INTRODUCTION TO NURSING THEORY
Domain
I. NURSING THEORY
Theory
- refers to a coherent group of general propositions used as
principles of explanation.
Nursing Theory
- a creative and rigorous structuring of ideas that project a
tentative, purposeful, and systematic view of
phenomena.
- through systematic inquiry, whether in nursing research
or practice, nurses are able to develop knowledge
relevant to improving the care of patients.
- Organized bodies of knowledge to define what nursing is,
what nurses do, and why do they do it.
- Nursing theories provide a way to define nursing as a
unique discipline that is separate from other disciplines
(e.g., medicine) and it has its own body of knowledge on
which delivery of care is based.
- It is a framework of concepts and purposes intended to
guide the practice of nursing at a more concrete and
specific level.
- Nursing, as a profession, is committed to recognizing its
own unparalleled body of knowledge vital to nursing
practice—nursing science. To distinguish this foundation
of knowledge, nurses need to identify, develop, and
understand concepts and theories in line with nursing.
DEFINITION OF TERMS
Beliefs and values that define a way of
Philosophy thinking and are generally known and
understood by a group or discipline.
A belief, policy, or procedure
proposed or followed as the basis of
action. It refers to a logical group of
Theory general propositions used as
principles of explanation. Theories
are also used to describe, predict, or
control phenomena
Concepts are often called the
building blocks of theories. They are
Concept
primarily the vehicles of thought that
involve images
Models are representations of the
interaction among and between the
concepts showing patterns. They
Models present an overview of the thinking
behind the theory and may
demonstrate how theory can be
introduced into practice.
A conceptual framework is a group of
related ideas, statements, or
Conceptual
concepts. It is often used
Framework
interchangeably with the conceptual
model and with grand theories
Propositions are statements that
Proposition describe the relationship between
the concepts.
Domain is the perspective or territory
of a profession or discipline.
Processes are a series of organized
Process steps, changes or functions intended
to bring about the desired result.
A paradigm refers to a pattern of
shared understanding and
Paradigm assumptions about reality and the
world; worldview or widely accepted
value system.
. A metaparadigm is the most general
statement of discipline and functions
as a framework in which the more
restricted structures of conceptual
Metaparadigm models develop. Much of the
theoretical work in nursing focused
on articulating relationships among
four major concepts: person,
environment, health, and nursing.
THE NURSING METAPRADIGM
There are four major concepts that are frequently interrelated and
fundamental to nursing theory: person, environment, health, and
nursing. These four are collectively referred to as metaparadigm
for nursing
1. Person – also referred to as Client or Human Beings) is the
recipient of nursing care and may include individuals,
patients, groups, families, and communities
2. Environment – or situation is defined as the internal and
external surrounds that affect the client. It includes all
positive or negative conditions that affect the patient, the
physical environment, such as families, friends, and
significant others, and the setting for where they go for
their healthcare.
3. Health - is defined as the degree of wellness or wellbeing
that the client experiences. It may have different
meanings for each patient, the clinical setting, and the
health care provider.
4. Nursing - The attributes, characteristics, and actions of the
nurse providing care on behalf of or in conjunction with,
the client. There are numerous definitions of nursing,
though nursing scholars may have difficulty agreeing on
its exact definition, the ultimate goal of nursing theories
is to improve patient care.
COMPONENTS OF NURSING THEORIES
For a theory to be a theory it has to contain a set of concepts,
definitions, relational statements, and assumptions that explain a
phenomenon. It should also explain how these components relate
to each other:
• Phenomenon
o describe an idea or responses about an event, a
situation, a process, a group of events, or a group
of situations
o may be temporary or permanent
o Nursing theories focus on the phenomena of
nursing
• Concepts
o interrelated concepts define a theory
o used to help describe or label a phenomenon
o words or phrases that identify, define, and
establish structure and boundaries for ideas
generated about a particular phenomenon
o Concepts may be:
➢ Abstract Concepts. Defined as mentally
constructed independent of a specific
time or place.
➢ Concrete Concepts. Are directly
experienced and related to a particular
time or place.
• Definitions
o used to convey the general meaning of the
concepts of the theory
o Definitions can be:
➢ Theoretical Definition. Define a
particular concept based on the
theorist’s perspective.
➢ Operational Definitions. States how
concepts are measured.
• Relational Statements
o define the relationships between two or more
concepts
o chains that link concepts to one another
• Assumptions
o accepted as truths and are based on values and
beliefs
o statements that explain the nature of concepts,
definitions, purpose, relationships, and structure
of a theory
WHY ARE NURSONG THEORIES IMPORTANT?
Nursing theories are the basis of nursing practice today. in many
cases, nursing theory guides knowledge development and directs
education, research, and practice.
Historically, nursing was not recognized as an academic discipline
or as a profession we view it today. Before nursing theories were
developed, nursing was considered to be a task-oriented
occupation. The training and function of nurses were under the
direction and control of the medical profession
1. Nursing theories help recognize what should set the
foundation of practice by explicitly describing nursing.
2. By providing a definition of nursing, nursing theory also
helps nurses to understand their purpose and role in the
healthcare setting.
3. Theories serve as a rationale or scientific reasons for
nursing interventions and give nurses the knowledge base
necessary for acting and responding appropriately in
nursing care situations.
4. Nursing theories provide the foundations of nursing
practice, helps generate further knowledge, and indicate
in which direction nursing should develop in the future
(Brown, 1964).
5. By providing nurses a sense of identity, nursing theory can
help patients, managers, and other healthcare
professionals to acknowledge and understand the unique
contribution that nurses make to the healthcare service
(Draper, 1990).
6. Nursing theories prepare the nurses to reflect on the
assumptions and question the values in nursing, thus
further defining nursing and increasing knowledge base.
7. Nursing theories aim to define, predict, and demonstrate
the phenomenon of nursing (Chinn and Jacobs, 1978).
8. It can be regarded as an attempt by the nursing profession
to maintain and preserve its professional limits and
boundaries.
9. In many cases, nursing theories guide knowledge
development and directs education, research, and
practice although each influence the others. (Fitzpatrick
and Whall, 2005).
CLASSIFICATIONS OF NURSING THEORY
There are different ways to categorize nursing theories. They are
classified depending on their function, levels of abstraction, or goal
orientation.
By Abstraction
- There are three major categories when classifying nursing
theories based on their level of abstraction: grand theory,
middle-range theory, and practice-level theory.
o 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
 o 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.
o 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
II.
By Goal Orientation
- Theories can also be classified based on their goals, they
can be descriptive or prescriptive.
o Descriptive Theories
➢ 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
➢ Two types of descriptive theories:
factor-isolating theory and explanatory
theory.
▪ Factor-Isolating Theory.
✓ Also known as
category-formulating
or labeling theory.
✓ this category is known
to describe the
properties and
dimensions of a
phenomena
▪ Explanatory Theory
✓ Explanatory theories
describe and explain
the nature of
relationships of
certain phenomena
to other phenomena.
o 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.
PURPOSE 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.
A. In Academic Discipline
o Much of the earlier nursing programs identified
the major concepts in one or two nursing
models, organized the concepts and build an
entire nursing curriculum around the created
framework.
o The unique language in these models was
typically introduced into program objectives,
course objectives, course descriptions, and
clinical performance criteria.
o The purpose was to explain the fundamental
implications of the profession and to enhance
the status of the profession.
B. In Research
o Development of theory is fundamental to the
research process where it is necessary to use
theory as a framework to provide perspective
and guidance to the research study.
 o Theory can also be used to guide the research
process by creating and testing phenomena of
interest.
o To improve the nursing profession’s ability to
meet the societal duties and responsibilities,
there need to be a continuous reciprocal and
cyclical connection with theory, practice, and
research. This will help connect the perceived
“gap” between theory and practice and promote
the theory-guided practice.
C. In Profession
o Clinical practice generates research questions
and knowledge for theory.
o In a clinical setting, its primary contribution has
been the facilitation of reflecting, questioning,
and thinking about what nurses do.
o Because nurses and nursing practice are often
subordinate to powerful institutional forces and
traditions, the introduction of any framework
that encourages nurses to reflect on, question,
and think about what they do provide an
invaluable service.
D. Interdependence of Theory and Research
o Theory is integral to research and research is
integral to theory.
o Theory guides the development of many
research questions and research helps generate
new theories, as well as determining whether
support for theories exists.
o What is important to remember is that theory is
not fact: it is a belief about how things work;
theory is a belief or “best guess” that awaits the
support of empirical evidence.
III. FOUR (4) WAYS OF KNOWING
- Professionals define themselves in terms of what
knowledge they possess and seek to acquire.
- Barbara Carper (1978) identified four fundamental
patterns of knowing that form the conceptual and
syntactical structure of nursing knowledge.
- These four patterns include: personal, empirical, ethical,
and aesthetic knowing.
Personal Knowing
• PERSONAL knowing refers to the knowledge we have of
ourselves and what we have seen and experienced.
• This type of knowledge comes to us through the process
of observation, reflection, and self-actualization.
• It is through knowledge of ourselves that we are able to
establish authentic, therapeutic relationships as it propels
us towards wholeness and integrity (Chinn & Kramer,
2015). When you began to study nursing, what knowledge
did you possess? Consider what you have learned since–
in your personal life, in school, and through practice.
• For example, through observation and practice, nurses
learn how to find veins, insert intravenous fluids or
medications, check vital signs, give immunizations and aid
doctors in medical procedures. Empirical knowing
encourages nurses to use fact-based approaches to
address patient needs.
Empirical Knowing
• We gain EMPIRICAL knowledge from research and
objective facts.
• developed by means of empirical research as descriptions
of people and situations, explanations of relations
between variables, or predictions about the effects of
nursing interventions on outcomes
• This knowledge is systematically organized into general
laws and theories.
• One of the ways we employ this knowledge is through the
use of evidenced-based practice (EBP).
• This way of knowing is often referred to as the “science”
of nursing (Chinn & Kramer, 2015). Can you relate how
study findings have changed your nursing practice?
Ethical Knowing
• ETHICAL knowing helps one develop our own moral
code; our sense of knowing what is right and wrong.
• Developed by means of values clarification and
dialogue about beliefs and values; the moral
component of nursing.
• For nurses, our personal ethics is based on our
obligation to protect and respect human life. Our
deliberate personal actions are guided by ethical
knowing.
• The “Code of Ethics for Nurses” can guide us as we
develop and refine our moral code. Can you think of
an occasion that you needed to make an ethical
decision? If you are like many practicing nurses, you
make several every single day
Aesthetic Knowing
• The final way of knowing identified by Carper (1978) is
AESTHETIC Knowing.
• Aesthetic knowing makes nursing an “art.” It takes all of
the other ways of knowing and through it creates new
understanding of a phenomenon.
• Developed by means of envisioning the individual’s
situation to understand the importance of that
individual’s behavior at a particular time, and how we are
going to delivery of nursing science.
• Aesthetic knowing is that “aha” moment that we have
when we uncovered something new; and just as an artist
creates a painting, you are afforded the opportunity of
new perspective. Consider a time when you had an “aha”
moment. How did you come to that discovery?