Introduction to Nursing Theories

THEORY
a supposition of system of ideas intended to explain something based on
general principles independent of the thing to be explained (Oxford Dict)
a set of concepts, definitions, relationships and assumptions that project a
systematic view of phenomena (Alligood)

Components of Theory:
1. CONCEPTS
ideas and mental images that help describe phenomena
building block of theory
TYPES OF CONCEPT:
Empirical Concept
knowledge derived from investigation, observation,
experiment, and experience
i.e. justice, truth, beauty, life lessons
Inferential Concept
indirectly observable concepts
i.e. pain, feelings, colds, aches and stress
Abstract Concept
not clearly observable directly and indirectly; non-
observable concepts
self-worth, self-esteem
2. DEFINITIONS
convey the general meaning of a concept
1. Conceptual Definitions
meaning of a word based on how a certain theory or
relevant literature perceives it to be
ex. definitions from dictionaries
2. Operational Definitions
based on the method of how it was measured or how the
person came up with the perception
ex. definition of a person based on his/her idea
3. ASSUMPTIONS
describes what is concept
 example: What is the concept of "caring"? or What is your understanding
about "about"?
4. PHENOMENON
aspect of reality that can be consciously sensed or experienced
example: disasters, eclipses, climate change, weather disturbances,
accidents
'Caring is a phenomenon since it can be sensed or experienced.'
5. PROPOSITIONS
describes the relationship/connection that exist among the concepts of
theory

PARADIGM
a model that explains the linkages of science, philosophies, theory accepted
and approved by the discipline

The Nursing Paradigm

patterns/models used to show a clear relationships between concepts

How does domain relate to nursing  theory?

- Nursing has identified its domain in a paradigm that includes four linkages:
1. Person/client – the one receiving nursing care
2. Health- the part of the health-illness continuum where the person is at the
time of interaction
3. Environment – place where  the person exists   
4. Nursing – nursing actions

What is a 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
What is a metaparadigm?
the most global perspective of a discipline and acts as “encapsulating unit”
or framework within which the more restricted structures develop
Types of Nursing Theories
Grand theories: broad and complex
Middle range theories: address specific phenomena and reflect practice
Descriptive theories: 1st level of theory development
Prescriptive theories: address nursing interventions and predict their
consequences

Importance of Nursing Theories

aims to describe, predict and explain the phenomenon of nursing
provide the foundations of nursing practice, help to generate further
knowledge and indicate in which direction nursing should develop in the future
helps us to decide what we know and what we need to know
helps to distinguish what should form the basis of practice by explicitly
describing nursing
better patient care, enhanced professional status for nurses, improved
communication between nurses, and guidance for research and education
maintain its professional boundaries

Characteristics of Nursing Theories

Interrelating concepts in such a way as to create a different way of looking at a
particular phenomenon
Logical in nature
Generalizable
Bases for hypotheses that can be tested
Increasing the general body of knowledge within the discipline through the
research implemented to validate them
Used by the practitioners to guide and improve their practice
Consistent with other validated theories, laws, and principles but will leave
open unanswered questions that need to be investigated

General System Theory

It describes how to break whole things into parts & then to learn how the
parts work together in “systems”. These concepts may be applied to different
kinds of systems, e.g. Molecules in chemistry, cultures in sociology, and organs
in Anatomy & Health in Nursing.
Adaptation Theory
 It defines adaptation as the adjustment of living matter to other living things &
to environmental conditions.
Adaptation is a continuously occurring process that effects change & involves
interaction & response.
Human adaptation occurs on three levels: The internal ( self); the social (
others) and The physical( biochemical reactions)

Developmental Theory
It outlines the process of growth & development of humans as orderly &
predictable, beginning with conception & ending with death.
The progress & behaviors of an individual within each stage are unique.
The growth & development of an individual are influenced by heredity,
temperament, emotional, & physical environment, life experiences & health
status.

Classifications of Nursing Theories

A. Depending on FUNCTION:
1. DESCRIPTIVE
identify the properties of a discipline
2. EXPLANATORY
examine how the properties relate and affect the discipline
3. PREDICTIVE
calculate relationships between properties, how they occur
4. PRESCRIPTIVE
identify under which condition relationship occur

B. Depending on the GENERALIZABILITY of their principle:

1. METATHEORY
the Theory of Theory
identifies specific phenomena through abstract concepts
2. GRAND THEORY
provides conceptual framework

C. PRINCIPLES of the discipline:

1. MIDDLE-RANGE THEORY
more precise and only analyzes a particular situation
2. PRACTICE THEORY
defines explicit goals and details how these will be achieved
D. Based on PHILOSOPHICAL underpinnings:
1. NEEDS THEORY
helping individuals to fulfill their physical/mental needs
*criticized for "relying too much" on medical model of health
2. INTERACTION THEORY
revolve around the relationships nurses and patients
*criticized for "ignoring" the medical model of health
3. OUTCOME THEORY
portray the nurse as the changing force, who enables individual to adapt
or cope with ill health
*criticized as "too abstract and difficult to implement"
4. HUMANISTIC THEORY
emphasize a person's capacity for self-actualization
Carl Rogers developed a "Person–Centered Model of Psychotherapy" that
emphasizes the uniqueness of the individual.
     

Link between Nursing Theory & Research Process

theories provide direction
components of theories drives the research questions for understanding
nursing
"spiral relationship between the two" - Chinn & Kramer (2004)

Florence Nightingale
1st modern nursing theorist
1st one to delineate what is considered the nursing goal and the practice
domain
“ placing the client in the best condition for nature to act upon him”
Taught about symptoms and what they indicate, rationale for actions and
trained powers of observation and reflection

Stages Of Theory Development

1. Silent knowledge stage
- Blind obedience to medical authority
- Training schools were hospital based, emphasis on carrying out physician’s
orders and few books, depended on physician’s diagnosis, exploited as workers and
as students.
- persisted for more than 80 years
2. Received knowledge stage
- Learning through listening to others
- Nursing now challenged to be in the university as opposed to apprenticeship
that happens to most hospital programs
- Nurses acquired non nursing degrees relying on the authority of educators,
sociologist, psychologist, physiologists and anthropologist to provide answers to
nursing problems.
3. Subjective knowledge stage
- Authority was internalized and a new sense of self emerged
- Negative attitude toward borrowed sciences or theories
- Defining on nursing and developing theories about and for nursing
- Researched focused on the nurse rather on the clients and clinical situation
4. Procedural knowledge stage
- Includes both separate and connected knowledge 
- Proliferation of approaches to theory development applying theory in practice
was frequently underemphasized
- Emphasis was on procedures used to acquire knowledge (methodology,
statistical procedures)
5. Constructed knowledge 
- Integration of different types of knowledge (intuition, reason and self- knowledge)
- Nursing theory based on empirical studies, theoretical literature client reports,
clinical experiences and nurses scholar intuition.

Florence Nightingale’s Influence on Knowledge Development in Nursing

Described nursing as both an art and a science.
Stressed the importance of caring for the ill person rather than the illness
Viewed person’s health as the direct result of environmental influences
(cleanliness, light, pure air, pure water, efficient drainage.
The turn of the 20th century marked the beginning of hospital based schools of
nursing. ▪ Nightingales principles were incorporated into modern nursing
theory.

Knowledge Development in Nursing

Paradigm- particular viewpoint/perspective
Metaparadigm- major concepts in a discipline that names the phenomena of
concern
 Metaparadigm in Nursing- person, health, environment, nursing
Two individuals with different paradigmatic views can look at the same
phenomenon and view the phenomenon differently.
A paradigm shift refers to the acceptance of the competing paradigm or a
shifting away from one worldview toward another worldview
Members of discipline cannot subscribe to two competing paradigms at the
same time
Four levels of Knowing/Nursing knowledge (Carper, 1978)
According to Chinn and Kramer (1995) 
Knowing refers to the individual human processes of experiencing and
comprehending the self and the world in ways that can be brought to
some level of conscious awareness
Knowledge, in contrast, is defined as knowing that can be shared or
communicated with others.  
Empirical – the science of nursing
Aesthetic- the art of nursing
Personal- intra and interpersonal nature of nursing
Ethical- the moral component of nursing

Philosophies of knowledge
There are three dominant philosophical views on how knowledge develops.
Rationalism: “reason” emphasizes that reason play in the development of
knowledge and the discovery of truth.
Empiricism: believes that knowledge is derived entirely from sensory
experience.
Historicism: recognizes that we are all influenced by our history and the
experiences, values and beliefs we acquired.

Significance of theory for nursing as a discipline

Discipline is specific to academia and a branch of education, a department of
learning or field/ domain of knowledge.
Profession refers to specialized field of practice, which is founded upon the
theoretical structure of the science or knowledge of that discipline and the
accompanying practice abilities. 
1. University baccalaureate programs proliferated, masters’ programs in nursing
were developed, and the curricula began to be standardized through the
accreditation process.
2. Attention to the importance of nursing conceptualizations for the research
process and the role of a conceptual framework in the purpose and design of
research production of science and nursing theoretical works also began to
publish.
3. Works began to be recognized for their theoretical nature, such as Henderson,
Nightingale and etc.
4. New nursing doctoral programs were beginning to open and they reopened
the discussion of the nature of nursing science. This becomes the first classic
reference for nursing as discipline and for distinguishing between the
discipline and profession.
5. Fawcett’s conceptualization of metaparadigm of nursing and unifying
conceptual-theoretical structure of knowledge recognize works of major
nursing theorist as conceptual framework and paradigms of nursing.
6. MAJOR SIGNIFICANCE IS--THE DISCIPLINE IS DEPENDENT UPON THEORY
6.1. Theoretical works have taken nursing to a higher level.
6.2. The emphasis has shifted from a focus on knowledge about how
nurses’ function, which concentrated on the nursing process, to focus on
what nurses know and how they use knowledge to guide their thinking
and decision making while concentrating on the patient
Nursing is recognize as a profession today