Nursing Theories

Introduction
“The systematic accumulation of knowledge is essential to progress in any
profession. However, theory and practice must be constantly interactive. Theory
without practice is empty and practice without theory is blind” (Cross, 1981).

Theory plays a major role in many ways. The term “theory” commonly used to
refer to the subject matter of any discipline. Sometimes “Theory” refers to some one’s
ideas or concept. For example my theory is that live in present rather than worrying
about past and future. On research grounds, the term theory refers to an abstract
generalization that presents a systematic explanation about how phenomenon is inter
related. Theory often provides framework for nursing research. One goal of research
is to extend the scope of the knowledge.

Theory and practice are closely inter-related with each other. Theory has no
any hatredness towards practice infact the worth of the theory is only based on extend
of practice of it. In some way the reward for the practice can be based on a systematic
knowledge from theory. The theorist can be both intellectual in thinking and efficient
in performance and the practioner can be both knowledgeable and skill full.
The word “theory” originated from the Greek word “Theoria” which means
vision. The common understanding that prevails or expectation is “theories are fact”.
But they are really from perspectives on truth or reality. Theories are view points or
ways of perceiving.

Definition of Theory

Kerlinger defines “the theory is set of interrelated concepts, definitions and

proportions (relationship of two or more concepts) that present a systematic view of
phenomena by specifying relations among variables, with the purpose of explaining
and predicting the phenomena”.
 Henkel defines “Theories refers to a hypothetical universe, hypothetical in the
sense that it encompasses all past, present and future cases to which theory applies,
whenever they may occur” Example theory of gravity, theory of haemostasis, system
theory.

According to Chinn and Jacob “Nursing theory is a set of concepts, deposition

and preposition that project a systematic view of phenomenon by designing specific
inter relationship among concepts for purposes of describing, explaining, predicting
and controlling phenomena.

Theory is a set of concepts, propositions or statements which are logically

interrelated deductive system.
Theory is a set of concepts interrelated to form propositions that are useful for
prediction and control.

Is Theory Essential For Nursing?

Today nursing is designated as an evolving profession. One of the described

qualities for the discipline to be called as profession is to have systematic knowledge
base. A strong foundation of the knowledge base lies in the imperishable content of
theory. Theory becomes essential for nursing discipline not only to label it as
profession but also theory in nursing serves the purpose of describing, explaining,
clarrifying, justifying, delineating, predicting and controlling to achieve desired out
comes for nursing.

Theory helps novice nurse to develop comprehend and process knowledge and
information and aids in application of practice with challenge thinking and new
analytical skills. Theory also provides purpose in every action of practice. The
existence of theory provides sound knowledge, values and beliefs about nursing
profession and also represents the individual and collective effort of our pioneer’s
contribution towards nursing profession.
 Nursing theory provides the foundation for nursing knowledge and gives
direction to nursing practice. Theory guides the development and future direction of
research in nursing.

Barnum (1998) offers this vivid analogy to describe nursing theory: A theory is
like a map of territory as opposed to an aerial photograph. The map does not display
the full terrain (buildings, moving vehicles, or grazing live stocks); instead it picks out
those parts that are important for its purpose. If its aim is to guide travelers, the map
will highlight roads; if its purpose is to describe the physical terrain, it will show
mountains, plains and rivers. But no map (or theory) reflects all that is contained
within a phenomenon. Such a map would defect its purpose: giving one a handle on
the phenomenon. The handle is created by making the essential parts stand out its
relief.

Development of Nursing Theory

The theory and practice of nursing are considered as the two eyes of the
nursing profession without theory, it is difficult to practice wisely & systematically
and also without theory, it is difficult to have scientific and uniform practical
application. The existence of theory alone is vain. Therefore the development of
theory and its practical application are essential for nursing profession.

The development of nursing theory has provided direction for the structure of
professional nursing practice, nursing education, nursing administration and nursing
research.

Chinn and Jacob (1994) emphasized the importance of nursing theory to

students and practicing professionals stating that “nursing theory ought to guide
research and practice, generate new ideas and differentiate the focus of nursing from
other professions”.
 The origin for theory in nursing historically began with pioneer in nursing
Florence Nightingale (1860) who first discussed the theory framework in “Note on
nursing”. She conceptualized the nurse’s role as modifying the environment to
encourage and facilitate reparative process by attending to ventilation, warmth, light,
diet, cleanness and a noise. Her contribution to nursing is still considered and
followed in terms of monitoring client’s nutritional status meeting eliminatory needs,
providing conducive environment and following standard precautions.

Nightingale, in establishing the discipline of nursing, spoke with firm

conviction about the nature of nursing as a profession that requires distinct knowledge
from other profession. The two world wars which has brought tremendous shift in the
roles woman and nurses was the turning point for the glow of nursing profession
itself.

Initially, the practice for training nursing personnel was given in the hospital
set up only. After the Second World War, nursing education slowly started in the
educational institution with widespread training of nursing personnel for acquiring
desired knowledge to practice profession skillfully. Followed by entry of graduates
and post graduates in nursing has created whirlwind to raise the standard of profession
to its greatest heights.

The first land mark was establishment of first research journal in the year 1950.
The nursing personnel were encouraged to publish the article for this journal by
conducting research in their arena. In the year 1960, doctoral programme in nursing
was envisioned and established. The more serious steps were undertaken by senior
nursing personnel with utmost effort to bring the doctoral programme to come into
existence.

In the late 1970, the growth of nursing profession was enormous both in
quantity and quality. Nearly 2000, doctorally prepared nurses with approximately 20
doctoral programmes in nursing were established. The post graduate and graduate
 programme in nursing has gained matured academic stature with standard quality
education.

Over the years, nursing has incorporated theories from non-nursing sources,
including theories of systems, human needs, change, problem solving, decision
making etc. as the educational preparations of nurses increased Nurses recognized that
much out of their intuitive knowledge could be utilized in explaining and
understanding theories developed in other discipline. Nurses started their liberal
contribution by formulating and developing theories to the profession. Many theorists
in the nursing profession gave shade for many theories with different dimensionalities
in the care of client.

Major Nursing Theories

S.
Year Theorist/Theory Purpose
No
1 1860 Florence Nightingale To help individuals responsible for
Notes on Nursing: What It Is, caring for the sick to “think how to
What It Is Not nurse.” Theory addresses fundamental
needs
2 1952 Hildegard E. Peplau To develop an interpersonal
Interpersonal Relations in interaction between client and nurse
Nursing
3 1955 Virginia Henderson To assist the client in gaining
The nature of Nursing independence as rapidly as possible
4 1960 Faye Glenn Abdellah To deliver nursing care for the whole
Patient – Centered Approaches individual
to Nursing
5 1961 Ida Jean Orlando To interact with clients to meet
The Dynamic Nurse – Patient immediate needs by identifying client
Relationship behaviors, nurse’s reactions and
nursing actions to take
6 1964 Lydia E. Hall To provide professional nursing care
 Nursing: What Is It? to people past the acute stage of illness
7 1964 Ernestine Wiedenbach To assist individuals in overcoming
Clinical Nursing – A Helping obstacles that prevent meeting
Art healthcare needs
8 1970 Martha E. Rogers To assist the client in achieving a
The Science of Unitary Man maximum level of wellness
9 1970 Sister Callista Roy To identify the types of demands
placed on a client and the client’s
adaptation to the demands
10 1971 Dorothea E. Orem To provide care and to assist the client
Nursing: Concepts of Practice to attain self-care
11 1971 Imogene M. King To use communication to help the
Open system Model client reestablish a positive adaptation
to his or her environment
12 1971 Joyce Travelbee To Assist individuals, families,
Interpersonal Aspects of communities, and groups to prevent or
Nursing cope with illness and regain health
13 1972 Betty Neuman To address the effects of stress and
The Neuman Systems model reactions to it on the development and
maintenance of health
14 1979 Jean Watson To focus on curative factors derived
Nursing: The Philosophy and from a humanistic perspective and
science of Nursing from scientific knowledge
15 1980 Dorothy E. Johnson To reduce stress so the client can
The Behavioral System Model recover as quickly as possible
for Nursing
16 1981 Rosemarie Rizzo Parse To focus on humans as living unity
Man – Living – Health: Theory and humans’ qualitative participation
of Nursing with health experience

Components of Theory
 A theory is a set of concepts, definitions, relationships and assumptions that
project a systematic view of phenomenon.

A nursing theory is a conceptualization of some aspects of nursing

communicated for the purpose of describing, explaining, predicting, and (or)
prescribing nursing care.

Nursing theories provide nurses with a perspective to view client situations, a

way to organise data and a method to analyse and interpret information. Applications
of nursing theory in practice depends on the nurses knowledge of nursing and other
theoretical models, how these models relate to each other and the use of these models
in designing nursing interventions.

Theory is developed after extensive research, which allows the researcher to

see a clear perspective of all components of a phenomenon. These are six components
of theory.

Goal

Goal refers to the aim or target to achieve the end result. Hence goal in the
context of theory refers to the aim for which the theory is developing and suggest the
limits of phenomenon to which the theory is applied. The Goal is the framework in
which the theory fits in. it provides right direction and avoids unnecessary deviation
to other arena.

Concept
Concept is an idea (or) symbolic representative of reality. Concepts are
cognitive formulation of an objects or events that are derived from one’s own
perception. A Theory consists of interrelated concepts which help to describe (or)
label phenomenon.
Definitions
 Definition within the context of theory conveys meaning that explicit attempt
to clarify the meaning of concept. This definition also describes the activity necessary
to measure the constructs, relationship or variables with in a theory. There are varied
concepts has its own meaning in relation to that theory. Definition helps to clarify the
meaning of each concept pertaining to the particular theory.

Relationship
Relationship refers to the linkage of concepts. Each theory has unique and
different concepts. These concepts are interrelated for the completion of theory.
Therefore relationship plays an important role as a component of theory.

Structure

Structure refers to an overall design (or) pattern to form the conceptual

relationship with in the theory. Structure provides shape to the theory by inter-relating
the concepts with arrows and pictures. It finally gives framework for the theory.

Assumption

Assumptions are statements of accepted truth that may be found prior to the
beginning of theoretical reasoning. Assumptions are the “taken for granted”
statements that determine the nature of concepts, definitions, purpose, relationships
and structure of the theory. Assumptions are statements that describe concepts or
connect two concepts that are factual.

Purposes of Theory
 1. To distinguish fact from pseudofact which are derived from multiple congruent
and similar observations of phenomenon over-time.
2. To integrate facts from many fields – Biology, Anatomy, Physiology,
Sociology, Psychology, Nutrition and make them useful for nursing.
3. To give direction for practice.
4. To act as a framework of knowledge store by serving as a guide for retrieval
and use of information.
5. To elucidate professional autonomy through enlightment of information in
education, research, administration and practice there by forming a basis for
power.
6. To identify and study the area which are not explored.
7. To formulate legislations governing nursing practice and administration,
research and education.
8. To formulate regulations interpreting nurse practice acts so that nurses and
others better understand laws.
9. To develop curriculum plans for nursing education.
10. To establish criteria for measuring quality of nursing care education and
research.
11. To guide development of nursing care delivery system.
12. To provide systematic structure and rationale for nursing activities.

Types of Theory
 Theories differ extensively in their level of generality. They are classified in
many different ways including their level of development. The classifications
according to the level of abstraction are

1) Grand theories (Macro theories).

2) Middle range theories.
3) Abstracted empiricism.

The classifications of theory according to the goals are

1) Descriptive theory.
2) Explanatory theory or prescriptive theory.

Theories classified by another typology are

1) Factor isolating theory.

2) Factor relating theory.
3) Situation relating theory.
4) Situation producing theory.

Grand Theories (Macro Theories)

Grand theories are broad in scope and complex in nature, and therefore require
further specification through research before they can be fully tested. They attempt to
explain almost everything about a subject. They are composed of numerous concepts
which are global in nature but often poorly defined and have ambiguous and unclear
relationship. Constructs and propositions are non existent or equally vague and
appeared to have little basis in the practical world.

Models of such theories are either impossible or in comprehensive. As

mentioned in earlier concepts grand theories are unclear and vague in nature but used
to give a researcher a way to think about data. Blalock calls these concepts as
“sensitising concepts” Example of sensiting concept is “Life experience” which may
give a researcher a beginning idea to view a new over stimulating and confusing
environment.

Middle-Range Theories
Theories that have more limited scope, less abstraction, address specific
phenomenon or concepts and reflect practice are considered middle range theories.

Merton (1968) sociologist describes “Middle range theories are those that look
at a piece of reality and identify a few key variables”. Propositions are clear and
hypotheses can be derived to test the theory. Inorder to develop middle range theories
the researcher is very close to the empirical world, often using the method of field
research, participant observation and interview. The research conceptualizes the
empirical data. For example Mishel’s theory of uncertainty in illness focus on the
experience of clients

Abstracted Empiricism

Abstracted empiricism is on the another extreme of the continuum, revealing

its concrete, firm, existing phenomenon and near sighted focus on only empirical
phenomenon. Abstracted empiricism implies that empiricism or facts are in isolation
from any theory.

Example : - In some hospital nurses prepare the patient for 12 hrs nil per oral status
prior to surgery because they believe that patient may aspirate the food contents
during the surgery where as in some other hospital nil per oral status is advised only
for 6 hrs, because the patient may loose energy after surgery.

These nurses in both the hospitals are planning the care based authority or
tradition rather than on theoretical protocols which ideally guide practice.
Descriptive Theory
 Descriptive theory is the first level of theory development. Descriptive theory
describes phenomenon as it is by identifying its major elements or events. They also
speculate why the phenomenon has those elements, describe the consequence of
phenomenon and how the relationship affects each other. Descriptive theory identifies
the sailent constituents of a theory i.e., naming the element or events. It may point out
complex and abstract concepts but it is not explanatory. The theory provides a basis
for nurses to assist in adapting to the uncertainty and the illness response.

Explanatory Theory / Prescriptive Theory

Explanatory theory is the next level in theory development. They are action
oriented, which tests the validity and predictability of nursing intervention. It may
deal with cause and effect, correlation and the condition under which the interaction
should occur. This theories guide nursing research for the development of specific
nursing interventions.

Dickoff and James two philosophers’ wiedenback, a nurse scientist presented

another typology of theories.

Factors Isolating Theories or Factor Naming Theories

This is the first level of theory development. This is otherwise known as

concept naming theory because it identifies and classifies the concepts. This theory is
mainly based on observations which are named under different categories which
includes phenomenon and description of each phenomenon. To simplify, here the
question to be answered is “what is this?”.

Factor Relating Theories or Situation Depicting Theories

This is the second level of theory. Here already identified factors are named
and related with each other. Here situations involving several variables are described
or depicted which increases a general understanding. In this theory relationship
between two concepts or factors is highlighted. Here the question to be answered is
“what is happening here?”.

Situation Relating Theories or Predictive Theories

This is the third level of theory. This theory explains the interrelationships
among concepts or propositions. These theories developmentally follow descriptive
theory and allow to predict cause and effect relationship. The two situations of X and
Y are causally related with each other. If X and Y will follow it, (i) What factors
promote X’s production of B? (ii) What factors inhibit X’s production of Y and
(iii) What are the conditions that influence A producing B. Here the researcher is very
much interested in finding out what will happen here?

Situation Producing Theories or Prescriptive Theories

This is the fourth level of theory. This theory discusses regarding the
importance of causal factors which in turn leads to effect. Without causal factor there
is no effect. Therefore this theory mainly concentrates on how effect can be produced
more foster by enhancing causal factors.

Dick off and his associates emphasis three points about prescriptive theory.
(i) Prescription is command.
(ii) The direction of command acts towards specific end.
(iii) Command is also directed to some specified agents.

Characteristics of Theory

(i) Theories are made up of concepts and propositions.

(ii) Concepts are interrelated to devise a new phenomenon with a designed
outlook.
(iii) Theories lay a platform for future researcher to test the existing hypothesis.
(iv) Theories describe, explain, predict, produce or control desired phenomenon
in a meaningful way.
 (v) Theory increases the general body of knowledge of the profession through
research to validate them.
(vi) Theories foster the nursing practice as a guiding force.

Metaparadigms of Nursing

Metaparadigm originates from two Greek words : “meta” meaning “with” and
“paradigm” meaning “pattern”. The four major concepts focused in metaparadigms of
nursing are person, health, environment and nursing.

Person:- Refers to the recipient of nursing care including clients, families and the
community. The multidimensional of the person is the central core of the nursing care
given.

Health:- ANA(1995) defines “Health as a dynamic state of being in which the

developmental and behavioural potential of the individual is realized to the fullest
extent possible”. The nurse is challenged to provide care based on the client is
individual level of health and health care needs at the time of care delivery.

Environment:- The situation or surrounding that affects the client is environment

which includes internal and external environment. The environment may be familiar,
friends, home, school, workplace, or community. The interaction of environment with
the person may have positive and negative effect on the level of health. Nursing has
unique responsibility to provide stable or improved environment for the betterment of
health of the individual.

Nursing:- ANA(1995) defines nursing is the “diagnosis and treatment of human

responses to actual or potential health problems”. Nurse assess, diagnose, sets goals,
implements, and evaluates by using her critical thinking skills, knowledge,
experience, attitudes and standards for providing wholistic care for the patient.