Module 1 : Theoretical Foundations in Nursing

• Introduction to Nursing Theory

• History and Philosophy of Nursing as Science

• Structure of Nursing Knowledge

Learning Targets

• Identify the evolution of nursing

• Define the different era’s of nursing

• Identify the similarities and differences of significance of nursing as a

discipline and profession

• Enumerate the criteria of a profession

5. Determine the historical views of the nature of science

6. Differentiate rationalism and empiricism

7. Define the following structures of nursing knowledge (metaparadigm,

philosophy, conceptual models, and grand theories), and

8. Apply the following theory principle

History of Nursing Theory

➔ This was dated way back when Florence Nightingale began to assume
the great significance of providing a clean and healthy environment to
achieve recovery of patients and continues up to present
➔ She also envisioned nurses as a body of educated women who
organized service and caring for wounded in wartime (Crimean War) and
establishment of Nursing school in London (St. Thomas Hospital)
pioneering activities in nursing practice and education.
➔ Nursing evolved through different eras. Profession did not start as what it
seemed to be. It started as a vocational course offering only skills during
their time.
Nursing as a Science:

Apprenticeship Model

• Nursing process was based on principles and traditions that were handed down through practice
seen by Florence during her time

• Other references note that this is a practice era dated before the curriculum era where to be a
nurse can have a diploma for only 2 years under vocational
 Historical Eras of Nursing’s Search for Specialized Knowledge
Historical Eras Major Question Emphasis Outcomes Emerging Goal

Curriculum Era: What curriculum Courses included on Standardized curricula Develop specialized
1900 to 1940s content should nurses nursing programs for diploma programs knowledge and higher
study to be nurses education

Research Era: What is the focus for Role of nurses and Problem studies and Isolated studies do not
1950 to 1970s nursing research? what to research studies of nurses yield unified knowledge

Graduate Education What knowledge is Carving out an Nurses have an Focus graduate
Era: needed for the practice advanced role and important role in health education on
1950 to 1970s of nursing? basis for nursing care knowledge
practice development

Theory Era: How do these There are many ways Nursing theoretical Theories guide nursing
1980 to 1990s frameworks guide to think about nursing works shift the focus to research and practice
research and practice? the patient

Theory Utilization Era: What new theories are Nursing theory guides Middle-range theory Nursing frameworks
21st Century needed to produce research, practice, may be from produce knowledge
evidence of quality education, and quantitative or (evidence) for quality
care? administration qualitative approaches care
Fawcett classified nursing models as paradigms with in a more
organized / specialized meta-paradigm of:

❖ Person

❖ Environment

❖ Health

❖ Nursing Concepts
Significance of Nursing Theory:

DISCIPLINE PROFESSION
● Specific to academia and refers to a branch of ● Refers to a specialized field of practice founded on the
education, a department of learning or a domain of theoretical structure of the science or knowledge of the
knowledge. discipline and accompanying practice abilities.

● Branch of education; theoretical works leading to higher ● Knowledge of that discipline and accompanying practice
level of education and practice. abilities.

● Functional Focus (what nurses do) - knowledge focus or ● Recognition and respect for their scholarly disciplined
what nurses know and how they use them for thinking contribution to the health of society.
and decision making while taking care of a patient.
(example: Nursing)

● Knowledge of persons, health and environment forms

the basis for nursing as a discipline

● Kuhn - stated, “ the study of paradigms is what mainly

prepares the student for membership in a particular
scientific community with which he / she will practice. By
studying and practicing with them, the clients or
community involved learn their trade.”
Criteria for the Development of the Professional status of Nursing:

1. Utilizes in its practice a well-defined and well- organized body of specialized

knowledge.

2. Constantly enlarges the knowledge it uses and improves its techniques of

education and service thru scientific method.

3. Entrusts the education of its practitioners to universities / colleges.

4. Applies knowledge in practical services important to community welfare.

5. Functions autonomously in developing professional policy.

6. Attracts individuals with intellectual and personal qualities of intensifying

service.

7. Strives to compensate nurses by providing freedom of action, opportunity

for continuous professional growth and economic security.
Historical Views of the Nature of Science

Epistemology (episteme – knowledge; logos – study of)

● meaning knowledge, understanding

● concerned with the theory of knowledge in philosophical inquiry or how

knowledge came to be.

● What is real is also considered knowledge.

● Branch of philosophy concerned with the nature & scope of knowledge.

● It is the study of knowledge & justifies beliefs.

● It questions what knowledge is & how it can be acquired.

● This aims to discover the meaning of knowledge, & called it the true
beginning of philosophy
 Philosophical Foundations of Science
RATIONALISM EMPIRICISM

● Priori reasoning -utilizes deductive; cause to effect or ● Way of looking at reality using the five senses.
general to particular
● An object is real in so far as seen, felt, smelled, tasted, heard
● Use of the rational senses in ensuring the truthfulness of a
phenomenon ● A theory which states that knowledge comes only or primarily
from sensory experience
● Understand the whole first before you can appreciate the
● Fundamental part of scientific method (experimentations)
lesser parts
● Knowledge is based on experience; ex. physical assessment
● Regards reason as the chief source & test of knowledge
● Gather information more and observe facts before finally
● Any view appealing to reason as a source of knowledge saying a theory exists.
or justification (theory-the-research approach)
● Reynolds, “research-then-theory strategy”
● Criterion of truth is not sensory but intellectual & deductive
(general to specific) ● It is inductive. (specific to general)

● ex: lack of social support will lead to hospital readmission, ● ex: collect data → diagnose
“not at all”
 History of Nursing Science:
Early 20th century views
● Positivism emerged as the dominant view of modern
science.
● Modern logical positivists believed that empirical research
and logical analysis were two approaches that would
produce scientific knowledge.
v Philosopher focused on the analysis of theory
structure.
v Scientists focused on empirical research.
v Increasing use of computers which permits the
analysis of large data.
Emergent of science & theory in the late 20th century
● Phenomenological Approach reduces observations or text to
the meanings of phenomena independent of their particular
context. This approach focuses on the lived meaning of
experiences.
v Several authors presented analysis challenging the
positivist position, thus offering the basis for a new
perspective in science.
v Empiricists view phenomena objectively, collect data and
analyze it to inductively propose theory.
 History of Nursing Science:
Interdependence of theory & research
● In constructing theory, theorists must be knowledgeable
about available empirical findings and able to take these
into account, because theory is concerned with organizing
and formalizing available knowledge of a given
phenomenon.
● The theory is subject to revision or maybe abandoned in
favor of an alternative explanation for new information.
Science as a social enterprise
● "Human beings do science" - Gale. It might be anticipated that
social, economic, or political factors may influence scientific
enterprise. It depends on the funds, popularity of certain
ideologies.
● Science progresses by the diversity of dialogue within the
discipline of nursing. The creation of a merged paradigm from
many paradigms is debated in relationship to the advancement
of nursing.
Theory Development Process
➢ Usually means “mere guess” or
unproved
➢ Literally means “a vision” or “a
beholding scene”
➢ Greek word “theoria”
➢ A set of statements that tentatively
describe, explain, or predict
relationships among concepts that
have been systematically selected
& organized as an abstract
representation of some
phenomenon (Powers & Knapp).
➢ A creative & rigorous structuring of
ideas that project a tentative,
purposeful & systematic view of
phenomenon. Validation of existing
knowledge as well as discovery of
new knowledge. We apply theory
to describe, explain, predict, or
prescribe nursing practice.
THEORY
➢ Scientifically, theory implies that ➢ An idea that is suggested or
something has been proven and is presented as possibly true but that
generally accepted as being true. is not known or proven to be true.
An idea or set of ideas that is
intended to explain facts or events.
➢ An internally consistent group of ➢ Scientifically theory implies that
relational statements (concepts, something has been proven and is
definitions & propositions) that generally accepted as being true.
present a systematic view about a
phenomenon & which is useful for
description, explanation, prediction
& control (Bodie & Chitty).
➢ The general principles or ideas that relate to principles or ideas that relate to a
particular subject.
Ex. Theory of Evolution
 Categories of Theory Components:
CONCEPTS
v are words or phrases that are
used to represent the
phenomenon observed or
experienced
v are the building blocks of
theories, “ideas”
v describe & classify
phenomena
CATEGORIES OF CONCEPTS
TYPE MEANING EXAMPLE
Abstract independent of a certain time and CHS
place
Concrete more specific time or place Nursing, Pharmacy
Discreet they belong or not belong to a patients, nurses, environment
particular categories or classes of
phenomena
Continous ▪ Concepts - classifications of pain, health – illness continuum
dimensions or gradations of a
phenomenon across a continuum
▪ Degrees or levels in a given
continuum
Theoretical Definitions establish meaning (dictionary) dictionary meaning
Operational Definitions how these concepts are used or provide measurement
will be used within the context of
the phenomenon
10 Phases of Concept Building Process:
1. Write a meaningful practice story.

2. Name the central phenomenon in the practice story.

3. Identify a theoretical lens for viewing the phenomenon.

4. Link the phenomenon to existing literature.

5. Gather a story from someone who has lived the phenomenon. 1

6. Reconstruct the shared story and create mini-saga that captures its message

7. Identify the core qualities of the phenomenon.

8. Use the core qualities to create a definition.

9. Create a model of the phenomenon

10. Write a mini synthesis that integrates the phenomenon with a population to suggest
research direction.
Relational Statements Statements in a theory may state definitions or
relations among concepts
Theoretical Statements Relate concepts to one another; permit analysis

Operational Statements Relate concepts to measurements

Linkages and Ordering:
Linkages of theoretical statements provide rationale of why theoretical
statements are linked; add
plausibility

Linkages of operational statements provides rationale for how

measurement variables are linked;
permit testability
Organization of concepts and eliminates overlap (tautology)
definitions into primitive and derived
terms

Organization of statements and eliminates inconsistency

linkages into premises and derived
hypotheses and equations
 SCIENTIFIC LAW vs THEORY

SCIENTIFIC LAWS THEORY

v A statement of fact that aims to explain, in brief and simple terms, an action or set v More complex & dynamic; maybe replaced
of actions
v Explains an entire group
v Generally accepted to be true and universal and can occasionally be expressed
in terms of a single mathematical equation v Can be changed or improved without changing the overall truth

v SIMPLE, TRUE, UNIVERSAL & ABSOLUTE v Developed from the scientific method

v Governs a single action, foundations for all science v ACCEPTED AT TRUE & PROVED

v Statement based on repeated experimental observations that describes some

aspects of the universe

v Always applies under same conditions, & implies that there is a causal
relationship involving its elements Hypothesis

v ex. Law of Universal Gravitation by Newton ● an educated guess based upon observation

● can be supported or proven false by experimentation or continued observation

● an idea or theory that is not proven but leads to further study or discussion

● an assumption made for the sake of argument\

● HAS NOT BEEN PROVED

● ex. watching excessive amounts of TV reduces a person’s ability to concentrate;

smoking leads to lung cancer
Contemporary Issues in Nursing Theory Development:

▪ Theoretical Boundaries and Levels to Advance Nursing Science

▪ Nursing Theory, Practice and Research

Reference: Alligood, M. (2018). Nursing theories
and their work (9th ed.). Singapore: Elsevier.