KNOWLEDGE

• Information, skills and expertise acquired by a person through various life experiences, or
through formal/informal learning
• The abstract or workable understanding of a subject or idea
• What is known in a particular field of discipline or study
• Facts and information or awareness or familiarity gained by experience of a fact or
situation

Sources of Knowledge
1. Traditional Knowledge
Nursing practice which is passed down from generation to generation
2. Authoritative knowledge
An idea by a person of authority which is perceived as true because of his or her expertise.
3. Scientific knowledge
Came from a scientific method through research wherein new ideas are tested and measured
systematically using objective criteria

In 1978 Carper described four “patterns of knowing” within nursing:

1. Empirical - Empirical or scientific knowledge is based on objective evidence obtained by the senses; it
requires validation and verification by others.
2. Ethical - Ethical knowledge examines philosophical premises of justice and seeks credibility through
logical justification.
3. Esthetic - Esthetic knowledge is used for creativity, form, structure, and beauty through criticism of the
meaning of the creative process and product.
4. Personal knowledge - Personal knowledge integrates and analyzes current interpersonal situations with
past experiences and knowledge.

What is Nursing?
Nursing is a “dynamic discipline. It is an art and a science of caring for individuals, families, groups &
communities geared toward promotion & restoration of health, prevention of illness, alleviation of suffering
& assisting clients to face death with dignity & peace. It is focused on assisting the client as he or she
responds to health - illness situations, utilizing the nursing process & guided by ethical- moral principles”
-Association of Deans of Philippine Colleges of Nursing [ADPCN]

Identifying nursing knowledge

Nursing knowledge is the means by which the whole purpose of caring for patients is achieved
because it underpins what we actually do. It is what defines us as nurses as opposed to similar
professions such as doctors or physiotherapists and helps to differentiate us from lay carers or
care support workers.
https://www.nursingtimes.net/roles/nurse-educators/defining-nursing-knowledge-29-11-2005/

Why is the structure of knowledge in nursing profession important?

Knowledge is what improves care if the nurse is aware of the best knowledge or evidence to use
in practice.

1
Knowledge Structure Levels with Examples

Structure Level Example

Metaparadigm Person, environment, health, and nursing
Philosophy Nightingale
Conceptual models Neuman’s systems model
Theory Neuman’s theory of optimal client stability
Middle-range theory Maintaining optimal client stability with structured activity
(body recall) in a community setting for healthy aging

Nursing Paradigms are patterns or models used to show a clear relationship among the existing theoretical
works in nursing. It embodies knowledge base, theory, philosophy, research, practice and educational
experience & literature identified with the profession.

Metaparadigm
The term metaparadigm came from the Greek word “meta” = “with” and “paradeigm” = “pattern”, and is
defined as “the core content of a discipline”. Metaparadigm is the highest level of knowledge. It is the
most abstract aspect of the structure of nursing knowledge. The metaparadigm of the discipline of nursing
establish a better direction and understanding of the nursing profession.

Nursing theories address and specify relationships among four major concepts that are central to nursing:
Person or client, Environment, Health, Nursing

NURSING META PARADIGM – consists of the four major concepts of the discipline – person, environment,
health and nursing

FOUR CONCEPTS to be central to Nursing

1. Who is the client?
PERSON
❖ In need
❖ Impaired health status
❖ Health problems
❖ Self-care deficit

2
 ❖ Incapable of change
❖ Experiencing disharmony

2. Where do client-nurse interactions occur? What settings or environment are deemed appropriate for
nursing?
ENVIRONMENT
❖ Hospital
❖ Outpatient clinics
❖ Community concept

3. What is the meaning of health?

HEALTH
❖ Holistic level of wellness that a person experience
❖ Health – illness continuum
❖ Ill heath dynamic process
❖ Interdependent with changing environment
❖ Process that a person some control over

4. What is the nature of nursing – the nurse’s role?

NURSING
❖ Client’s behalf
❖ Mutually with the client
❖ Educating the client

Philosophy in nursing
Philosophy is the next knowledge level after metaparadigm. It specifies the definition of
metaparadigm concepts in each conceptual models of nursing. It sets forth the meaning of phenomena
through analysis, reasoning and logical argument. A nursing philosophy puts together or some or all
concepts of metaparadigm.

Models of nursing
❖ Provides a way to visualize reality into simplify thinking
❖ Show how various concepts are interrelated and applies theory to predict and evaluate
consequences of alternative actions
❖ Includes the four concept and considered as central to the discipline of nursing

A conceptual model is a representation of an idea or body of knowledge based on the own understanding
or perception of a person or researcher on a certain topic, phenomena or theory. It can be represented by
diagram or narrative form which shows how concepts are interrelated

3
What is a THEORY?
Theory is “a creative and rigorous structuring of ideas that project a tentative, purposeful, and
systematic view of phenomena”.
-Chinn and Kramer [1999]

Creative underscores the role of human imagination and vision in theory development, but caution
that the creative processes are also rigorous, systematic, and disciplined.
Tentative open to revision as new evidence emerges.
Their definition of theory requires that there be a purpose for the theory that it suggests a direction
in how to view facts and events.

Theory is an organized system or supposition of ideas that is proposed to explain a given

phenomenon of accepted knowledge intended to explain a set of fact, event or phenomena.

A theory explores phenomena, expresses relationships between facts, generates a

hypotheses, and predicts future events and relationships.

Primary Purpose: To generate knowledge in a field.

Components of a Theory
1. Concept specifically, is an idea, thought, or notion formulated or conceived in the mind or an
experience perceived and observed. “Building Blocks” of theories.

2. Proposition is a statement that expresses or explains the relationships of different concepts and is
capable of being tested, believed, or denied.

3. Definition is composed of various descriptions which convey a general meaning and reduces the
vagueness in understanding a set of concepts.

4. Assumption is a statement that specifies the relationship or connection of factual concepts or

phenomena.

The following diagram explains the relationships of concepts, propositions, assumptions

and definitions with theory and phenomena.

Characteristics of a Theory
• Theories should be simple but generally broad in nature
• Theories must be logical in nature.
• Theories can correlate concepts in such a way as to generate a different way of looking at
a certain fact or phenomenon
• Theories contribute in enriching the general body of knowledge through the studies
implemented to validate them.
• Theories can be the source of hypotheses that can be tested for it to be elaborated.
• Theories can be used by practitioners to direct and enhance their practice.
• Theories must be consistent with other validated theories, laws, and principles but will
leave open unanswered issues that need to be tested.

4
Nursing Theory
• Attempt to describe or explain the phenomenon called nursing
• An articulated and communicated conceptualization of invented or discovered reality in or
pertaining to nursing for the purpose of describing, explaining, and predicting or prescribing
nursing care.
• It is composed of context, content and process

Importance of nursing theories

• It provides the foundations of nursing practice

• Helps to decide what we know and what we need to know
• Aims to describe, predict, and explain the phenomenon in nursing
• It helps to distinguish what should form the basis of practice
• Maintains professional boundaries

Basic processes in the development of nursing theories

1. General system theory - it describes how to break whole things into parts and then learn how the parts
works together in systems
2. Adaptation theory - the adjustment of living matter to other living things and to environmental conditions
3. Developmental theory - it outlines the process of growth and development of humans as orderly and
predictable, beginning with conception and ending with death.

Classification of Nursing Theories

According to function
1. Descriptive or Factor-isolating theories
primary level of theory development
Identify and describe major concept of phenomena
Present a phenomenon based on the five senses together with their meanings

2. Explanatory or Factor-relating theories

Present relationship among concept and propositions
Provides information on how and why concepts are related

3. Predictive or Situation-relating theories

Relationship of concepts under a certain condition that describe future outcomes consistently
Generated and tested using experimental research

4. Prescriptive or Situation-producing theories

Nursing action test the validity and certainty of a specific nursing intervention.
Commonly used in testing new nursing interventions

According to 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.

1. Grand 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.

2. 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.

5
 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.

2. Practice-Level Nursing Theories (Micro-Range Theories)

Practice nursing theories are situation specific theories that are narrow in scope and focuses
on a specific patient population at a specific time. It provide frameworks for nursing
interventions and suggest outcomes or the effect of nursing practice.

Classification According to Meleis

Afaf Ibrahim Meleis (2011), in her book Theoretical Nursing: Development and Progress, organizes the
major nurse theories and models using the following headings: needs theories, interaction theories, and
outcome theories. These categories indicate the basic philosophical underpinnings of the theories.

1. Needs theory – based around helping individuals to fulfill their physical and mental needs.
2. Interaction theory – revolves around the relationship of nurses with the patients.
3. Outcome theory – nurse as changing force, who enables individual to adapt or to cope with ill
health.
4. Humanistic theory – in response to the psychoanalytic thought that a person’s destiny was
determined in early life.

According to Alligood
In her book, Nursing Theorists and Their Work, Raile Alligood (2017) categorized nursing theories into four
headings: nursing philosophy, nursing conceptual models, nursing theories and grand theories, and
middle-range nursing theories.

1. Nursing Philosophy. Is the most abstract type and sets forth the meaning of nursing phenomena
through analysis, reasoning, and logical presentation. Works of Nightingale, Watson, Ray, and
Benner are categorized under this group.

2. Nursing Conceptual Models. 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. Conceptual models of Levine, Rogers, Roy, King, and Orem are under
this group.

3. 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.

4. Middle-Range Theories. Are precise and answer specific nursing practice questions. They
address the specifics of nursing situations within the perspective of the model or theory from which
they are derived. Examples of Middle-Range theories are that of Mercer, Reed, Mishel, and
Barker.

/iacsrnman