PROGRESSION FROM CONCEPTUAL FRAMEWORK TO THEORY
Define nursing into different perspective.
- Nursing has been defined in 3 different perspectives: An art,
science, and a profession.
NURSING (as an art)
• an art of caring sick and well individual. It refers to the dynamic skills
and methods in assisting sick and well individual in their recovery and in the
promotion and maintenance of health.
*It involves the creative application of knowledge in the service of people.
NURSING (as a science)
• It is the “body of abstract knowledge” arrived through scientific research
and logical analysis.
NURSING (as a profession)
*It is a CALLING in which its members profess to have acquired special
knowledge by training or experience, or both so that they may guide,
advise, or save others in that special field
What are the foundations of nursing? Why do we need to study nursing?
1. Education- theory gives meaning to knowledge to improve practice by
describing, explaining and predicting phenomena
2. Research- if research, theory, and practice are to be meaningfully related,
then nursing theory should lead itself to research testing, and research
testing should lead to knowledge that guides practice
3. Clinical Practice- a nurse’s power is increase through theoretical
knowledge because systematically developed methods guide critical
thinking and decision making in professional practice and they are more
likely to be successful
THEORY- a set of statements that tentatively describe, explain or predict
relationships among concepts that have been systematically selected and
organized as an abstract representation of some phenomenon
NURSING THEORY- group of concepts derived from nursing models
- a body of knowledge that describes or explains nursing and is used to
support nursing practice
- a set of concepts. Definitions, relationships and assumptions or
propositions derived form nursing models or from other disciplines and
project a purposive systematic view of phenomena by designing specific
interrelationships among concepts for the purposes of describing,
explaining, and predicting
TYPES OF THEORY DEFINITIONS
1. Definitions focusing on structure
2. Definitions focusing on practice goals
3. Definitions focusing on tentativeness
4. Definitions focusing on research
5. Definitions focusing in developing and connecting concepts and the use of
theory in practice as well as research
6. Definitions focusing on progression from conceptual framework to theory
STRUCTURE
>McKay (1969) defined theory as :
“Logically interrelated sets of confirmed hypothesis” This definition
incorporates research as a significant step in theory development and
discounts conceptualizations that are based only or mental processes
PRACTICE GOALS
> Different theorists define nursing theory as: “A conceptual system or
framework invented for some purpose” Dickoff and James (1968)
> Theory is defined in terms of a conceptual framework
> This definition also brings to our attention the potential for inventing nursing
reality
TENTATIVENESS
> The source of nursing theory is not “what is” but “what ought to be”, and
that existing conceptualizations are indeed nursing theories because she
asserts, quibbling over labels of theory, concept, framework, and so forth are
“mere splitting of hairs” Barnum 1998
RESEARCH
> Theory as: “A coherent set of hypothetical, conceptual, and pragmatic
principles form a general frame of reference for a field of inquiry” Ellis, 1968
FOCUSING IN DEVELOPING AND CONNCETING CONCEPTS AND THE
USE OF THEORY IN PRACTICE AS WELL AS RESEARCH
> Using theory in practice and research, and it does not restrict theory to
research-verified propositions. Chinn and Kramer, 2004
> Theory as “one or more relatively concrete and specific concepts that are
derived from a conceptualmodel, the propositions that narrowl describe these
concepts, and the propositions that state relatively concrete and speicifc
relations between two or more of the concepts” Fawcett, 2005
ROOTS OF NURSING THEORY
> Anthropology- study of human and human behavior
> Psychiatry- diagnosis and treatment of mental, emotional and behavioral
disorders
> Sociology- functioning of human society
BASIC TERMINOLOGIES RELATED TO THEORY
> Phenomena- subject matter of a discipline
> Concept- a complex mental idea or phenomenon
-it is the major components of theory
-its labels is used to identify phenomena
Types of Concepts
* Abstract- are independent of time or place and they are indirectly
observable (Ex:hope)
* Concrete- specific to time and place and are observable
-Ex: a person’s features e.g. eye color, height or weight
-in nursing the four metaparadigms: person, health, environment,
nursing
> Assumptions- these are statements that form the bases for defining concepts
and framing propositions
- they are accepted as truths, and they represent values and beliefs
> Domain-contains the subject matter of a discipline, the main agreed-on values
and beliefs, the central concepts, the phenomenon of interest, the central
problems of the discipline, and the methods used to provide some answers in
the discipline
> Epistemology- it is a branch of philosophy that focuses on reflection and
investigations about the nature and foundation of knowledge
> Ontology- the discipline that provides the logical tools to analyze the nature of
basic and fundamental categories (Grossman, 1983)
-in nursing to mean a study and critical analysis of the core of beings
> Evidence-based practice- implementation of findings from the most recent
investigations for the purpose of providing quality care
> Model
*Verbal- worded statements, a form closely related to knowledge
development
-Ex: conceptual models of nursing are word structures that provide a
specific view on nursing through the interrelationship of concepts in the structure
*Schematic- explains using schema, symbols or visualization
-Ex: diagrams, drawings, graphs, pictures that facilitate understanding
> Conceptual framework/model- a set of interrelated concepts that symbolically
represents and conveys a mental image of a phenomenon
> Theoretical framework- a basic structure developed to organize a number o
concepts that are focused on a particular set of questions
Note: Distinction between theories, conceptual frameworks and theoretical
frameworks (Theories answer a set of questions; frameworks and models
provide direction for research projects and to represent theories; they both differ
in coherence)
> Paradigm- used to denote the prevailing schema or approaches within a
discipline; shared by scientific community
-another term for conceptual framework or conceptual model
> Disciplinary Matrix- includes the shared commitments of the community of
scholars, its shared symbolic generalizations, and its exemplars, which are the
shared problems and solutions in the discipline
> Metaparadigm- most abstract level of knowledge
-it specifies the main concepts that encompasses the subject matter and the
scope of the discipline
> Parsimony- presenting of ideas succinctly, under the premise that
explanations should be clearest when made using the fewest statements
-principle of economy of though and avoid redundancy
> Pholosophy- next level of knowledge
-specifiges the defnition of the metaparadigm concepts in each of the
conceptual model of nursing
-theories that is formalized from philosophies like Nightingales’, Watson,
and Benner
> Praxis- theories based on praxis allow for action, activity, development, and
constant dynamic changes but most importantly, on the dialectic relationship
between theory, action and critical reflection
> Science- a unified body of knowledge about phenomena that iss upported by
agreed-on evidence
-includes disciplinary questions and provides answers to questions that are
central to the discipline
- in nursing, it talks about diseases
> Tautology- redundancies, repetitions and circular statements are described as
tautological
> Teleology- branch of philosophy that deals with ends or
consequences
- postulates that the purpose of any action must be
> Virginia Henderson (Nov 30, 1897-March 19, 1996)
understood in terms of final causes
- a nurse, theorist, and author known for her Need
-an inquiry into the consequences of the phenomenon
Theory
being studied
-Nursing as “The unique function of the nurse is to
> Principles- basic generalizations that is accepted as true
assist the individual, sick or well, in the performance of
and that can be used as a basis for reasoning or conduct
those activities contributing to health or its recovery.”
- a general scientific theorem or law that has numerous
-her definition and components are logical and the 14
special applications across a wide field
components are a guide for the individual and nurse in
reaching the chosen goal
CRITERIA IN EVALUATING A THEORETICAL
- the first 9 components are physiological. The tenth
FRAMEWORK
and fourteenth are psychological aspects of
communicating and learning. The eleventh component
1. CLARITY - the major concepts, subconcepts, and their
is spiritual and moral. The twelfth and thirteenth
definitions are identified
components are sociologically oriented to occupation
-the diagrams and examples may facilitate clarity and
and recreation
should be consistent
-the logical development should be clear and
14 NEEDS:
assumptions should be consistent with the theory goals
1. Breathe normally.
- there must be intersubjectivity (shared agreement)
2. Eat and drink adequately.
3. Eliminate body wastes.
2. SIMPLICITY- should be sufficiently comprehensive and
4. Move and maintain desirable postures.
at a level of abstraction to provide guidance but it should
5. Sleep and rest.
have as few concepts as possible with simplistic
6. Select suitable clothes-dress and undress.
relations to aid clarity
7. Maintain body temperature within normal range by
adjusting clothing and modifying environment.
3. GENERALITY- the scope of concepts and goals within
8. Keep the body clean and well groomed and protect the
the theory are examined
integument.
-the broader the scope, the greater the significance
9. Avoid dangers in the environment and avoid injuring
of the theory
others.
10. Communicate with others in expressing emotions,
4. EMPIRICAL PRECISION- this is linked to the testability
needs, fears, or opinions.
and ultimate use a theory and it refer to the extent that the
11. Worship according to one’s faith.
defined concepts are grounded in observable reality
12. Work in such a way that there is a sense of
-there should be a match between theoretical claims
accomplishment.
and empirical evidence
13. Play or participate in various forms of recreation.
14. Learn, discover, or satisfy the curiosity that leads to
5. DERIVABLE CONSEQUENCES- nursing theory guides
normal development and health and use the available
research and practice, generates new ideas, and
health facilities.
differentiate the focus of nursing from other professions
-theory should reveal what knowledge nurses must, and
> Faye Glenn Abdellah (March 13, 1919- present)
should send time pursuing
- a pioneer in nursing research who developed the
“Twenty-One Nursing Problems.”
NOTE: Nursing theories are essential to guide practice.
-her model of nursing was progressive for the time in
that it refers to a nursing diagnosis during a time in which
HISTORY OF NURSING
nurses were taught that diagnoses were not part of their
role in health care.
> Hildegard Peplau (Sept. 1, 1909 - March 17, 1999)
- the twenty-one nursing problems identified in the
- An American nurse who is the only one to serve the
nursing theory are comprised of ten steps used to
American Nurses Association (ANA) as Executive Director
identify the patient’s problems and eleven skills used
and later as President
in developing a treatment typology of nursing care
-she became the first published nursing theorist since
plan.
Florence Nightingale
-“Mother of psychiatric nursing.” Her scope of
influence transcended her psychiatric nursing specialty and
had a profound effect on the nursing profession, nursing
science, and nursing practice
TEN STEPS USED TO IDENTIFY THE PATIENT’S PROBLEMS
1. Learn to know the patient.
2. Sort out relevant and significant data
3. Make generalizations about available data in relation to
similar nursing problems presented by other aptients
4. Identify the therapeutic plan
5. Test generalizations with the patient and make additional
generalizations
6. Validate the patient’s conclusions about his nursing problems
7. Continue to observe and evaluate the patient over a period of
time to identify any attitudes and clues affecting his behavior
8. Explore the patient’s and family’s reaction to the therapeutic
plan and involve them in the plan
9. Identify how the nurses feel about the patient’s nursing
problems
10. Discuss and develop a comprehensive nursing care plan
ELEVEN SKILLS USED IN DEVELOPING A TREATMENT
TYPOLOGY OR NURSING CARE PLAN
1. Observation or health status
2. Skills of communication
3. Application of knowledge
4. Teaching of patients and families
5. Planning and organization of work
6. Use of resource materials
7. Use of personnel materials
8. Problem-solving
9. Direction of work of others
10. Therapeutic use of the self
11. Nursing procedure
> Ernestine Wiendenbach (Aug. 18, 1900- March 8, 1998)
- she believed that there were 4 main elements to clinical
nursing
-they included: a philosophy, a purpose, a practice and the
art
-Nursing as the practice of identification of a patient’s
need for help through observation of presenting behaviors
and symptoms, exploration of the meaning of those
symptoms with the patient, determining the cause(s) of
discomfort, and determining the patient’s ability to resolve
the discomfort or if the patient has a need for help from the
nurse or other healthcare professionals
> Lydia Hall (Sept. 21, 1906- Feb. 27, 1969)
-an advocate for chronically ill patients and worked to
involve the community in public health issues
-her Care, Cure, Core Theory was developed through her
interest and research in the field of rehabilitation of
chronically ill patients
-as a result of her expertise in rehabilitation, Hall became
inolved in the creation of the Loeb Center for Nursing and
Rehabilitation at the Montefiore Medical Center (MMC) in the
Bronx, New York.
> Joyce Travelbee (1926-1973)
-deals with the interpersonal aspects of nursing,
focusing especially on mental health
-she explains “human-to-human relationship is
the means through which the purpose of nursing if
fulfilled”
-“Every human being suffers because he is a
human being, and suffering is an intrinsic aspect of
the human condition”
-nursing is an interpersonal connection, whereby the
nurse facilitates the progress of a patient, a family, or
a community in preventing or coping with an illness
or with suffering in ways that could lead to finding
meaning with the experience
> Kathryn E. Barnard (April 16, 1938 - June 27, 2015)
- CHILD INTERACTION THEORY means the role
mother-newborn interactions have in early childhood
developments
-believed deeply that every child not only has the
right to early nurturing relationships but also that those
relationships are the foundation for life-long health
development
-she observed that a rocking morion improved
infants’ weight gain and motor and sensory functions
> Evelyn Adam (April 16, 1938 - June 27, 2015)
- developed the Child Health Assessment Model
-concerns improving the health of infants and their
families
-her findings on parent-child interaction as an
important predictor of cognitive development helped
shape public policy
-she is the founder of the Nursing Child
Assessment Satellite Training Project (NCAST)
which produces and develops research-based products,
assessment and training programs to teach
professionals, parents and other caregivers the skills to
provide, nurturing environments for young children
> Nancy Roper/Winefred W. Logan/Alison J. Tierney
(1918-2004)
- a British nurse theorist, lexicographer and creator
with Logan and Tierney of the Roper-Logan-Tierney
model of nursing used widely in nurse training in the
United Kingdom, USA and Europe since mid-1970s
-Nursing is a theory of nursing care based on
activities of daily living, which are often abbreviated
ADLs or ALs.
THE ROPER-LOGAN-TIERNEY MODEL OF
NURSING: BASED ON ACTIVITIES OF DAILY LIVING
>maintaining a safe environment
>communciating
>breathing >working and playing
>eating and drinking >expressing
>eliminating sexuality, sleeping,
>personal cleaning and dressing and dying
>controlling body temperature
>mobilizing
> Ida Jean (Orlando) Pelletier (Aug. 12, 1926- Nov. 28, 2007)
-it explains that the role of the nurse is to find out and
meet the patient’s immediate needs for help
-nurse’s job is to find out the nature of the patient’s
distress and provide the help he or she needs
-her Deliberative Nursing Process Theory 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
HISTORY OF NURSING
1. PRIMATIVE TIMES (6TH CENTURY)
-women practice nursing because of low status in society
-took care of children and sick members of the family
-personalistic cause of the disease
-superstitious and believes in magic
-slave society “slave nurses”
-sickness is due to active intervention of:
>human-caused by ghosts
>non-human caused by ghosts
>superhuman beings caused by deities
-superstitious and believes in magic
-wet-nursing, take care of babies/children of their masters
-masters/healers are the people who are responsible in
decision making when it does to health
FOUNDING OF RELIGIOUS ORDERS
3 Attributes of Nurses
1. Self-denial
2. Devotion to hard work and duty
3. With spiritual calling
MAIN GUIDING PRINCIPLES
1. “Love thy neighbour as thy self”
2. Parable of the Good Samaritan
-Beneficience (doing good to others)
2 types of beeneficience
1. Ordinary-doing good to others
2. Ideal-entails sacrifice
2. APPRENTICE NURSING PERIOD (6TH-18TH CENTURY) knowledge according to their level of abstraction. The
>Crusades- men practiced nursing
-Knights of St. Lazarus
*established a standard among hospitals in Europe
*took care of clients with skin problems like leprosy
>Knights of St. John of Jerusalem- also known as Knights
Hospitalers
-Founded hospitals
>Florence Nightingale- established a nursing school in St.
Thomas Hospital in London which adopted the Nightingale
System
-made her the Mother of Modern Nursing
3. EDUCATIONAL NURSING PERIOD (18TH
CENTURY-20TH CENTURY)
>Philosophy of Nightingale System
a. government funds should be allowed to nursing
education
-earned her title of being the First Nurse Political
Activist
b. Training schools of nursing should be in close affiliation
NIGHTINGALE’S PHILOSOPHY
-Florence devoted her life to the service of others. She
had a strong calling to nursing that allowed her to help and
care for all human beings
-Proper wound care and sterilization all started with
Florence Nightingale’s nursing vision. She taught her
students to not only concentrate on nursing tasks but to
focus on the patient as a whole responding to
psychological and social aspects as well
C. Professional nurses should train nurses
D. Nursing students should be provided with residence
near their training hospitals
-written orders of doctors insisted
-nurses should go with doctors during rounds
HISTORY OF NURSING SCIENCE
>Curriculum Era (1900s-1940s)
>Research Era and Graduate Education Era
(1950s-1970s)
>Theory Era (1980s-1990s)
>Theory Utilization Era (21st century)
4. LATE 20TH CENTURY
-specialization in medicine
-conceptualization of the role of clinical nurse specialist
-increase clinical content of education (1900’s)
5. CONTEMPORARY PERIOD (21ST CENTURY)
-globalization of nursing
-period after World War 2
-borderless nursing or transcultural nursing
-professionalization of nursing
LESSON 3
NURSING KNOWLEDGE DEVELOPMENT
- this lesson covers the structural hierarchy differentiates
the various components of contemporary nursing
components of the structural hierarchy are listed here.
Each component is defined and described in detail in this
lesson.
The Knowledge Holarchy
-defined as the type of fractal that consists of
conceptual arrangements
-it uses the term “holon” (from the pre-Socratic Greek
word “holos”)
-as a way of determining the difference of reasons from
emotions and how this affects human’s personal in a
larger scale when social and political processes are
involved and in the war
Holarchy of Nursing Knowledge
>Metaparadigm
>Philosophies
>Conceptual Models
>Theories
>Empirical Indicators
Nursing knowledge holarchy
>Testing theory (top-down)
-from the top of the holarchy as a whole and looking
downward with the metaparadigm as being the center
or the “core” and the most abstract component
-deductive way
-and as you move your eye outward, you will see the
rings going towards concreteness and specific which
are the empirical indicators
>Generating theory (bottom-up)
-done the opposite way from inductive reasoning
and thinking to the broader one
-seeing first the most concrete specific entities of
the outer ring, the empirical indicators of the holarchy,
and proceeding to the most abstract inner ring and
that is the metaparadigm
COMPONENTS OF THE HOLARCHY (by Jacqueline
Fawcett)
>CTE (Conceptual, Theoretical, Empirical)
1. METAPARADIGM- worldview of a discipline - a
discipline is a distinct way of viewing all phenomena,
which ultimately defines the limits and nature of its
inquiry (Donaldson and Crowley, 1978)
-most abstract view of a discipline
>4 Metaparadigm Concepts
*Human beings
-the recipient of care
-this encompasses the person’s spirituality,
culture, family, and friends or even their
socioeconomic status
*Environment
-involves both internal and external factors
related to the patient
-this includes the interactions patients with their
visitors as well as their surroundings
*Health- includes the quality and wellness of the
patient
-includes the access the patient has to
healthcare
*Nursing- this refers to the nurse and how she or
he will apply their knowledge and skills when caring
for the patient
-it refers to the attributes of the nurse who is
providing the care
>Some theorists presented these concepts with
terminology variation
*Client
*Client-nurse
*Practice
*Environment
2. PHILOSOPHIES- a statement encompassing
ontological claims about the phenomena of central
interest to a discipline, epistemic claims about how
those phenomena come to be known, and ethical
claims about what the members of a discipline value
FUNCTION OF PHILOSOPHY
-to communicate what the members of a discipline believe to
be true in relation to the phenomena of interest to that
disipline
4 PHILOSOPICAL AREAS OF INQUIRY
1. Ontological Area- the study of reality or the metaphysical
-the inquiry along the lines of “What is said to exist or
be?” And if it exists, “What is there to it?”
-in nursing, ontology is what we believe is “true” in terms of
the central interest to the discipline
-it answers the question “What is it that we believe
exists?”
2. Epistemology area- the study of knowledge
-in nursing, this area includes questions such as:
>”What can we know?”
>”How do we know?”
>”How do we know what we know about the
phenomena of interest?”
>”In which category does the knowledge belong?”
3. Ethics area- it is the moral philosophy
-in nursing, we ask normative moral questions such as:
>”What ought I do as a nurse?”
>”How ought I act to be ethical in practice?”
>”What ought we do as a profession?”
4. Logics area- a method of inquiry or logical reasoning
through which arguments are presented and evaluated
6 NURSING PHILOSOPHERS
1. Florence Nightingale
2. Jean Watson
3. Marilyn Anne Ray
4. Patricia Benner
5. Karl Martinsen
6. Katie Ericksson
WORLD VIEWS
>Reaction
>Reciprocal
>Simultaneous
CONCEPTUAL MODEL- a set of relatively abstract and
general concepts that address the phenomena of central
interest to a discipline, the propositions that broadly
describe those concepts, and the propositions that state
relatively abstract and general relations between two or
more of the concepts
Other terms that is used interchangeably:
>conceptual framework
>conceptual system
>paradigm
>disciplinary matrix
Function
-to characterize relationships of phenomena in a
coherent format in order to shape a distinctive frame of
reference
-a reciprocal relationship exists between conceptual
models and nursing practice in that conceptual models
provide the characterization and structure for nursing
practice
A unique facet of each conceptual model:
-it provides an individual with the ability to interpret and
characterize reality from the particular model
-each discipline does not have just one reality, but
rather multiple realities
-each model gives the discipline a unique perspective
of the metaparadigm concepts and provides a path for
concrete theories such as the middle-range theories to be
generated and tested for practice
-nurses see the world and their observations about the
world through some frame of refeernce, choosing a
credible model is central to expert practice
7 CONCEPTUAL MODELS
1. Myra Estrin Levine
2. Martha E. Rogers
3. Dorothea E. Orem
4. Imogene King
5. Betty Neuman
6. Sister Callista Roy
7. Dorothy e. Johnson
THEORY- defined as “one or more relatively concrete
specific concepts that are derived from a conceptual model,
the propositions that narrowly describe those concepts and
the propositions that state relatively concrete and specific
relations between two or more concepts”.
Functions of Theory:
>Research inquiry-based on theory-testing or theory-
generating research
>Research-supported theory translated into practice
THEORY BY LEVEL OF ABSTRACTION
>Grand- “Macro theory”
-concepts and propositions that are less broad and
abstract than a conceptual model but not as specific and
concrete as middle-range theory (Fawcett,2005)
-a grand theory sometimes can be used as the “C” which
means the conceptual of the CTE structure, replacing the
conceptual model in this structure
There are three identified theories:
>Newman’s theory of health as expanding consciousness
>Parse’s theory of human becoming
>Leininger’s theory of culture care, diversity, and
universality
>Middle-Range Theory- less abstract, narrower in scope and
has fewer concepts and propositions than the grand theory
-they provide elements that especially align with practice
in nursing that’s why numerous theories emerged
-this guides research and have specificity for practice
-are supported strongly by empirical data (indicators)
EMPIRICAL INDICATORS- a very concrete and specific real
world proxy for middle-range theory concept
-is the actual instrument, experimental condition, or
procedure that is used to observe or measure a middle-
range theory
-the information obtained from empirical indicators is
typically called “data”
-this provides a way for middle-range theories to be
tested or generated, but there is no direct link between
empirical indicators and conceptual models, philosophies, or
the metaparadigm
-research instruments with data about concepts, nursing
protocols, nursing practice quality indicators, and other
outcome data used by nurses, among many other methods,
can be used as empirical indicators
-these empirical indicators can be used to test or
generate middle-range theories