NCM 100: THEORETICAL

FOUNDATIONS OF NURSING

A.Y. 2020 - 2021

Early Views on Nursing Theory

 Confusing, of no practical value, ‘too theoretical’

 Confusion over terms: conceptual framework,

conceptual model, and theory

 Levels, testing, analysis, one theory or many

“In the early days, theory was expected to be obscure. If

it was clearly understandable, it wasn’t considered a very
good theory” (Levine, 1995, p11).
Nursing Theories & Nursing Practice

 Nursing theories are a relatively new component of the

nursing profession.

 Nursing theories have a made a strong and lasting impact on

the education, training and development of professional
nurses. They have also influenced patient care and
outcomes in everyday nursing practice.

 As the nursing profession continues to evolve and define

itself, new nursing theories will be needed to guide nurses
practicing at the bedside.
Benefits of theory based practice

 Structure & organization

 Systematic, purposeful
approach

 Focused practice =
coordinated and less
fragmented care

 Goals & outcomes

identifiable and traceable
 PARADIGM
 Paradigm: “A boundary structure which consists of items
or phenomena for investigation for a given disciplinary
perspective” (Kim, 2009/1989, p.43).
 A model that explains the linkages of science, philosophy,
and theory accepted and applied by the discipline
(Alligood and Marriner – Tomey, 2002)

A Metaparadigm is a “gestalt or total world view within a

discipline … the broadest consensus within the discipline
…of the general parameters” (Hardy, 2009/1978, (cited in Reed & Shearer, p.531)
 METAPARADIGM
 The general perspective of a discipline that identifies the
primary phenomenon that are of interest to that discipline
that explain how the discipline deals with those
phenomena in a unique manner (Fawcett, 2000)

 Its purpose or function is to summarize the intellectual and

social missions of the discipline and place boundaries of a
subject matter of that discipline
Requirements of a Metaparadigm

 Identify a domain that is distinctive from the domains

of other disciplines

 Encompass all phenomena of interest to the discipline

in a parsimonious manner

 Perspective – neutral

 International in scope and substance

Nursing’s Metaparadigm

The most
abstract and
general
component of
the structural
hierarchy of
nursing
knowledge
(Kuhn, 1977)
1. Person

― Holistic being in the world: composed of physical,

intellectual, biochemical and psychosocial needs

― An open system

― An integrated whole

― An adaptive system

― A being who is greater than the sum of its parts

2. Health

― Ability to function independently

― Successful adaptation to life’s stressors

― Achievement of one’s full life potential

― Unity of mind, body and soul

3. Environment

― External elements that affect the person

― Internal and external conditions that influence the

organism

― Significant others with whom the person interacts, and an

open system with boundaries that permit the exchange of
matter, energy and information with human beings
4. Nursing

― A science, an art and a practice discipline and involves

caring

― Goals of nursing care includes care of the well, care of the

sick, assisting with self – care activities, helping individuals
attain their human potential, and discovering and using
nature’s law of health
 Classifications of
Nursing Theories

THEORIES IN NURSING
METATHEORY

 Philosophy or worldview: to describe the

philosophical basis of the discipline
 Refers to a theory about theory
 Focuses on broad issues such as the
processes of generating knowledge and
theory development
 Forum for debate within a discipline (Chinn &
Kramer, 2004, Powers & Knapp, 1995)
Scope of Nursing Metatheory

 Most abstract
 Philosophical world
views
 Philosophy of nursing
 Critical theory
 Feminist theory

*Refers to complexity and degree of abstraction

GRAND Theories

 Macro theory: to describe the

comprehensive conceptual frameworks
 Most complex and broadest concept
 Attempt to explain broad areas within a
discipline and may incorporate numerous
other theories
 Nonspecific
GRAND Theories

 Consist of broad conceptual frameworks

that reflect wide and expansive perspectives
for practice and ways of describing,
explaining, predicting and looking at nursing
phenomena

 Developed through thoughtful and insightful

appraisal of existing ideas as opposed to
empirical research
Scope of Nursing Grand Theories

 Complex and broad

 Relatively abstract concepts
that lack operational definitions
 Non specific
 Not immediately applicable or
testable without further
definitions
 Eg. Orem, Roy, Rogers
MIDDLE RANGE Theories

 Lies between the nursing models and more

circumscribed, concrete ideas

 Substantively specific and encompass a

limited number of concepts and a limited
aspect of the real world.
MIDDLE RANGE Theories

 Comprised of relatively concrete concepts

that are operationally defined and
relatively concrete propositions that may
be empirically tested (Higgins & Moore, 2000)

 May be a (1) description of a particular

phenomenon, (2) an explanation of the
relationship between phenomena, or (3) a
prediction of the effects of one
phenomenon or another
Scope of Middle Range Nursing Theories

 Less abstract
 Focus on a particular
phenomenon
 Eg social support, quality
of life, hope, anxiety;
death and dying
PRACTICE Theories

 Microtheoires, perspective theories or

situation – specific theories and are least
complex

 More specific than middle range theories

and produce specific directions for practice
(Higgins & Moore, 2000; Peterson, 2004; Whall, 2005)
PRACTICE Theories

 Contain fewest concepts and refer to

specific, easily defined phenomena

 Narrow in scope, explain a small aspect of

reality, and tend to be prescriptive.

 Usually limited to specific populations or

fields of specific and often use knowledge
from other discipline (McKenna, 1993)
Scope of Practice Nursing Theories

 Specific phenomenon with

specific population or field of
practice
 Eg theory of departure
in college students;
 Eg Death and
Bereavement in Teens
 Fewest concepts
PARTIAL Theories

 Those in the development stage

 Concepts have been identified and some

relationships between and have been
identified, but the theory is not complete
Other KINDS of THEORIES

Type or Purpose of Theory:

 Factor – isolating theories

 Factor – relating theories

 Situation – relating theories

 Situation – producing theories

Factor - isolating theories

 Descriptive, names concepts and dimensions

 Tested by descriptive research

 Describes ‘what is’

 May include models that illustrate an experience,

culture, or process
Factor - relating theories

 Attempts to explain how or why concepts related

 Eg smoking and fetal size
 Helping and lifespan in a nursing home

 Statistical correlation research

Situation - relating theories

 Predictive of future outcomes. If this, then that…

 Eg smoking and fetal size
 Helping and lifespan in a nursing home

 Cause and effect, empirical testing

Situation - producing theories

 Prescriptive for future outcomes and defined goals.

 Smoking cessation and improved birth weight
 Cocaine abuse and fetal addiction

 Prescribe directed interventions and consequences of

interventions

 Propositions call for change among specific patient

groups and conditions
JULES ANTONETTE S. ALAMIN, MSN
N C M 1 0 0 A . Y. 2 0 2 0 - 2 0 2 1