimensions of phenomena.
2. Explanatory Theory
 Explanatory theories describe and explain the nature
of relationships of certain phenomena to other
phenomena.
 Prescriptive Theories
Address the nursing interventions for a

phenomenon, guide practice change, and
predict consequences.
Includes propositions that call for change.
In nursing, prescriptive theories are used to
anticipate the outcomes of nursing
interventions.
 Components of the theory
The components of the theory are as follows:
1. Components

2. Definitions Concepts Definitions

3. Assumptions
4. Phenomenon
Phenomenon

Assumptions or
1. Concepts. A theory is composed of
interrelated concepts.

Concepts help describe or label
phenomena. Using Levine’s Conservation
Model in Nursing Practice as an example,
there are concepts that affect the nursing
practice- the “why’s” of nursing actions” The
three major concepts that form the basis of
the model and its assumptions are as follows:
1. Conservation
2. Adaptation
3. wholeness
Another example is King’s
Theory of Goal attainment in
nursing Practice.According to this
model, the concepts that are
critical to goal attainment in
nursing practice are as follows:
1. personal system
2. interpersonal system
3. social system
2. Definitions
The definitions within the description of the
theory convey the general meaning of the

concepts in a manner that fits the theory.
These definitions also describe the activity
necessary to measure the constructs,
relationships, or variables within a theory(
Chinn and Kramer 2004).
For example:
Levine’s Conservation Model Defines
conservation as the keeping together of the
life system; that individuals continuously
defend their wholeness.
3. Assumptions
Are statements that describe concepts or
connect two concepts that are factual.

Assumptions are the “taken for granted”
statements that determine the nature of the
concepts, definitions, purpose, relationships
and structure of the theory.
 The assumptions in Levine’s conservation
model are that: individuals continuously
defend their wholeness; adaptation is an
ongoing process of change; nursing is
human interaction; nurses promote
wholeness through the use of conservation
principle.
4. Phenomenon
A Pnemenon is an aspect of reality
that can be conciously sensed or

experienced. Nursing theories focus
on the phenomena of nursing and
nursing care.
Examples of phenomena in nursing
include caring self-care, and client
response to stress.
Philosophy.

and values that

Philosophy. Beliefs
define a way of thinking and are
generally known and understood by
a group or discipline.
 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 deriv ed
from an individual’s experience and
perception.
3.Has a major concept like nursing, person, health or
environment.

4. Definitions give meaning to concepts which can either be

descriptive or procedural .

5. Major concepts may not be present in the theory but a

main concept is usually present and the author is usually
Known for that example Orem’s Self Care Theory
 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)
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.)


 Development of Theory


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.

Theories used using the practice theory strategy
evolved from clinical practice. Example Orlando’s
nursing process theory

3. Research theory or inductive method must evolve

from research findings or empirical evidence.

 

https://www.slideshare.net/AbdelrahmanAlkilani/nursing-
process-theory-orlando

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.


 The nurse know how he or she will apply their knowledge
and skills when caring for patients.
 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
 Nursing theory Group of related concepts that derive from
the nursing models. Some derive from other nursing
discipline like Leininger which comes from anthropology
(Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.)
 Uses of theory
 care and with goals,
1. Theory guides and improve nursing practice
Theory provides goal for nursing
nursing practice is rendered more effective and
efficient. Theories help to focus the goals, making
nurses more confident about the practice.
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
 Ways of Classifying Nursing
Theories
1. Needs-Based Theories
2. Interaction Theories
3. Outcome Theories
 Classification According to Meleis
 Afaf Ibrahim Meleis (2011), in her book Theoretical
Nursing: Development and Progress, organizes the major

nurse theories and models using the following
headings: needs theories, interaction theories, and
outcome theories. These categories indicate the basic
philosophical underpinnings of the theories.
 Needs-Based Theories. The needs theorists were the
first group of nurses who thought of giving nursing care
a conceptual order. Theories under this group are based
on helping individuals to fulfill their physical and
mental needs. Theories of Orem, Henderson, and
Abdella are categorized under this group. Need theories
are criticized for relying too much on the medical model
of health and placing the patient in an overtly
dependent position.
Interaction Theories. These
theories placed the emphasis of

nursing on the establishment and
maintenance of relationships and
highlight the impact of nursing on
patients and how they interact
with the environment, people, and
situations. Theories of King,
Orlando, and Travelbee are
grouped under this category.
Outcome Theories. These theories
describe the nurse as controlling
 care by using
and directing patient
their knowledge of the human
physiological and behavioral
systems. Nursing theories of
Johnson, Levine, Rogers, and Roy
belong to this group.
 Classification According to
Alligood
In her book, Nursing Theorists and

Their Work, Raile Alligood (2017)
categorized nursing theories into four
headings:
1. nursing philosophy
2. nursing conceptual models
3. nursing theories
4. grand theories
5. middle-range nursing theories.
Nursing Philosophy. Is the
most abstract type and sets
 of nursing
forth the meaning
phenomena through analysis,
reasoning, and logical
presentation. Works of
Nightingale, Watson, Ray, and
Benner are categorized under
this group.
Nursing Conceptual Models. Are
comprehensive nursing theories

that are regarded by some as
pioneers in nursing. These theories
address the nursing metaparadigm
and explain the relationship
between them. Conceptual models
of Levine, Rogers, Roy, King, and
Orem are under this group.
Grand Nursing Theories. Are
works derived from nursing

philosophies, conceptual models,
and other grand theories that are
generally not as specific as middle-
range theories. Works of Levine,
Rogers, Orem, and King are some
of the theories under this category.
 Middle-Range Theories. Are
precise and answer specific
nursing practice questions. They
 of nursing
address the specifics
situations within the perspective of
the model or theory from which
they are derived.
Examples of Middle-Range
theories are that of Mercer, Reed,
Mishel, and Barker.
MID1960’s- debates and
discussion regarding the proper
direction and appropriate disciple

for nursing knowledge
development.
MID 1970’s- Evaluation of 25 years
of nursing research revealed that
nursing lacked conceptual
connections and theoretical
frameworks.
Milestone:
1. Standardization of curricula for

nursing master’s education
2. Doctoral education for nurses
should be in nursing.
Transition from vocation to
profession.
Nursing practice is based on
Nursing Science.
1980’s –Preparadigm period to
paradigm period

Introduced an organizational
structure for nursing knowledge
development to the nursing
literature.
Utilization phase of the theory Era-
emphasis shifts from the
development to the use and
application of what is known.
 Definition:

 Theory Attributes 
1. CONCEPT
Ø A mental idea of phenomenon
Ø A comprehensive idea or generalization
Ø A unit of thought
Ø Building block of all theories
Ø Components of every theory
Ø Variables that are tested during research (Mintz-Binder, 2019)
Ø For example, anxiety is a concept, which may or may not be easy
to identify. Though anxiety can be identified through behaviors
or symptoms. A patient who has anxiety may exhibit rapid
breathing, palpitations, or irritation.
2. CONCEPTUAL FRAMEWORK/MODEL
Ø A set of interrelated concepts that symbolically
represents and conveys a mental image of a
phenomenon. Conceptual models of nursing identify

concepts and describe their relationships to the
phenomenon of central concern to the discipline:
person, environment, health and nursing.( Power
and Knapp,1995)
Ø A set of concepts and the propositions that integrate
them into a meaningful configuration ( Marriner-
Tomey and Alligod, 1998)
Ø Composed of concepts or construct that describe
ideas about individuals, groups, situations and
events of particular interest or discipline(e.g.,
Nursing)
Ex. Of conceptual model

3. Theory
Ø A set of statements that tentatively describe, explain,
or predict relationships among concepts that have

been systematically selected and organized as an
abstract representation of some phenomenon( power
and knapp, 19195). These systematic organized
perspective serve as guides for nursing action in
administration, education, research and practice.
Ø A well- substantiated explanation of some aspect of
the natural world; an organized system of accepted
knowledge that applies in a variety of situations/
hypothesis.
Ø An expectation of what should happened, barring
unforeseen circumstances.
Ø A coherent statement or set of statement that
attempts to explain observed phenomena.
Ø An explanation for some phenomena that is

based on observation, experimentation, and
reasoning.
Ø Weaves together concepts to describe their
relationships with each other.
Ø Explains the relationships among the
concepts
Ø Explains how these relationships interrelate
with each other (Mintz-Binder, 2019)
4. Model
Ø A diagram of concepts and their relationship with each other

(Morse, 2017) 
5. Theoretical Framework
Ø Used for conducting research or the underpinning of
policy
Ø Represents what the researcher thinks will happen in the
study based on the chosen theory
Ø Way of organizing the concepts (called variables in
research) and their relationship with each other By
creating a model, a framework visually illustrates how a
research study will be conducted, based on the theory
(Morse, 2017)
Ex. Theoretical framework

6. Assumption
Ø Premise without proof something usually
unspoken, believed to be the truth, though no

hard proof something taken for granted (Morse,
2017)

7. Proposition
Ø Statements that link the concepts together
beliefs about the theory shared as statements.
Ø Explains the reasoning for the relationship
between the concepts (Mintz-Binder, 2019)
8. Metaparadigm
ØA process by which an academic

discipline communicates its
fundamental characteristics.
ØAll nursing theories address each
concept by defining the concept
and applying it to concepts or
tenets of the theory.
 Nursing Theoretical Works
represents

The most comprehensive ideas
And systematic knowledge about
nursing;
Therefore theory is vital to both The
discipline and the profession.
 SIGNIFICANCE OF THE:
a. Discipline is specific to academia and a

branch of education, a department of
learning or field of knowledge.

b. Profession refers to specialized field of

practice, which is founded upon the
theoretical structure of the science or
knowledge of that discipline and the
companying practice ability
 Significance of theory for nursing as a
discipline
1. University baccalaureate programs

proliferated, masters programs in nursing were
developed, and the curricula began to be
standardized through the accreditation process.

2. Attention to the importance of nursing

conceptualizations for the research process and
the role of a conceptual framework in the
purpose and design of research production of
science and nursing theoretical works also
began to publish.
3. Works began to be recognize for their
theoretical nature, such as Henderson,
Nightingale and etc.

4. KEYNOTE ADDRESS, New nursing
doctoral programs were beginning to
open and they reopened the discussion
of the nature of nursing science. This
becomes the first classic reference for
nursing as discipline and for
distinguishing between the discipline and
profession.
5. Fawcett’s conceptualization of metaparadigm of nursing
and unifying conceptual- theoretical structure of
knowledge recognize works of major nursing theorist as
conceptual framework and paradigms of nursing.

6. MAJOR SIGNIFICANCE IS THE DISCIPLINE IS
DEPENDENT UPON THEORY
6.1. Theoretical works have taken nursing to a higher level.
6.2. The emphasis has shifted from a focus on knowledge
about how nurses function, which concentrated on the
nursing process, to focus on what nurses know and how
they use knowledge to guide their thinking and decision
making while concentrating on the patient.
 Significance of theory for nursing
as a profession

Clearly, nursing is recognize as a profession today.
1. Bixler and Bixler published a set of criteria tailored to
nursing in the American Journal of Nursing in 1959.

They stated that a profession:

a. Utilizes in its practice a well-defined and well-
organized body of specialized knowledge that is on the
intellectual level of the higher learning.

b. Constantly enlarges the body of knowledge it uses

and improves its techniques of education and service by
the use of the scientific method.
c. Entrusts the education of its
practitioners to institution of higher
education. 
d. Applies its body of knowledge in
practical services that are vital to
human and social welfare.
e. Functions autonomously in the
formulation of professional policy
and in the control of professional
activity thereby.
f. Attracts individuals of intellectual
and personal qualities who exalt
service above personal gain and

who recognizes their chosen
occupation as a life work.

g. Strives to compensate its

practitioners by providing freedom
of action, opportunity for
continuous professional growth and
economic security.
 LESSON 2: History and
Philosophy of Science

At the end of this course the students should be able to:
1. Analyzed the structure of nursing knowledge from
an historical and contemporary basis.
2. Identified the history and philosophy of science
3. Enumerate the 4 major concepts of nursing theory
4. Critiqued theories and models from nursing and
other disciplines for use in professional nursing
practice.
 B. History and Philosophy of
Science

 Rationalism
 Empiricism
 Early 12 century views
 Emergent views
“Why should nurses be interested in the
history and philosophy of science? The
history and philosophy of science is
important as a foundation for exploring

whether scientific results are actually truth.
As nurses our practice should be based upon
truth and we need the ability to interpret the
results of science. Nursing science provides us
with knowledge to describe, explain and
predict outcomes. The legitimacy of any
profession is built on its ability to generate
and apply theory.”
(McCrae, 2011, p. 222)
Modern science was established over 400
years ago as an intellectual activity to
formalize given phenomena of interest in an

attempt to describe, explain, predict, or
control states of affairs in nature. Scientific
activity has persisted because it has
improved quality of life and has satisfied
human needs for creative work, a sense of
order, and the desire to understand the
unknown (Bronowski, 1979; Gale, 1979; Piaget, 1970).
The development of nursing science has evolved
since the 1960s as a pursuit to be understood as a
scientific discipline. Being a scientific discipline

means identifying nursing’s unique contribution to
the care of patients, families, and communities. It
means that nurses can conduct clinical and basic
nursing research to establish the scientific base for
the care of individuals across the life span. For
example, research revealed gaps between the pain
management needs of patients and the information
communicated by patients and clinicians during
office visits.
Although many older adults have
painful but not readily visible

conditions (e.g., symptomatic
osteoarthritis), little research has
examined how the style or format of
a health care practitioner’s questions
influence the quality and amount of
diagnostic information obtained
from older adults.
A recent study tested the theory that a certain
type of question would elicit the most response.
The theory was confirmed when findings

supported that the open-ended questions
prompted patients to provide a larger amount of
diagnostically useful pain information than did
the closed-ended questions (McDonald, Shea,
Rose, & Fedo, 2009). While this study is one
example of nursing science, advance practice
nurses should be familiar with the long history of
the science of nursing.
 Historical views of the nature of
science
To formalize the science of nursing, basic

questions must be considered, such as: What is
science, knowledge, and truth? What methods
produce scientific knowledge? These are
philosophical questions. The term epistemology is
concerned with the theory of knowledge in
philosophical inquiry. The particular
philosophical perspective selected to answer these
questions will influence how scientists perform
scientific activities, how they interpret outcomes,
and even what they regard as science and
knowledge (Brown, 1977).
Although philosophy has been
documented as an activity for 3000
years, formal science is a relatively new

human pursuit (Brown, 1977; Foucault,
1973). Scientific activity has only
recently become the object of
investigation.
Two competing philosophical
foundations of science, rationalism
and empiricism, have evolved in the
era of modern science with several
variations. Gale (1979) labeled these
alternative epistemologies as centrally
concerned with the power of reason
and the power of sensory experience.
Gale noted similarity in the divergent
views of science in the time of the
classical Greeks. For example, Aristotle

believed that advances in biological
science would develop through
systematic observation of objects and
events in the natural world, whereas
Pythagoras believed that knowledge of
the natural world would develop from
mathematical reasoning (Brown,
1977; Gale, 1979).
Nursing science has been characterized by
two branching philosophies of knowledge

as the discipline developed. Various terms
are utilized to describe these two stances:
1. empiricist and interpretive mechanistic
2. holistic,quantitative and qualitative
3. deductive and inductive forms of
science. Understanding the nature of
these philosophical stances facilitates
appreciation for what each form
contributes to nursing knowledge.
 Rationalism
Rationalist epistemology (scope of knowledge)

emphasizes the importance of a priori reasoning
as the appropriate method for advancing
knowledge. A priori reasoning utilizes
deductive logic by reasoning from the cause to
an effect or from a generalization to a
particular instance. An example in nursing is
to reason that a lack of social support (cause)
will result in hospital readmission (effect).
This causal reasoning is a theory until
disproven. The traditional approach
proceeds by explaining hospitalization

with a systematic explanation (theory) of
a given phenomenon (Gale, 1979). This
conceptual system is analyzed by
addressing the logical structure of the
theory and the logical reasoning involved
in its development. Theoretical assertions
derived by deductive reasoning are then
subjected to experimental testing to
corroborate the theory.
Reynolds (1971) labeled this approach
the theory-then-research strategy. If the
research findings fail to correspond with the

theoretical assertions, additional research is
conducted or modifications are made in the
theory and further tests are devised;
otherwise, the theory is discarded in favor
of an alternative explanation (Gale,
1979; Zetterberg, 1966).
Popper (1962) argued that science would
evolve more rapidly through the process of
conjectures and refutations by devising

research in an attempt to refute new ideas.
For example, his point is simple; you can
never prove that all individuals without
social support have frequent
rehospitalizations since there might be one
individual that presents with no
rehospitalization.
A single person with no social support that
does not have a readmission disproves the
theory that all individuals with a lack of

social support have hospital readmissions.
From Popper’s perspective, “research
consists of generating general hypotheses
and then attempting to refute them”
(Lipton, 2005, p. 1263). So the hypothesis
that a lack of social support results in
hospital readmission is the phenomena of
interest to be refuted.
The rationalist view is most clearly evident
in the work of Einstein, the theoretical
physicist, who made extensive use of

mathematical equations in developing his
theories. The theories Einstein constructed
offered an imaginative framework, which
has directed research in numerous areas
(Calder, 1979). As Reynolds (1971) noted, if
someone believes that science is a process of
inventing descriptions of phenomena, the
appropriate strategy for theory construction
is the theory-then-research strategy.
In Reynolds’ view, “as the continuous
interplay between theory construction
(invention) and testing with empirical

research progresses, the theory becomes
more precise and complete as a
description of nature and, therefore, more
useful for the goals of science” (Reynolds,
1971, p. 145).
 Empiricism
The empiricist view is based on the central idea that

scientific knowledge can be derived only from
sensory experience (i.e., seeing, feeling, hearing
facts). Francis Bacon (Gale, 1979) received credit for
popularizing the basis for the empiricist approach to
inquiry. Bacon believed that scientific truth was
discovered through generalizing observed facts in
the natural world. This approach, called
the inductive method, is based on the idea that the
collection of facts precedes attempts to formulate
generalizations, or as Reynolds (1971) called it,
the research-then-theory strategy
One of the best examples to
demonstrate this form of logic in
nursing has to do with formulating
differential diagnoses. Formulating a
differential diagnosis requires
collecting the facts and then devising
a list of possible theories to explain
the facts.
The strict empiricist view is reflected in the work of
the behaviorist Skinner. In a 1950 paper, Skinner
asserted that advances in the science of psychology
could be expected if scientists would focus on the

collection of empirical data. He cautioned against
drawing premature inferences and proposed a
moratorium on theory building until further facts
were collected. Skinner’s (1950) approach to theory
construction was clearly inductive. His view of
science and the popularity of behaviorism have been
credited with influencing psychology’s shift in
emphasis from the building of theories to the
gathering of facts between the 1950s and 1970s
(Snelbecker, 1974).
The difficulty with the inductive mode of
inquiry is that the world presents an infinite
number of possible observations, and,

therefore, the scientist must bring ideas to his or
her experiences to decide what to observe and
what to exclude (Steiner, 1977).

In summary, deductive inquiry uses the theory-

then-research approach, and inductive inquiry
uses the research-then-theory approach. Both
approaches are utilized in the field of nursing.
Early twentieth century views of science
and theory


During the first half of this
century, philosophers focused on the analysis
of theory structure, whereas scientists focused
on empirical research (Brown, 1977). There was
minimal interest in the history of science, the
nature of scientific discovery, or the similarities
between the philosophical view of science and
the scientific methods (Brown, 1977).
Positivism, a term first used by
Comte, emerged as the dominant
 (Gale, 1979).
view of modern science
Modern logical positivists believed
that empirical research and logical
analysis (deductive and inductive)
were two approaches that would
produce scientific knowledge
(Brown, 1977).
The logical empiricists offered a more lenient
view of logical positivism and argued that
theoretical propositions (proposition affirms or

denies something) must be tested through
observation and experimentation (Brown, 1977).
This perspective is rooted in the idea that
empirical facts exist independently of theories
and offer the only basis for objectivity in science
(Brown, 1977). In this view, objective truth
exists independently of the researcher, and the
task of science is to discover it, which is an
inductive method (Gale, 1979).
This view of science is often
presented in research method
 first sets up
courses as: “The scientist
an experiment; observes what occurs
…. reaches a preliminary hypothesis
to describe the occurrence; runs
further experiments to test the
hypothesis [and] finally corrects or
modifies the hypothesis in light of
the results” (Gale, 1979, p. 13).
The increasing use of computers,
which permit the analysis of large data

sets, may have contributed to the
acceptance of the positivist approach
to modern science (Snelbecker, 1974).
However, in the 1950s, the literature
began to reflect an increasing
challenge to the positivist view,
thereby ushering in a new view of
science in the late twentieth century
(Brown, 1977).
Emergent views of science and theory in the late
twentieth century

In the latter years of the twentieth century, several
authors presented analyses challenging the
positivist position, thus offering the basis for a new
perspective of science (Brown, 1977; Foucault,
1973; Hanson, 1958; Kuhn, 1962; Toulmin,
1961). Foucault (1973) published his analysis of
the epistemology (knowledge) of human sciences
from the seventeenth to the nineteenth century.
His major thesis stated that empirical knowledge
was arranged in different patterns at a given time
and in a given culture and that humans where

emerging as objects of study. In The
Phenomenology of the Social World, Schutz (1967)
argued that scientists seeking to understand the
social world could not cognitively know an
external world that is independent of their own
life experiences. Phenomenology, set forth by
Edmund Husserl (1859 to 1938) proposed that the
objectivism of science could not provide an
adequate apprehension of the world (Husserl
1931, 1970).
A phenomenological approach reduces
observations or text to the meanings of

phenomena independent of their particular
context. This approach focuses on the lived
meaning of experiences.
In 1977, Brown argued an intellectual
revolution in philosophy that emphasized
the history of science was replacing formal
logic as the major analytical tool in the
philosophy of science.
One of the major perspectives in the new
philosophy emphasized science as a process of
continuing research rather than a product

focused on findings. In this emergent
epistemology, emphasis shifted to
understanding scientific discovery and process
as theories change over time.
Empiricists view phenomena objectively, collect
data, and analyze it to inductively proposed
theory (Brown, 1977).
This position is based upon objective truth
existing in the world, waiting to be
discovered. Brown (1977) set forth a new
epistemology challenging the empiricist
view proposing that theories play a
significant role in determining what the
scientist observes and how it is interpreted.
The following story illustrates Brown’s
premise that observations are concept
laden; that is, an observation is influenced
by values and ideas in the mind of the
observer:
“An elderly patient has been in a trauma and
appears to be crying. The nurse on admission
observes that the patient has marks on her

body and believes that she has been abused;
the orthopedist has viewed an x-ray and
believes that the crying patient is in pain due
to a fractured femur that will not require
surgery only a closed reduction; the chaplain
observes the patient crying and believes the
patient needs spiritual support. Each
observation is concept laden.”
 LESSON 3: Structure of Nursing
Knowledge

1. Identified the structure of Nursing
Knowledge
2. Enumerate characteristics of theory
3. Identified the components of the theory
4. Explained the Purpose and Importance of
nursing theory
 C.Structure of Nursing Knowledge
1. Structure level
2. Metaparadigm 
Person
Health
Environment
Nursing
3. Philosophy4.
4.Conceptual models
5. Theory
6. Middle-range theory
STRUCTURE LEVEL EXAMPLE

Metaparadig Person,
environment,
m

health,and nursing

Nightingale
Philosophy
Conceptual Models Newman’s system model

Theory Neuman’s theory of

optimal client’s stability

Middle Range Theory Maintaining optimal client

stability with structured
acitivity
( body recall) in a
community setting for
healthy aging.
 Metaparadigm
A process by which an academic
discipline communicates its

fundamental characteristics.
All nursing theories address each
concept by defining the concept and
applying it to concepts or tenets of the
theory.
Nursing metaparadigm consists of four
concepts:/ Four major concepts of
nursing theories.
 METAPARADIGM:
1. Person: The focus of nursing care

Example: Watson’s Theory of Human
Caring views the patient holistically,
while Johnson’s Behavioral System
model views the person through a lens
of seven different subsystems
Person: refers to all human beings.
People are the recipients of nursing care;
they include individuals, families,
communities and groups.
 2. Health: Depending on the theorist, health and
illness can be perceived as two separate
constructs (or concepts) or health and illness is
time)
over

viewed as a continuum (changes slowly

Example: King’s Theory of Goal Attainment

views health a functional state throughout a
person’s life (a continuum), while Neuman’s
Systems model views health and illness as two
separate constructs

 Health: addresses the person’s state of well

being
3. Nursing: A process whereby nurses provide care. The
process changes based on the theorist.
Example: Watson’s Theory of Human Caring views


nursing as provision of care using the 10 carative factors
whereas Orem’s Self-Care Deficit theory where nurses’
focus of care is assisting patients to meet their self-care
needs
 Nursing: Is central to all nursing theories. Definitions
of nursing describe what nursing is, what nurses do,
and how nurses interact with clients. It is the
“diagnosis and treatment of human responses to actual
or potential health problems”( ANA, 19195).
 Example: the nurse establishes nursing diagnoses of
fatigue, change in body image, and altered coping
based on the medical diagnosis of heart condition.
4. Environment: the person’s environment
within a global context (Mintz-Binder, 2019)
Environment: Includes factors that affect

individuals internally and externally. It
means not only everyday surroundings but
also settings where nursing care is
provided.

 Characteristics of theory
A theory is:
Ø Interrelat ing concepts in such a way as to create a

different way of looking at particular phenomenon.
Ø Logical in nature
Ø Generalizable
Ø Basis for hypotheses that can be tested.
Ø Increasing the general
discipline hrough body of knowledge
the research implemented with
to in the
validate t
them.by the practitioners to guide and improve their
Ø used
practic
Ø Ce onsistent with other validated theories, laws and
principles but will leave open unanswered questions
that need to be investigated.
Components of the theory
The components 
of the theory are as
follows:
1. Concepts
2. Definitions
3. Assumptions
4. Phenomenon
1. Concepts. A theory is composed of
interrelated concepts. Concepts help describe
or label phenomena. Using Levine’s

Conservation Model in Nursing Practice as
an example, there are concepts that affect the
nursing practice- the “why’s” of nursing
actions” The three major concepts that form
the basis of the model and its assumptions
are as follows:
a. Conservation
b. Adaptation
c. Wholeness
Another example is King’s Theory of
Goal attainment in nursing Practice.
According to this model, the concepts

that are critical to goal attainment in
nursing practice are as follows:
a. personal system
b. interpersonal system
c. social system
d. Definitions
2. Definition
The definitions within the description of the theory
convey the general meaning of the concepts in a

manner that fits the theory. These definitions also
describe the activity necessary to measure the
constructs, relationships, or variables within a theory
( Chinn and Kramer 2004).

For example:
Levine’s Conservation Model Defines conservation
as the keeping together of the life system; that
individuals continuously defend their wholeness.
3. Assumptions - Are statements that describe
concepts or connect two concepts that are
factual. Assumptions are the “taken for

granted” statements that determine the nature
of the concepts, definitions, purpose,
relationships and structure of the theory.
The assumptions in Levine’s conservation
model are that: individuals continuously defend
their wholeness; adaptation is an ongoing
process of change; nursing is human
interaction; nurses promote wholeness through
the use of conservation principle.
4. Phenomenon- A Phenomenon is an aspect of
reality that can be consciously sensed or
experienced. Nursing theories focus on the

phenomena of nursing and nursing care.
Examples of phenomena in nursing include caring
self-care, and client response to stress.

Philosophy.
Philosophy. Beliefs and values that define a way
of thinking and are generally known and
understood by a group or discipline.
Paradigm
A model that explains the linkages of

science, philosophy, and theory accepted
and applied by the discipline (Alligood and
Marriner – Tomey, 2002)Copyright 2004 by
Delmar Learning, a division of Thomson
The definition of a paradigm is a widely
accepted example, belief or concept.
Anexample of paradigm is evolution.
An example of paradigm is the earth being
round
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
 How does domain relate to nursing
theory

 its domain in
Nursing has identified
a paradigm that includes four
linkages:
1) person/client
2) health
3) environment
4) nursing
 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
 IMPORTANCE OF NURSING
THEORIES
Nursing theory  aims to describe,
predict and explain the phenomenon
of nursing (Chinn and Jacobs1978).
It should provide the foundations of
nursing practice, help to generate
further knowledge and indicate in
which direction nursing should
develop in the future (Brown 1964).
Theory is important because it
helps us to decide what we know
and what we need  to know
(Parsons1949).
It helps to distinguish what should
form the basis of practice by
explicitly describing nursing.
This can be seen as an attempt by
the nursing profession to maintain
its professional boundaries.
 CHARACTERISTICS OF
THEORIES
Theories: 
Øinterrelate concepts in such a way as to
create a different way of looking at a
particular phenomenon.
Øare logical in nature.
Øare generalizable.
Øare the bases for hypotheses that can be
tested.
Ø increase the general body of knowledge
within the discipline through the

research implemented to validate them.
Ø are used by the practitioners to guide
and improve their practice.
Ø are consistent with other validated
theories, laws, and principles but will
leave open unanswered questions that
need to be investigated.
 BASIC PROCESSES IN THE
DEVELOPMENT OF NURSING
THEORIES

Nursing theories are often based
on and influenced by broadly
applicable processes and theories.
Following theories are basic to
many nursing concepts.
A. General System Theory:
Øit describes how to break whole
and then to learn
things into parts
how the parts work together in "
systems".
ØThese concepts may be applied to
different kinds of systems, e.g..
Molecules in chemistry , cultures in
sociology, organs in Anatomy and
health in Nursing.
B. Adaptation Theory
Ø It defines adaptation as the adjustment of
living matter to other living things

to environmental conditions.
and
Ø Adaptation i s a continuously occurring
process that effects change and involves
interaction and response.
Ø Human adaptation occurs on three
levels:
1. the internal ( self )
2. the social (others)
3. the physical ( biochemical reactions )
C. Developmental Theory
Ø It outlines the process of growth and
development of humans as orderly and

predictable, beginning with conception and
ending with death.
Ø The progress and behaviors of an individual
within each stage are unique.
Ø The growth and development of an
individual are influenced by heredity ,
temperament, emotional, and physical
environment, life experiences and health
status.
 COMMON CONCEPTS IN
NURSING THEORIES
Four concepts common in nursing theory that

influence and determine nursing practice are:
1. The person( patient)
2. The environment
3. Health
4. Nursing (goals, roles, functions)
Each of these concepts is usually defined and
described by a nursing theorist. Of the four concepts,
the most important is that of the person. The focus of
nursing is the person.
 Why do we study nursing theory
Ø Everyday practice enriches theory.

Ø Both practice and theory are guided by values and
beliefs.
Ø Theory helps to reframe our thinking about
nursing.
Ø Theory guides use of ideas and techniques.
Ø Theory can close the gap between theory and
research.
Ø To envision potentialities
Ø (Gordon, Parker, & Jester, 2001)Copyright 2004 by
Delmar Learning, a division of Thomson Learning,
Inc.
 The use of theory in everyday practice
among Nurses


Ø Organize patient data
Ø Understand patient data
Ø Analyze patient data
Ø Make decisions about nursing interventions
Ø Plan patient care
Ø Predict outcomes of care
Ø Evaluate patient outcomes
(Alligood, 2001)Copyright 2004 by Delmar
Learning, a division of Thomson Learning, Inc.
Philosophy - Beliefs and
values that 
define a way
of thinking and are
generally known and
understood by a group or
discipline.
CONCEPTUAL MODEL-
A conceptual model is a
a system that
representation of
uses concepts and ideas to form
said representation.
Conceptual modeling is used
across many fields, ranging from
the sciences to socioeconomics to
software development.

THEORY Ø Weaves
 together concepts to their
relationships with each
describe
other
Ø Explains the relationships among the
concepts
Ø Explains how these relationships
interrelate with each other (Mintz-
Binder, 2019)
 TYPES OF THEORIES:
There are three major categories

when classifying nursing theories
based on their level of abstraction:
1. grand theory
2. middle-range theory
3. practice-level theory.
 Ø Grand Nursing Theories
Ø are abstract, broad in scope, and complex,

therefore requiring further research for
clarification.
Ø Grand nursing theories do not provide
guidance for specific nursing interventions
but rather provide a general framework and
ideas about nursing.
Ø Grand nursing theorists develop their works
based on their own experiences and the time
they were living explaining why there is so
much variation among theories.
ØAddress the nursing metaparadigm
components of person, nursing,
health, and environment.

Examples:
Johnson’s Behavioral System’s model
Roy’s Adaptation model
Rogers’ Science of Unitary Beings
Orem’s Self-Care Deficit Nursing
theory
Watson’s Theory of Human Caring
 Middle-Range Nursing Theory
Ø Created in the 1990s

Ø Narrower focus, more concrete, specific
Ø Focused on a clinical specialty
Ø Created with less depth and detail than grand theories
(Mintz-Binder, 2019)
Examples:
Ø Kolcaba’s Comfort theory
Ø Pender’s Health Promotion model
Ø Swanson’s Theory of Caring
Ø Leininger’s Culture Care Theory
Ø Peplau’s Theory of Interpersonal Relations
 Practice-Level Nursing Theories
Ø Practice nursing theories are situation specific

theories that are narrow in scope and focuses on a
specific patient population at a specific time.
Ø Practice-level nursing theories provide frameworks
for nursing interventions and suggest outcomes or
the effect of nursing practice.
Ø Theories developed at this level have a more direct
effect on nursing practice as compared to more
abstract theories.
Ø These theories are interrelated with concepts from
middle-range theories or grand theories.
 By Goal Orientation

 Theories
can also be classified
based on their goals, they can
be descriptive or prescriptive.
 Descriptive Theories
Ø Descriptive theories are the first level of

theory development. They describe the
phenomena and identify its properties
and components in which it occurs.
Ø Descriptive theories are not action
oriented or attempt to produce or change
a situation.
Ø There are two types of descriptive
theories: factor-isolating
theory and explanatory theory.
 Types of descriptive theory:
a. Factor-Isolating Theory - Also known

as category-formulating or labeling
theory.
b. Theories under this category describe
the properties and dimensions of
phenomena.
c. Explanatory Theory -describe and
explain the nature of relationships of
certain phenomena to other
phenomena.
 Prescriptive Theories
 interventions for
ØAddress the nursing
a phenomenon, guide practice change,
and predict consequences.
ØIncludes propositions that call for
change.
ØIn nursing, prescriptive theories are
used to anticipate the outcomes of
nursing interventions.
 Ways of Classifying Nursing
Theories

Needs-Based Theories
Interaction Theories
Outcome Theories
 Classification According to
Meleis

Afaf Ibrahim Meleis (2011), in her
book Theoretical Nursing: Development
and Progress, organizes the major nurse
theories and models using the following
headings: needs theories, interaction
theories, and outcome theories. These
categories indicate the basic philosophical
underpinnings of the theories.
 Needs-Based Theories

 The needs theorists were the first group
of nurses who thought of giving nursing
care a conceptual order. Theories under
this group are based on helping
individuals to fulfill their physical and
mental needs. Theories of Orem,
Henderson, and Abdella are categorized
under this group. Need theories are
criticized for relying too much on the
medical model of health and placing the
patient in an overtly dependent position.
 Interaction Theories
 the emphasis of
 These theories placed
nursing on the establishment and
maintenance of relationships and
highlight the impact of nursing on
patients and how they interact with the
environment, people, and situations.
Theories of King, Orlando, and
Travelbee are grouped under this
category.
 Outcome Theories
These theories 
describe the nurse
as controlling and directing patient
care by using their knowledge of
the human physiological and
behavioral systems. Nursing
theories of Johnson, Levine,
Rogers, and Roy belong to this
group
 Classification According to
Alligood
Theorists and Their
In her book, Nursing
Work, Raile Alligood (2017) categorized
nursing theories into four headings:
1. nursing philosophy
2. nursing conceptual models
3. grand theories
4. middle-range nursing theories.
Nursing Philosophy. Is the
most abstract type and sets forth

the meaning of nursing
phenomena through analysis,
reasoning, and logical
presentation. Works of
Nightingale, Watson, Ray, and
Benner are categorized under
this group.
Nursing Conceptual Models. Are
comprehensive nursing theories

that are regarded by some as
pioneers in nursing. These theories
address the nursing metaparadigm
and explain the relationship
between them. Conceptual models
of Levine, Rogers, Roy, King, and
Orem are under this group.
Grand Nursing Theories. Are works
derived from nursing philosophies,

conceptual models, and other grand
theories that are generally not as
specific as middle-range theories.
Works of Levine, Rogers, Orem, and
King are some of the theories under this
category.
Middle-Range Theories. Are
 specific
precise and answer
nursing practice questions. They
address the specifics of nursing
situations within the perspective of
the model or theory from which
they are derived. Examples of
Middle-Range theories are that of
Mercer, Reed, Mishel, and Barker.
 Purposes of Nursing Theories
The primary purpose of theory in the

profession of nursing is to improve practice
by positively influence the health and quality
of life of patients. Nursing theories are also
developed to define and describe nursing
care, guide nursing practice, and provide a
basis for clinical decision making. The
accomplishments of nursing in the past led to
the recognition of nursing in academic
discipline, research, and profession.
 In Academic Discipline
Much of the earlier nursing
identified
programs 
the major concepts in one or two
nursing models, organized the
and build an entire nursing
concepts
curriculum
around the created framework. The unique
language in these models was
introduced
objectives,
typically into
courseprogram objectives
descriptions, and course
,
performance
clinical criteria. The purpose was
explain the fundamental implications
to
of
the profession and to enhance the status of
the profession.
REFERENCES:
1.Currentnursing.com/nursing_theory/nursing_theori
es_overview.html 
2. https://nursekey.com/
3. Modified from Alligood, M. R. (2010). Nursing theory:
Utilization & application (4th ed.).
St. Louis: Mosby; and Fawcett, J.
(2005). Contemporary nursing knowledge: Conceptual
models of nursing and nursing theories (2nd ed.).
Philadelphia: F.