Theory

 A set of concepts, definitions, relationships, and assumptions that project a systematic view of a phenomena
 It may consist of one or more relatively specific and concrete concepts and propositions that purport to account
for, or organize some phenomenon.

COMPONENTS OF A THEORY
1) Concepts
 Ideas and mental images that help to describe phenomena

2) Definitions
 Convey the general meaning of the concepts

3) Assumptions
 Statements that describe concepts

4) Phenomenon
 Aspect of reality that can be consciously sensed or experienced

DEFINITION OF TERMS

Models
 Constructed of theories and concepts
 Used to help nurses assess, plan, and implement patient care by providing a framework within which to work
 Help nurses achieve uniformity of care

Proposition
 Explain relationships between concepts.

Theory Vs. Model

 Theory
 A set of statements that is developed through a process of continued abstractions.
 It is a generalized statement aimed at explaining phenomenon.
 Model
 A model is a purposeful representation of reality.

Paradigm
 A model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline

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?

 Nursing has identified its domain in a paradigm that includes four linkages
1. Person/Client
2. Health
3. Environment
4. Nursing

Importance of Nursing Theory

 Aims to describe, predict, and explain the phenomenon of nursing
 Provides the foundation of nursing practice
 Help generate further knowledge
 Indicate which direction nursing should develop in the future
 Theory is important because it helps us to decide what we know and
what we need to know – Parsons (1949)
 It helps to distinguish what should form the basics of practice by
explicitly describing nursing.
 This can be seen as an attempt by the nursing profession to maintain
its professional boundaries.

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

Why Do We Study Nursing Theory

 Everyday practice enriches theory
 Both practice and theory are guided by values and beliefs
 Theory helps to reframe our thinking about nursing
 Theory guides use of ideas and techniques
 Theory can close the gap between theory and research
 To envision potentialities
 The study and use of nursing theory in nursing practice must have roots in the everyday practice of
nurses

How Nurses Use Theory in Everyday Practice

 Organize patient data
 Understand patient data
 Analyze patient data
 Make decisions about nursing interventions
 Plan patient care
 Predict outcomes of care
 Evaluate patient outcomes

How do Student Nurses begin to use Nursing Theories?

 What is the nature of knowledge needed for the practice of nursing?
 What does it mean to me to practice nursing?

NON-NURSING THEORIES
 Becker’s Health Belief Model (HBM)
 Lazarus and Folkman’s Theory of Stress and Coping
 Ajzen’s Theory of Planned Behavior (TPB)
 Bandura’s Social Cognitive Theory

Commonly Used Non-Nursing Theories

 Systems Theory
 Basic Human Needs Theory
 Health and Wellness Models
 Stress and Adaptation
 Developmental Theories
 Psychosocial Theories

What is The Link Between Nursing Theory and The Research Process?
 Theory provides direction for nursing research
 Relationships of components in a theory help to drive the research questions for understanding nursing
 Indicate a spiral relationship between the two

Current Trends That Influence Nursing Theory

 Medical Science
 Nursing Education
 Professional Nursing Organizations
 Evolving Research Approaches
 Global Concerns
 Consumer Demands
 Technologies

Vision Statement of Riverside College

 A premier Philippine educational institution of choice which provides global leaders and professionals.

Mission Statement of Riverside College

 Riverside College develops leaders and professionals through excellent programs in healthcare and various
disciplines that cultivate creativity and critical thinking anchored on Lux et Caritas.

Values of Riverside College

 Integrity
 Excellence
MODULE 1: OVERVIEW OF THE COURSE
Topic 1 – Orientation to the Theoretical Foundations in Nursing
 There are Three Things That Describe Nursing
 Varied, Dynamic, and Diverse
 Dynamic and diverse as a kaleidoscope of ethnic, cultural, and religious manifestations of the people who
receive nursing care.
 All nursing acts are geared towards realizing and restoring the patient’s biopsychospiritual well-being and
assisting the client to live a dignified and normal life.
 It is important that nursing is grounded on accepted scientific truths and principles in order to give safe and
quality nursing care.
 Simply put, a Nursing Theory strives to explain the Science and Art of Nursing.

DIFFERENT DEFINITIONS OF NURSING ACCORDING TO AUTHORITIES AND OTHER INTERNATIONAL ORGANIZATIONS

1) American Nurses Association (ANA)

 Nursing is the diagnosis and treatment of human responses to actual or potential health problems.

2) International Council of Nurses (ICN)

 Nursing encompasses the autonomous and collaborative care of individuals of all ages, families, groups and
communities, sick or well and in all settings.
 Includes promotion of health, prevention of illness and the care of ill, disabled, and dying.

3) Association of Deans of Philippine Colleges of Nursing (ADPCN)

 A dynamic discipline, an art and a science of caring from prevention to death and dying with dignity and peace.
 Focuses on assisting the client to respond to health-illness situations, utilizing the nursing process,
guided by ethico-legal moral principles.
 According to Henderson, a theorist, Nursing is to assist clients in the performance of activities contributing to
health, its recovery or peaceful death that clients would perform unaided, if they had the necessary will,
strength or knowledge.

MODULE 2: INTRODUCTION TO NURSING THEORY

Topic 1 – History of Nursing Theory

NURSING THEORY
 Strives to explain the Science and Art of Nursing
 There is no single exact classification of Nursing Theory in each time, place and setting.
 Nursing theorists, regardless of orientation, have tried to shed light to it in their own unique way.
 We Filipinos, as a unique nation and race, have our own interpretation of Nursing, both as an art and as a
science.
 It can be said then that Filipino nurses do practice a unique form of Nursing that is attune with the
Filipino spirit and culture
 Nursing science, therefore, is a melting pot of the different knowledge, creeds and backgrounds of care and
healing that has been collected and preserved since the dawn of time.
 It is important for the nursing students to achieve a simple and working knowledge of the concepts that make
up a nursing theory.
 Since it is highly dynamic and undergoes change or evolution, as new discoveries are made and
information are renewed from time to time.

Overview of the History of Nursing

 Nuns served as nurses for the sick in the old times.
 Before, nursing is done by religious organizations or religious authorities.
 Use of animals like snakes to heal the sick
 Midwives in the old times were also nurses caring for those who were pregnant and helped deliver children.
 No sterile techniques and no anesthesia
 The practice of Trephination (boring of skulls) to heal the sick.
 Nurses helping sick soldiers in the old times.
 Lois Pasteur on treating patients with rage virus (rabies) had successfully inoculated the virus for treatment.
 Ancient Egyptians doctors mummified their dead to study cancer
 It is also important to remember the following:
 In the old times, it is the women of the house that are responsible for taking care of the sick.
 In the dark ages, herbal medicines and concoctions were used to treat conditions.
 People ask for divine intervention and prayer in order to get well soon
 The Bubonic Plague in the Middle Ages killed about ¾ of Europe and Asia.
 o Thus, doctors were interested to go to school/universities to study.
Topic 2 – Significance of Nursing Theory
 There must be a statement, a document or a set of facts that explains everything in our lives.
 Without all of these, we will just like be blinded individuals without basis of our actions.
 Since our practices within the family or culture especially about health has been preserved, there must be
theories behind them that explains why they become working knowledge
 And when we say working, that means, they have become very effective as documented by our
ancestors.

Theory
 An organized system of accepted knowledge
 Composed of concepts, propositions, definitions, and assumptions
 Intended to explain a set of fact, event or phenomena.

Concept
 An idea formulated by the mind, an experience perceived and observed (justice, love, war, disease)

Proposition
 Explains the relationships of different concepts
 Ex. Children who do not want to stay in the hospital because of their fear of injections

Definition
 Various descriptions which convey general meaning & reduces the vagueness in understanding a set of
concepts.

Assumption
 A statement that specifies a connection or relationship of factual concepts or phenomena.
 Ex. All patients who are not able to take good care of themselves need nurses.

RELATIONSHIPS
 The following diagram explains the relationships of
concepts, propositions, assumptions and definitions
with theory and phenomena.

Remember
 Theory has no absolute proof, an abstract statement to predict, and tested by observation and research.

WHAT OTHER FAMOUS PERSONS SAID ABOUT THE THEORY

Parker (2001)
 Organize, coherent set of concepts and their relationship to each other that offers descriptions, explanations,
and predictions about phenomena.

Potter (2004)
 Set of concepts, definitions, relationships and assumptions that project a systematic view of Phenomena.

Blackwell (2005)
 Reasoned proposed explanation of an occurrence or of something that will occur or be produced, for which
absolute proof is lacking.

Delaune and Ladner (2006)

 Set of concepts and propositions that provide early way to view a phenomenon.

Mosby (2006)
 It is an abstract statement formulated to predict, explain or describe the relationships among concepts,
constructs an event.
 It is tested by observation and research using factual data.

Kozier (2008)
 Supposition or system of ideas that is proposed to explain a phenomenon.

NURSING THEORY
 A group of interrelated concepts that are developed from various studies of disciplines and related experiences.
 Aims to view the essence of nursing care
  Theories are specifically contributed by different nursing theorists from different times and ages.
 Ex. In the 19th century, Florence Nightingale projected a valuable relationship between health and
environmental factors like fresh air, sunlight, and ventilation.
Florence Nightingale
 “Lady With the Lamp”
 She is the First Nursing Theorist
 Daughter of a rich man who defied society in her time
 Statistician and a Nurse
 Volunteered to go to Scutari to help the soldiers
 Part of a wealthy family, Florence Nightingale defied the expectations of the time and pursued what she saw as
her God-given calling of nursing.
 During the Crimean War, she and a team of nurses improved the unsanitary conditions at a British base hospital,
greatly reducing the death count.
 Her writings sparked worldwide health care reform, and in 1860 she established St. Thomas' Hospital and the
Nightingale Training School for Nurses.
 A revered hero of her time, she died on August 13, 1910, in London.

Why Was She Called “The Lady With A Lamp”?

 Florence always made rounds to visit and check patients in Scutari (Turkey).
 She was remembered as someone who always brought her lamp at night when she visited the wounded and sick
soldiers of the Crimean War.

Did She Really Meet Queen Victoria?

 Yes, she met queen Victoria when she arrived with forty nurses from Scutari barrack hospital in November 1854.
 Queen Victoria was anxious to hear of the state of the soldiers
 She requested details from Miss Nightingale’s reports.
 She was given a jewel brooch for her service to the sick as well as for her bravery.

What Happened to the Hospital in Scutari?

 The soldiers were dying because the condition of the hospital was very poor.
 There were not enough lights coming from windows and fresh air was not in proper circulation.
 The place was very dirty, there were rats and other pests roaming around the insides of the hospital.
 The water source was also very scarce.
 Florence made changes to all of these during her time.

NURSING THEORY
 An articulated and communicated conceptualization of invented or discovered reality (Central Phenomena and
Relationships) in or pertaining to nursing.
 For the purpose of describing, explaining, predicting, or prescribing nursing care.
 This definition states the importance of expressing nursing theory in providing direction to nursing care.
 According to Meleis (1991)

COMPONENTS OF A THEORY

1) Context
 Resembles environment to which nursing act takes place

2) Content
 Subject of the theory

3) Process
 Method by which the nurse acts in using nursing theory

The Complexity of Nursing

 Different definitions by many authors are inevitable.
 There is Beauty in diversity especially in refining the complexity of nursing.
 In the near future, the certainty of nursing theories will become more dependable as extensive studies and
researches become stronger and widespread, and it is possible that more nursing theories will evolve.

Topic 4 – The Nursing Theory

 With the history and definitions of Nursing, we can easily determine the distinct and unique role of nurses in the
promotion of health, treating of symptoms in the actual disease, and as well as prevention of diseases in the
future.
  It is imperative that the making of a nursing model is essential as it will give us in the healthcare, patterns in the
delivery of care to make it more effective, and to show clear bases in theories for the actual work as we face
various trials in the delivery of care during these difficult times.
NURSING PARADIGMS
 Pattern or models used in the nursing profession.
 Focused on relationships among 4 Major Concepts or Metaparadigms
 Metaparadigms
 Greek meta meaning “with” and paradeigma meaning “pattern”
 Paradigms – Highest Level Of Knowledge

1) Person
 The recipient of nursing care (individuals, families and communities)
 Example:
 Florence Nightingale proposed that the physical, intellectual, and spiritual being of a person is not
capable of manipulating the environment to promote health.
 This means that a person is a passive recipient of care.

2) Environment
 The external and internal aspects of life that influence the person.
 Example:
 Physical environment is emphasized by Florence Nightingale in her theory.
 She focused on ventilation, warmth, noise, light, and cleanliness.

3) Health
 The holistic level of wellness that the person experiences.
 Example:
 Florence Nightingale defined nursing as:
o “A profession for women (a calling) with the goal to discover and use the laws governing health
in the service of humanity.”
 She believed that the goal of all nursing activity should promote client’s health.

4) Nursing
 The interventions of the nurse rendering care in support of, or in cooperation with the client.
 The attributes of the nurse in giving care.
 Example:
 FN emphasized that a nurse is responsible in promoting the well-being of clients by manipulating the
environment.

CLASSIFICATION OF NURSING THEORIES ACCORDING TO FUNCTION

1) Descriptive
 Factor-isolating Theory
 To know the properties and workings of a discipline

2) Explanatory
 Factor-relating Theories
 To examine how properties, relate and thus affect the discipline

3) Predictive
 Situation-relating Theory
 To calculate relationships between properties and how they occur

4) Prescriptive
 Situation-producing Theories
 To identify under which conditions relationships occur

Characteristics of a Theory
1. Can correlate concepts in such a way as to generate a different way of looking at a certain fact or phenomenon.
2. Must be logical in nature.
3. Should be simple but generally broad in nature.
4. Can be the source of hypotheses that can be tested for it to be elaborated.
5. Contribute in enriching the general body of knowledge through the studies implemented to validate them.
6. Can be used by practitioners to direct and enhance their practice.
 7. Must be consistent with other validated theories, laws, and principles but will leave open unanswered issues
that need to be tested.

Concepts
 The Building Blocks of Theories
 It can come from an empirical (observed or experience) phenomena or any abstraction of how a person
perceived an object that is not physically present or observed like charity, caring, patience.
 A concept enhances one’s capacity to understand phenomena as it helps define the meaning of a word.
 2 Types of Concepts:
 Abstract Concepts
o Are indirectly observed or intangible.
o It is independent of time and place
o Examples are love, care, and freedom.
 Concrete Concepts
o Sre directly observed or tangible
o Examples are nurse, mother, and pain
 Can be used in making or formulating a conceptual or operational definition.

Conceptual Definitions
 Are the meaning of a word based on how a certain theory or relevant literature perceives it to be.
 Examples are roles/ concepts of nurse, patient care, and environment.

Operational Definitions
 Are meaning of a word based on the method of how it was measured or how the person come up with that
perception.
 An example of this type is the significance of pain perception and practiced nursing intervention.
 It sets forth the meaning of phenomena through analysis, reasoning and logical argument.

Philosophy
 Works that specify philosophical approaches to Nursing are considered as a philosophy.
 Such as that of Nightingale’s
 Furthermore, theory may be formed from these philosophies such the work of Watson and Benner.
 Philosophies have contributed to the knowledge development in nursing by forming a basis for subsequent
developments especially in area of human science.
 They can be represented thru a diagram or in a narrative form which shows how concepts are interrelated.

PERSON → PHYSICAL FITNESS (Exercise) → LOWERED BP

 This a theoretical framework presented by a nurse theorist, Lydia Hall

Science
 From the Latin scientia meaning “knowledge”
 Refers to any systematic knowledge or practice in a discipline of study.
 In a more casual sense, science refers to a system of acquiring knowledge based on the scientific method.
 It is also the organized body of knowledge gained through research.

STEPS IN THE SCIENTIFIC METHOD

1) Observation
 Integration of knowledge and/or phenomenon by a rational/ sentient being
 Example: Elmer, a nurse-researcher observes a certain nursing phenomenon and makes a study about it.

2) Gathering Information/Data
 Recognition and collecting data for a scientific problem or inquiry.
 Example: His colleague, Dave helps him to gather data thru various methods.

3) Forming Hypothesis
 An attempt to explain or suggest a nature of a phenomenon.
 Example: they both make a hypothesis, an intelligent guess on the nature of the phenomenon.

4) Experimental investigation
 A set of examinations done to solve the query raised through the hypothesis process.
 Example: they conduct a survey and interview and apply statistical treatment on the data.

5) Conclusion or Theoretical Explanation

  A statement explaining a set of natural phenomena or a scientific query derived from Experimental
Investigation.
 Example: Based on the result, they draw a conclusion. as new data emerges, the study is re- examined and
verified.

Knowledge
 Information, skills and expertise, or through various life experiences, or through Formal/informal Education,
Self-Study and Vocational
 The abstract or workable understanding of a subject or idea.
 What is known in a particular field of discipline or study
 Facts and information or awareness or familiarity gained experienced of a fact or situation.
 No single agreed classification of knowledge.
 Knowledge acquirement involves several cognitive processes.

COGNITIVE PROCESS OF KNOWLEDGE

TYPES OF COGNITIVE PROCESSES

1) Perception
 Achieving understanding of sensory data.

2) Association
 Combining 2 or more concepts/ideas to form a new concept, or for comparison.

3) Learning
 Acquiring experience, skills, information and values.

4) Reasoning
 Mental process of seeking conclusions through reason.

5) Communication
 Transferring data from sender to receiver using different mediums or tools of communication.

SOURCES OF KNOWLEDDGE
1) Traditional
 A nursing practice which is passed down from generation to generation.
 When asked about the basis of the nursing practice the answer would be as simple as:
 “It’s always been practiced this way.”
 Ex. Routine changing of bed linens (soiled or not), common in ICU setup; adopted but no research data to
support.

2) Authoritative
 An idea by a person of authority which is perceived as true because of his or her expertise.
 Ex. Nurse supervisor teaching a novice on insertion of urinary catheter; teaching through experience.

3) Scientific
 Came from scientific method through research.
 These new ideas are tested and measured systematically using objective criteria.
 Ex. Student nurse giving tepid sponge bath (TSB) to patient with fever should know the rationale (reason) behind
this procedure, which is heat transfer through evaporation (basic physics).

Phenomenon
 All natural events that the human senses can perceive can be called a phenomenon.
  In nursing, phenomena can be:
 Clinical or Environmental Setting of Nursing (Ex. Health Center)
 Disease Process (Ex. Stomach Ulcer)
 Client’s Behavior (Ex. Guarding Behavior at the Pain Site)
 Interventions (Ex. Care of the Client in Pain)
 Practices That Are Utilized In Nursing Theories & Metaparadigms (Person, Nursing, Health, Environment)
NURSING THEORY DEVELOPMENT
Education
 Nursing theories were primarily used to develop and guide nursing education in universities and institutions.
 They were once known to be more established in the field of academics rather than in clinical practice.
1. Nursing programs built a complete curriculum around these theories in 1970-1980
2. Prepared students for practice as members of the professional community
3. Ensured adequate and quality nursing delivery, to clarify, improve the status of nursing as a profession.
Research
 Research is inspired from assumptions in the past
 Through evolution of technology, ideas, and emerging nursing issues, answers to questions encountered in
practice are provided. Interpretations and perspectives are generated.
1. Grand Theory
2. Middle-Range Theory
3. Critical Theory
Clinical Practice
 Nursing theories enriches nurse’s ability.
 Guide critical thinking and decision-making in clinical nursing practice
 Better understanding on the basis and nature of their work and be able to express it clearly in collaboration with
other professionals
 Strengthen professional independence by guiding the deepest and most important part of their practice.
 Critical in assisting nurses to facilitate questions, reflections, and critical thinking in every aspect of care.
 Example: Using critically similar strategies to children with suspected maltreatment
cases.
 Leininger’s Transcultural Nursing

INTERDEPENDENCE OF THEORY AND RESEARCH

 “Practice without theory, like map without route, is blind; theory without practice, like
route without map, is empty.”

FLORENCE NIGHTINGALE
Florence Nightingale was born in the city of Florence, Italy on 12 May 1820. She was the second daughter of
wealthy parents (her elder sister was called Parthenope). When she was young Florence was very interested in
mathematics. She was also a devout Christian and when she was 17, she felt God was calling her to serve him. At first,
Florence was not sure how God wanted her to serve but by 1844 she was convinced she was to nurse the sick. Her
parents, William and Frances disapproved because at that time nursing was definitely not a respectable job. Her family
tried to talk Florence out of it but she was determined. A man named Richard Monckton Miles tried to persuade
Florence to marry him but she refused even though she adored him. Florence Nightingale was determined to sacrifice
herself. Nevertheless, it was several years before she got any nursing experience. In 1851 she went to Kaiserwerth in
Germany to learn. Then in 1853, she was given her first post, reorganizing a small hospital in Harvey Street, London, The
Institution for the Care of Sick Gentlewomen in Distressed Circumstances.

Florence In The Crimean War

As a result of her work Sidney Herbert the Secretary of War invited her to go on a mission to soldiers wounded
fighting the Russians. (At that time Britain, France and Turkey were fighting Russia. Nightingale sailed with 38 nurses to
Turkey on 21 October 1854. They arrived at Scutari Hospital in November. But an alarming number of soldiers in Scutari
Hospital died of disease while under Nightingale's care. (The death rate in Scutari was higher than in other, similar
hospitals). So in 1855, the British government sent a sanitary commission to investigate. They found the hospital at
Scutari was built over a blocked sewer. The commissioners flushed the sewer and improved ventilation in the hospital.
As a result number of deaths in the hospital dropped dramatically. Despite the fact that the death rate in her hospital
was very high and it only fell when the sanitary commission did its work Florence became a heroine to the public.

Nightingale returned to Britain in 1856. She was commissioned to investigate the living conditions of British
soldiers in peacetime. In 1858 she published her findings as Notes on Matters Affecting the Health, Efficiency and
Hospital Administration of the British Army. This work contained many statistical analyses. Though she is usually
remembered as a nurse Florence was a talented statistician. In 1858 she became the first woman member of the Royal
Statistical Society. In 1874 she became an honorary member of the American Statistical Society. Florence did NOT invent
the pie chart (it was invented by William Playfair in 1801). For her work, Nightingale used polar area diagrams (invented
by a Frenchman named Andre-Michel Guerry in 1829).

In 1860 Florence Nightingale opened the Nightingale Training School for Nurses at St Thomas Hospital. She
greatly raised the standards of nursing. Every probationer who entered the school was interviewed by Florence and
supervised by her. In old age, Florence suffered from ill health and she went blind. By the mid-1890s Florence was an
invalid. However, she was awarded the Order of Merit in 1907. Florence Nightingale died on 13 August 1910.