EVOLUTION OF

NURSING
MIDTERM LECTURE – PART 1

GEEVEE NAGANAG VENTULA, RN

 OBJECTIVE
At the end of this lecture, the students will
be able to:
1. Define what is a theory and a nursing theory
2. Recognize the importance of theories in nursing
3. Identify the history and stages of the development
of nursing theories
4. Differentiate empiricism from rationalism
5. Enumerate the different metaparadigm in nursing
6. Describe the different patterns of knowing
7. Categorize nursing theories
Table of 01 INTRODUCTION TO NX THEORY
Definitions | History | Importance
Contents
02 HISTORY & PHILOSOPHY OF SCIENCE
Rationalism | Empiricism

03 STRUCTURE OF NURSING KNOWLEDGE

Metaparadigm | Patterns of Knowing | Classifications
INTRODUCTION
TO NURSING
THEORY
PART ONE
 WHAT IS A
THEORY? LAW
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.
(McEwen & Wills, 2019)
WHAT ARE NURSING THEORIES?
● Nursing theories are organized bodies of
knowledge to define what nursing is, what
nurses do, and why they do it.
● Nursing theories provide a way to define
nursing as a unique discipline that is
separate from other disciplines.
● It is a framework of concepts and purposes
intended to guide nursing practice at a more
concrete and specific level.
 SIGNIFICANCE OF THEORIES IN NURSING

ONE TWO THREE FOUR

Offers Makes nursing Defines and Leads to
structure practice more clarifies coordinated and
and overtly nursing and less fragmented
organization purposeful its purpose care
 HISTORY OF NURSING THEORIES
1860 1952 1955 1960
Mother of modern Florence Hildegard Virginia Faye Abdellah
nursing
Nightingale Peplau Henderson published her
defined nursing introduced conceptualized work “Typology of
in her her Theory of the nurse’s role 21 Nursing
“Environmental Interpersonal as assisting sick Problems,” which
Theory” as “the Relations that or healthy shifted the focus
act of utilizing emphasizes the individuals to of nursing from a
the patient’s nurse-client gain disease-centered
environment to relationship as independence in approach to a
assist him in the foundation meeting 14 patient-centered
his recovery.” of nursing fundamental approach.
nurse in a military hospital before practice. needs.
maayos ang relationship
namamatay dahil sa walang proper hindi lang may sakit ang
dapat sa pasyente, trusting
hygiene , hindi conducive inaalagan kundi pati mga
relationship to provide what
the patient needs may sakit
 HISTORY OF NURSING THEORIES
1962 1968 1970 1971
A Ida Jean Orlando Dorothy Johnson Martha Dorothea
D
P
emphasized the pioneered Rogers viewed Orem stated in
I reciprocal the Behavioral nursing as both a her theory that
E relationship System science and an nursing care is
NURSING between patient Model and upheld art as it provides required if the
PROCESS and nurse and the fostering of a way to view the client is unable to
viewed nursing’s efficient and unitary human fulfill biological,
professional effective being, who is psychological,
function as finding behavioral integral with the developmental, or
out and meeting functioning in the universe. social needs.
the patient’s patient to prevent Science of Unitary Self-care deficit theory
immediate need illness. Human Being, nursing is both if the patient need care we give care
but if the patient can let them be
for help. science and art
independent according to their needs .
Only help if its required
 HISTORY OF NURSING THEORIES
1971 1972 1979 1979
Imogene Betty Neuman, in Sr. Callista Jean
King’s Theory of her theory, states Roy viewed the Watson develope
Goal attainment that many needs individual as a d the philosophy
stated that the exist, and each set of interrelated of caring,
nurse is may disrupt systems that highlighted
considered part of client balance or maintain the humanistic
the patient’s stability. Stress balance between aspects of
environment and reduction is the these various nursing as they
the nurse-patient goal of the stimuli. intertwine with
relationship is for system model of scientific
meeting goals nursing practice. knowledge and
towards good nursing practice.
health.

mutual goal setting between

the nurse and patient
STAGES IN THE DEVELOPMENT
OF NURSING THEORY

STAGE ONE:
SILENT KNOWLEDGE
Blind obedience to
medical authority
 STAGES IN THE DEVELOPMENT
OF NURSING THEORY

STAGE TWO:
RECEIVED KNOWLEDGE
Learning through listening
to others
STAGES IN THE DEVELOPMENT
OF NURSING THEORY

STAGE THREE:
SUBJECTIVE KNOWLEDGE
Authority was internalized to
foster a new sense of self.
start of creating different nursing theories
 STAGES IN THE DEVELOPMENT
OF NURSING THEORY

STAGE FOUR:
PROCEDURAL KNOWLEDGE
Includes both separate and
connected knowledge
STAGES IN THE DEVELOPMENT
OF NURSING THEORY

STAGE FIVE:
CONSTRUCTED KNOWLEDGE
Combination of different types
of knowledge (intuition, reason,
and self-knowledge)
 STAGES IN THE DEVELOPMENT
OF NURSING THEORY

STAGE SIX: present time

INTEGRATED KNOWLEDGE
Assimilation and application of
“evidence” from nursing and
other health care disciplines
 HISTORY AND
PHILOSOPHY OF
SCIENCE
PART TWO
 WHAT IS
EPISTEMOLOGY?
origin of knowledge
Epistemology is the branch of philosophy concerned
with knowledge. Epistemologists study the nature,
origin, and scope of knowledge,
epistemic justification, the rationality of belief, and
various related issues.
 WHAT IS
EPISTEMOLOGY?
Epistemology is the branch of philosophy concerned
with knowledge. Epistemologists study the nature,
origin, and scope of knowledge,
epistemic justification, the rationality of belief, and
various related issues.
 DISTINCTIONS IN EPISTEMOLOGY

A PRIORI A POSTERIORI
knowledge that is known knowledge that is known
independently of by experience (that
experience (that is, it is is, it is empirical, or
non-empirical, or arrived arrived at through
at before experience, experience).
usually by reason). It will
henceforth be acquired
through anything that is experience
independent from
experience.
knowledge is innate, in born or from within

RATIONALISM EMPIRICISM
RATIONALISM EMPIRICISM
A PRIORI A POSTERIORI
INDEPENDENT OF EXPERIENCE knowledge is gained from
experiences
 RATIONALISM VS. EMPIRICISM
KNOWLEDGE IS FROM REASON OR INTUITION
Rationalism is the
epistemological view that
reason is the chief source of
knowledge and the main
determinant of what
constitutes knowledge. More
broadly, it can also refer to
any view which appeals to
reason as a source of
knowledge or justification.
In philosophy, empiricism is
a theory that states that
knowledge comes only or
primarily from sensory
experience. Empiricism
emphasizes the role
of empirical evidence in the
formation of ideas, rather
than innate
ideas or traditions.
STRUCTURE OF
NURSING
KNOWLEDGE
PART THREE
 THE NURSING METAPARADIGM
Individual Person (also referred to as Client or Human Beings) is

P PERSON
Family
Community the recipient of nursing care and may include
Group
I-F-C-G
individuals, patients, groups, families, and
communities.

E
ENVIRONMENT
Environment (or situation) is defined as the internal and
external surroundings that affect the client.

H HEALTH
Health is defined as the degree of wellness or well-being
that the client experiences. overall health status

The nurse‘s attributes, characteristics, and actions

NURSING
N provide care on behalf of or in conjunction with the
client.
FOUR FUNDAMENTAL WAYS OF
KNOWING
BARBARA A. CARPER a professor in texas 1978
1. 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).

putting ourselves on the shoes of our patient

FOUR FUNDAMENTAL WAYS OF
KNOWING

2. EMPIRICAL KNOWING
We gain EMPIRICAL knowledge from research and
objective facts. 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).
factual from science
FOUR FUNDAMENTAL WAYS OF
KNOWING
3. ETHICAL KNOWING
ETHICAL knowing helps one develop our own moral
code; our sense of knowing what is right and wrong.
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” (American
Nurses Association, 2015) can guide us as we
develop and refine our moral code.
FOUR FUNDAMENTAL WAYS OF
KNOWING
4. AESTHETIC KNOWING the art of nursing
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. 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.
STAGES IN THE DEVELOPMENT
OF NURSING THEORY

The most recently devised pattern is EMANCIPATORY

KNOWING. According Jackson (2009), emancipatory
knowing is a combination of both a traditional social
idea and a developing dimension of nursing knowledge
(Chinn & Kramer, 2008). This pattern of knowing elevate
nurse leaders to the next step, and have actively changed
the work place environment, and have positively
impacted outcomes for both patients and nurses.
*recognized social and political
problems in injustice and inequity
2 CLASSIFICATION OF NURSING THEORIES
(SCOPE AND PURPOSE)

BASED ON SCOPE
 Grand theories are abstract, broad in scope, and
complex, therefore requiring further research for
clarification.

GRAND Grand nursing theories do not guide specific

nursing interventions but rather provide a

NURSING general framework and nursing ideas.

THEORIES
Grand nursing theorists develop their works
based on their own experiences and their time,
explaining why there is so much variation
among theories.
broad they can cover all metaparadigm components
Address the nursing metaparadigm components
of person, nursing, health, and environment.
 More limited in scope (compared to grand
theories) and present concepts and propositions
at a lower level of abstraction. They address a
MIDDLE specific phenomenon in nursing.

RANGE Due to the difficulty of testing grand theories,

nursing scholars proposed using this level of

NURSING theory.

Most middle-range theories are based on a grand

THEORIES theorist’s works, but they can be conceived from
research, nursing practice, or the theories of
other disciplines.

more on ganito ang maeecounter

na theories
 example is a certain group of population
Practice nursing theories are situation-specific
theories that are narrow in scope and focuses on
a specific patient population at a specific time.
PRACTICE Practice-level nursing theories provide
LEVEL frameworks for nursing interventions and
suggest outcomes or the effect of nursing

NURSING practice.

Theories developed at this level have a more

THEORIES direct effect on nursing practice than more
abstract theories.
These theories are interrelated with concepts
from middle-range theories or grand theories.
CLASSIFICATION OF NURSING THEORIES
(SCOPE AND PURPOSE)

BASED ON PURPOSE
FACTOR-ISOLATING THEORIES
Descriptive theories are those that
describe, observe, and name
concepts, properties, and dimensions.
DESCRIPTIVE
Descriptive theory identifies and
describes the major concepts of
THEORIES
phenomena but does not explain how
or why the concepts are related.
to provide observation and meaning of phenomena
FACTOR-RELATING THEORIES

Factor-relating theories, or
explanatory theories, are those that
relate concepts to one another, EXPLANATORY
describe the interrelationships
among concepts or propositions, and
THEORIES
specify the associations or
relationships among some concepts.
SITUATION-RELATING THEORIES

Situation-relating theories are

achieved when the conditions under PREDICTIVE
which concepts are related are stated
and the relational statements are THEORIES
able to describe future outcomes
consistently.
SITUATION-PRODUCING THEORIES

Situation-producing theories are

those that prescribe activities
necessary to reach defined goals. PRESCRIPTIVE
Prescriptive theories address nursing
THEORIES
therapeutics and consequences of
interventions.
 KEY POINTS
“Theory” refers to the systematic explanation of events in which constructs and concepts
are identified, relationships are proposed, and predictions are made.
Theory offers structure and organization to nursing knowledge and provides a systematic
means of collecting data to describe, explain, and predict nursing practice.
Florence Nightingale was the first modern nursing theorist; she described what she
considered nurses’ goals and practice domain to be.
There has been an evolution of stages of theory development in nursing. Nursing is currently in
the “integrated knowledge” stage, which emphasizes EBP and translational research.
Theory development increasingly sources meta-analyses, as well as nursing research, and
is largely directed toward middle range and situation-specific/practice theories.
Theories can be classified by scope of level of abstraction (e.g., grand theory, middle range
theory, and situation-specific theory) or by type or purpose of the theory (e.g.,
description, explanation, prediction, and prescription)
The concepts of nursing, person, environment, and health are widely accepted as the dominant
phenomena in nursing; they have been identified as nursing’s metaparadigms.
 Thank You!
Do you have any questions?
gventula@spup.edu.ph

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