Theoretical Foundation in Nursing

Theory - helps explain an event by

• Defining ideas or concepts
• Explaining relationship among the concepts
• Predicting outcomes
Nursing Theory
• Describes, explains, predicts and/or prescribes nursing care
● Nursing Theory
• help to generate further knowledge
• indicate in 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.
Components of a Theory
● Phenomenon –an observable event
● Concepts – abstract description of phenomena, building blocks of theories
● Definitions – meaning of the concept
● Theoretical/conceptual
● Operational
● Assumptions – statements that describe concepts
● Paradigm
- Conceptual framework
Nursing metaparadigm
- Person
- Health
- Environment/Situation
- Nursing
The Domain of Nursing
● Person
- recipient of nursing care.
● Health
degree of wellness or well-being that the client experiences. .
● Environment
- or situation , positive or negative
internal and external surrounding that affects the patient.
● Nursing
. nurse’s attributes, characteristics, and actions provide care on behalf of or in
conjunction with the client
Evolution of Nursing Theory
Dark Era – 1500-1860
Florence Nightingale –First nursing theorist
Curriculum Era
1900-1940s
Research era
1950-1970s
Graduate Education era
1950-1970s
Theory Era
1980-1990s
Theory Utilization Era
2000-at present

Classification of Theory
BY ABSTRACTION
Grand – broad in scope, complex
Middle-ranged – limited in scope and less abstract
Practice – narrow in scope and focus
Identify if the following nursing theories is an example of Grand, Middle-ranged or Practice
Theories
Orem's self-care deficit theory suggests patients are better able to recover when they maintain
some independence over their own self-care.
● Nelson Breastfeeding theory, which recommends that when educating a new mother
about breast-feeding, the nurse should be respectful of the mother’s right to decide,
and carefully consider how promote  breastfeeding without causing conflict.
● The outcome is a more positive breastfeeding experience for the mother and infant.

Classification of Theory
BY GOAL ORIENTATION
Descriptive – describe phenomena, speculate on why phenomena occur and describe the
consequences of phenomena.
Prescriptive – address nursing interventions for a phenomena and predict their consequence of
a specific nursing intervention
This is Billy, he is an elementary student and is at risk of developing health problems due to
obesity.
What do you think are the causes of this condition?
Help to explain patient assessments
Billy is getting bigger, he is becoming obese and is at risk for chronic childhood disease such as
DM.
Billy will be educated on healthy eating choices and the importance of playing outside and
being active.
Action oriented, test a specific nursing intervention

Fundamental Patterns of Knowing

Empirical
● The Science of Nursing
Based on the assumption that what is known is accessible through the physical senses:
Seeing, touching, hearing
Identify the elements lacking in this situation to increase ability to provide care.
Ethics
● Moral knowledge in Nursing
Matters of obligation, what ought to be done.
It requires consideration of all patterns of knowing.
Is it right or wrong for a nurse to be deceiving to a patient regarding their condition if the family
requests it?
Aesthetic
● The Art of Nursing
Encompasses knowledge of the experience of nursing.
Ability to skillfully perform nursing activities.
It is constantly changing as we build on knowledge with experience.

Which situation is persistent to Aesthetic knowledge development?

a. A nurse using their moral compass to support “choices” in hospice.
b. A nursing student uses self-reflection while completing their clinical journal.
c. A nurse recalls their knowledge of ambulatory care to mobilize client.
d. All of the above

Personal
● Knowing what you do and doing what you know.
Self knowing that is conscious to know fully who you are and understand your actions and
relationships being made on the job through care.
Experiential knowing - understanding
Interpersonal knowing - awareness

Classification of Theory according to Afaf Meleis

 Needs-based theories - based on helping individuals to fulfill their physical and
mental needs
 Interaction theories - emphasized nursing on the establishment and
maintenance of relationships
 Outcome theories - describe the nurse as controlling and directing patient care
using their knowledge of the human physiological and behavioral systems
Identify the following theory
1. Human to Human Relationship Theory by Joyce Travelbee
According to Travelbee, “caring involves the dynamic, reciprocal, interpersonal connection
between the nurse and patient” 
2. The Nursing Need Theory – Virginia Hederson
According to Henderson, individuals have basic needs that are components of health. They
may require assistance to achieve health and independence, or assistance to achieve a peaceful
death.
3. Behavioral System Model – Dorothy Johnson
Defined Nursing as “an external regulatory force which acts to preserve the organization and
integration of the patient's behaviors at an optimum level under those conditions in which
the behavior constitutes a threat to the physical or social health, or in which illness is found.
4. Deliberative Nursing Process Theory – Ida Jean Orlando
Focuses on the interaction between the nurse and patient, perception validation, and the use of
the nursing process to produce positive outcomes or patient improvement.

Classification of Theory According to Martha Alligood

 Nursing Philosophies
 Nursing Conceptual Models
 Grand Theories
 Middle-range Theories
Nursing Philosophies
 Nursing Philosophy. It is the most abstract type and sets forth the meaning of nursing
phenomena through analysis, reasoning, and logical presentation.
Florence Nightingale
+ Founder of Modern Nursing and Pioneer of the Environmental Theory. (patient-care
theory)
+ Defined Nursing as “the act of utilizing the environment of the patient to assist him in
his recovery.”
+ Caring for the patient is of more importance than the nursing process, the relationship
between patient and nurse, or the individual nurse.
+ Identified five (5) environmental factors: fresh air, pure water, efficient drainage,
cleanliness or sanitation, and light or direct sunlight.
Case Study:
You are caring for an 82-year-old woman who has been hospitalized for several weeks for burns
that she sustained on her lower legs during a cooking accident. Before the time of her
admission, she lived alone in a small apartment. The patient reported on admission that she
has no surviving family. Her support system appears to be other elders who live in her
neighborhood. Because of transportation difficulties, most of them are unable to visit
frequently. One of her neighbors has reported that she is caring for the patient’s dog, a
Yorkshire terrier. As you care for this woman, she begs you to let her friend bring her dog to the
hospital. She says that none of the other nurses have listened to her about such a visit. As she
asks you about this, she begins to cry and tells you that they have never been separated. You
recall that the staff discussed their concern about this woman’s well-being during report that
morning. They said that she has been eating very little and seems to be depressed.
Based on Nightingale’s work, identify specific interventions that you would provide in caring for
this patient
Describe what action, if any, you would take regarding the patient’s request to see her dog.
Discuss the theoretical basis of your decision and action based on your understanding of
Nightingale’s work.

Jean Watson
+ She pioneered the Philosophy and Theory of Transpersonal Caring.
+ “Nursing is concerned with promoting health, preventing illness, caring for the sick, and
restoring health.”
+ Mainly concerns with how nurses care for their patients and how that caring progresses
into better plans to promote health and wellness, prevent illness and restore health.
 + Focuses on health promotion, as well as the treatment of diseases.
+ Caring is central to nursing practice and promotes health better than a simple medical
cure.
What are the C’s of Caring?
1. Compassion
2. Competence
3. Confidence
4. Conscience
5. Commitment

Marilyn Anne Ray

+ Developed the Theory of Bureaucratic Caring
+ Challenges participants in nursing to think beyond their usual frame of reference and
envision the world holistically while considering the universe as a hologram.
+ Presents a different view of how health care organizations and nursing phenomena
interrelate as wholes and parts in the system.
Bureaucratic Caring: is spiritual-ethical caring—complex, dynamic patterns of meaning of
caring emerging in and related to the context or institution.
What issues ( ethical, spiritual, legal, socio-cultural, economic, and physical) from the structure
of Theory of Bureaucratic Caring can influence “end of life” issues?

Patricia Benner
“From Novice to Expert”
+ States that caring practices are instilled with knowledge and skill regarding everyday
human needs.

Nursing Conceptual Models

• Nursing Conceptual Models. These 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.

Myra Estrine Levine

According to the Conservation Model, “Nursing is human interaction.”
+ When a person is in a state of conservation, it means that individual has been able to
effectively adapt to the health challenges, with the least amount of effort.

Martha Rogers
Theory of Human Beings, defined Nursing as “an art and science that is humanistic and
humanitarian.
+ The Science of Unitary Human Beings contains two dimensions: the science of nursing,
which is the knowledge specific to the field of nursing that comes from scientific
research; and the art of nursing, which involves using nursing creatively to help better
the lives of the patient.
Sister Callista Roy
Adaptation Model defined nursing as a “health care profession that focuses on human life
processes and patterns and emphasizes the promotion of health for individuals, families,
groups, and society as a whole.”
+ Views the individual as a set of interrelated systems that strives to maintain a balance
between various stimuli.

Imogene King
Theory of Goal Attainment
+ “Nursing is a process of action, reaction and interaction by which nurse and client share
information about their perception in a nursing situation” and “a process of human
interactions between nurse and client whereby each perceives the other and the
situation, and through communication, they set goals, explore means, and agree on
means to achieve goals.”
Dorothea Orem
+ In her Self-Care Theory, she defined Nursing as “The act of assisting others in the
provision and management of self-care to maintain or improve human functioning at
the home level of effectiveness.”
+ Focuses on each individual’s ability to perform self-care.
+ Composed of three interrelated theories:
+ (1) the theory of self-care,
+ (2) the self-care deficit theory, and
+ (3) the theory of nursing systems, wholly compensatory, partially compensatory, and
supportive-educative.
Case Study
Mrs. S came to the hospital with complaints of pain over all her joints, stiffness which is more in
the morning and reduces by activities.
She has these complaints since 5 years and has taken treatment from local hospital. The
symptoms were not reducing and came to this hospital for further management.
Patient was able to do the ADL by herself but the way she performed and the posture she used
was making her prone to develop the complications of the disease. She also was malnourished
and was not having awareness about the deficiencies and effects.
Applying Orem’s Theory of Self-Care Deficit
Identify Therapeutic Self-Care demands this patient has deficiencies?
Nursing goals?
Describe the nursing system.
+ Orem's self-care deficit theory suggests patients are better able to recover when they
maintain some independence over their own self-care.

Nursing Grand Theories

• 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.
Virginia Henderson
+ Developed the Nursing Need Theory
+ Focuses on the importance of increasing the patient’s independence to hasten their
progress in the hospital.
+ Emphasizes the basic human needs and how nurses can assist in meeting those needs.
+ The Need Theory emphasizes the importance of increasing the patient's independence
and focus on the basic human needs so that progress after hospitalization would not
be delayed.
Case Study
+ Ms. XYZ 25 years old female client was admitted in the surgical unit, with attempted
suicide. Two weeks ago, she ingested toilet cleaner because of a family dispute. Ms. X
lived a rural life and had studied till 8th standard. Upon history taking, her mother
informed that her marriage was planned two days before the incident. She was
reluctant to share the reason for her suicide but stated that she was stressed out and
tried to kill herself. Later on, her mother reported that she was impulsive and emotional
person and was in live with someone but the family was willing for her marriage. Her
physical assessment revealed alert, oriented but depressed female.
+ Her chief complaints were difficulty in breathing and mood swings. Her CT scan and
endoscopy showed damaged larynx, mouth and stomach ulcers respectively. The
dietician advised liquid diet but Ms. X showed dislike and resisted eating. Due to her
limited intake, Foley’s catheter was passed for accurate record of her daily intake and
output .She was noncompliance towards her intake and developed dehydration,
irritability and insomnia as evidenced by dry mouth, sunken eyes with dark circles
around.
+ She was too feeble to walk with imbalance gait, lost interest in self-care and refused to
participate in hygiene care such as dressing, hair brushing and face washing. She was
not willing to interact and discuss her feelings with the nurse.
+ Managed the case by employing Virginia Henderson’s theory into nursing theory
process.
+ 14 Components – Assessment findings of Mrs XYZ

Faye Glenn Abdellah

+ Developed the 21 Nursing Problem Theory
+ Changed the focus of nursing from disease-centered to patient-centered and began to
include families and the elderly in nursing care.
+ The nursing model is intended to guide care in hospital institutions but can also be
applied to community health nursing, as well.
+ The patient-centered approach to nursing was developed from Abdellah’s practice,
and the theory is considered a human needs theory.
+ The model has interrelated concepts of health and nursing problems, as well as
problem-solving,
which is an activity inherently logical in nature.  
 + The problem-solving approach introduced by Abdellah has the advantage of increasing
the nurse’s critical and analytical thinking skills since the care to be provided would be
based on sound assessment and validation of findings.

Dorothy E. Johnson
+ Behavioral System Model 
+ Advocates to foster efficient and effective behavioral functioning in the patient to
prevent illness and stresses the importance of research-based knowledge about the
effect of nursing care on patients.
+ Describes the person as a behavioral system with seven subsystems.
+ Johnson's Behavioral system model is a model of nursing care that advocates the
fostering of efficient and effective behavioral functioning in the patient to prevent
illness.
+ Behavioral Assessment
+ Using Johnson’s Behavioral System Model, identify the following:
+ Achievement
+ how to do activities of daily living (ADLs)
+ Attachment-affiliative
+ Aggressive-protective
+ Dependency
+ Ingestive

Rosemarie Rizzo Parse

+ Human Becoming Theory
+ “Nursing is a science, and the performing art of nursing is practiced in relationships with
persons (individuals, groups, and communities) in their processes of becoming.”
+ Explains that a person is more than the sum of the parts, the environment, and the
person is inseparable and that nursing is a human science and art that uses an abstract
body of knowledge to help people.
+ It centered around three themes: meaning, rhythmicity, and transcendence.

Case Study
Mrs. Brown, a 48-year-old woman, is living with a diagnosis of breast cancer. She has just come
into the oncology clinic for her third round of chemotherapy. When asked how she is doing,
Mrs. Brown starts speaking about how tired she is and how she is feeling burdened with
keeping secrets from her daughter. Mrs. Brown has not told her daughter about her cancer
diagnosis because she is afraid of how her daughter might react. Mrs. Brown says she is just
barely holding on to things at this time, and she cannot take much more. She is also concerned
about the chemotherapy and what she can expect, because the side effects are getting more
intense.
In order to invite Mrs. Brown to speak, the nurse may initially ask her to say more about her
situation. In the cadence of speech, Mrs. Brown may pause, giving the nurse an opening to pose
questions that assist Mrs. Brown’s exploration of how burden is all about? What does it mean?
What does Mrs. Brown think will happen if her daughter gets upset? Thinking about and
picturing an anticipated event is, according to Parse an opportunity to rehearse and to clarify
how best to be in light of anticipated consequences. In this way, the person is helped with
decisions about how best to go forward or how to change the situation. The practice
dimensions and processes happen all at once as nurses honor the other’s unfolding meanings,
rhythms, and ways of moving forward.
+ The primary purpose of nursing theory is to improve practice by positively influencing
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.

LOCAL NURSING THEORIES

Local Theories and Models of Nursing Intervention (Philippine Setting)
1. Locsin’s Technological Nursing as Caring Model
2. Agravante’s CASAGRA Transformative Leadership Model
3. Divinagracia’s COMPOSURE Model
4. Kuan’s Retirement and Role Discontinuity Model
5. Abaquin’s PREPARE ME Holistic Nursing Interventions
6. Laurente’s Theory of Nursing Practice and Career
7. Synchronicity in Human-space-time: A theory of Nursing Engagement in a Global
Community

Rozzano C. Locsin
Technological competency as caring in nursing is the harmonious coexistence between
technologies and caring in nursing.
Technological Competency as Caring in Nursing
╸ This practice theory is focused on “knowing persons,” with key elements of
technological knowing, designing, and participative engaging
How Does Technology Affect Nursing?
1. Monitoring
2. Medications
3. Health Records
4. Communication

Carolina S. Agravante
Transformational Leadership Theory is focused primarily on the educational and psycho-
spiritual aspect of nursing.
According to care complex , caring personality rests on the possession of a care complex with in
a person as an energy source of caring. - The framework explains and predicts the continuous
formation of nursing leadership behavior in nursing faculty that will eventually affect their
teaching function.
Servant-leader spirituality
Self-mastery
Special expertise
╸ Application of the theory
 ╸ To be always committed to bring out the best to every member of the team.
╸ Enhancing competence in every skill, compassion to every service and empowerment to
the nursing profession.
╸ Leading and at the same time be of service.
╸ Leader with values and committed to sustain compassionate nursing care regardless of
the different global challenges we have in today’s new generations.

Carmelita Divinagracia
Theory of COMPOSURE Behaviors
COMpetence
Presence and Prayer
Open-mindedness
Stimulation
Understanding
Respect and Relaxation
Empathy

Sister Letty G. Kuan

Retirement and Role Discontinuity Theory
She values the effect of retirement as a phase of one’s life and its accompanying adjustments.
She identified the determinants of positive perceptions in retirement and positive reactions
toward role discontinuities

Case Scenario:
╸ As the couple Mitch and Leo approach their 60s, they have realized the price for the
choices they have made: while they have little debt, they have relatively little saved for
their retirement. Leo has worked for his current employer for 10 years, but since the
kids started college, he could only afford to contribute the minimum. Savings from
previous employer plans were rolled into an individual retirement saving but very
minimal only has left. Still they need to buy mainenance medications for themselves.

Carmencita Abaquin
PREPARE ME” Interventions
Presence
Reminisce Therapy
Prayer
Relaxation
Meditation

Cecilia Laurente
Theory of Nursing Practice and Career.
She emphasized effective communication and using the family as an entry point to help a
patient.
Synchronicity in Human–Space–Time: A Theory of Nursing Engagement in a Global
Community
Freslyn Lim-Saco RN, MN 
Cliford Masayon Kilat RN, MA 
Rozzano Locsin PhD RN

Synchronicity in the Human–Space–Time Theory of Nursing is about the innovative process of

nursing engagement expressed as interpersonal relating, technological knowing, rhythmical
connecting, and transformational engaging. The philosophical and theoretical perspectives
declare the evolutionary design in affirming the meaningful human caring experiences within
nursing practice. Moreover, theory-based practice sustains the human science view of
wholeness of persons while focusing on the inclusion of the coexistence between technology
and caring in nursing. The practice of nursing approaches human caring beyond the customary,
fragmented, and routinary healthcare commitment.