CHAPTER 1

Nursing Theory: An Introduction

"I attribute my success to this - I never gave or took any excuse." - Florence
Nightingale -, Nurse, Writer, Feminist and Statistician

Lesson Objectives

 Exploring the relationship between person, health, environment, nursing, and

other related concepts in regards to caring for and managing altered health is
a vital area of discussion.
 Identify the differences between terms related to the nursing metaparadigm.
 Describe how nursing theory affects a nurse's approach to their work.

Nursing is a complex and ever-changing field, with a wide range of ethnic,

cultural, and religious influences on the people who receive care. All nursing
practices are focused on achieving and restoring the patient's physical, mental, and
spiritual health, and helping them to live a life of dignity and normalcy. To ensure safe
and effective care, nursing must be based on accepted scientific facts and principles. In
short, a Nursing Theory is an attempt to explain the Science and Art of Nursing.
Although there is no universal classification of Nursing Theory, numerous Nursing
theorists have attempted to offer their own perspectives. Filipino nurses have their own
distinctive way of practicing Nursing that is reflective of the Filipino culture and spirit.
Therefore, it can be said that Filipino nurses have a unique approach to Nursing both
as an art and science.
Nursing Science is a combination of various knowledge, beliefs, and
backgrounds of health and care that has been gathered and maintained since over
time. It is vital for nursing students to have a basic understanding of the ideas that
form a nursing theory, as it is ever-changing and evolves as research and information
advances.

WHAT IS THEORY?
A theory is an organized and structured set of ideas that is made up of concepts,
propositions, definitions and assumptions meant to explain a set of facts, events or
phenomena. According to the definition given by Chinn and Kramer (1991), a theory
can be described as “a creative and rigorous structuring of ideas that projects a
tentative, purposeful and systemic view of phenomena”. This definition emphasizes
the tentative nature of theories.
 A concept is an idea or experience that is formulated or perceived by the mind,
for example, justice, love, war, and disease while a proposition explains the
connections between these concepts. An example of this is the fear of injections that
causes some children to stay away from the hospital. A definition is a set of
descriptions that give a general understanding of a concept, such as Peplau's
definition of Nursing as a significant and therapeutic interpersonal process.
An assumption is a statement that establishes a link between factual concepts or
phenomena. An example of this is the assumption that all people who cannot take care
of themselves need nurses.

How other Authors DEFINE THEORY

Parker (2001) "A theory, by traditional definition, is an organized, coherent set of

concepts and their relationship to each other that offers
descriptions, explanations and predictions about a phenomena."

Blackwell “[It is] a reasoned proposed explanation of an occurrence, or of

(2005) something that will occur or be produced, for which absolute proof
is lacking."

Delaune and "A theory is a set of concepts and propositions that provide an early
Ladner (2006) way to view phenomena."

Mosby (2006) “[It is] an abstract statement formulated to predict, explain or

describe the relationships among concepts, constructs or events. It
is tested by observation and research using factual data."

Kozler (2008) “A theory is a supposition or system of ideas that is proposed to

explain a given phenomenon.”

Potter and “A theory helps explain an event by defining ideas or concepts,

Perry (2014) explaining relationships among the concepts and predicting
outcomes."

Smith and “A theory is a notion or an idea that explains experiences,

Parker (2015) interprets observation, describes relationships and projects
 How other Authors DEFINE THEORY

outcomes."

BOX 1.a CHARACTERISTICS OF A THEORY

 By correlating concepts, theories can provide a new perspective on a

particular fact or phenomenon.
 Theories must be rational in their form.
 Theories should be straightforward yet generally comprehensive in scope.
 Hypotheses can be derived from theories that can be further tested and
developed.
 Theories can help to broaden our understanding by providing evidence
through research and testing.
 Practitioners can use theories to guide and improve their practice.
 Theories must be in accordance with other already established theories, laws
and principles, yet leave open questions that require further testings.

WHAT IS NURSING?

 The American Nursing Association (ANA) describes Nursing as the

“diagnosis and treatment of human responses to actual or potential health
problems”.

Additionally, the International Council of Nurses (ICN) highlights that

Nursing includes “autonomous and collaborative care of individuals of all
ages, families, groups and communities, sick or well and in all settings.
Nursing includes the promotion of health, prevention of illness, and the care
of ill, disabled and dying people. Advocacy, promotion of a safe
environment, research, participation in shaping health policy and in
patient and health systems management, and education are also key
nursing roles.”

 Henderson's definition of Nursing is described as “to assist clients in the

performance of activities contributing to health, its recovery or peaceful
death that clients will perform unaided if they had the necessary will,
strength or knowledge.”

 The Association of Deans of Philippine Colleges of Nursing

(ADPCN) describes Nursing as a dynamic discipline. "It is an art and a
science of caring for individuals, families, groups and communities geared
toward[s] promotion and restoration of health, prevention of illness,
 alleviation of suffering and assisting clients to face death with dignity and
peace. It is focused on assisting the client as he or she responds to health-
illness situations, utilizing the nursing process and guided by ethico-moral-
legal principles."

 This field of study is dedicated to helping communities, families, and

individuals reach their optimal level of health and functioning. It is both a
science and an art, aimed at improving the quality of life as perceived by the
clients.

NICE TO KNOW

Following the definition of the American Nurses Association (ANA), nurses are responsible
for treating the signs and symptoms (human responses) of a disease, while physicians treat
the disease entity itself. For instance, a physician may treat a client with tuberculosis using
medications, while a nurse would focus on managing the cough and other breathing
difficulties which are manifestations of tuberculosis. Through this, we can understand the
distinct and unique role nurses play in the promotion of health.

WHAT ABOUT A NURSING THEORY?

Nursing theory is a collection of interconnected ideas that have been established
through a variety of disciplines and related experiences. This seeks to comprehend
the core of nursing care. Various nursing theorists from different eras have
contributed to the development of theories; for example, in the 19th century, Florence
Nightingale highlighted the important link between health and environmental elements
like fresh air, sunlight, and ventilation.

Meleis (2012) emphasizes the significance of a nursing theory for providing

direction to nursing care, which is a conceptualization of invented or discovered
reality (central phenomena and relationships) in or pertaining to nursing. This
conceptualization is used to describe, explain, predict or prescribe nursing care.
The various definitions offered by different authors demonstrate the complexity of
nursing, and as research and studies become more widespread, the reliability of
nursing theories will likely increase, allowing for the potential emergence of new
theories.
COMPONENTS OF A THEORY
Nurses are able to provide caring nursing practices due to the knowledge

gained from theories, which comprise concepts, definitions, assumptions or

propositions that explain a phenomenon.

Phenomenon Describes a concept or opinion about an occurrence, circumstance,

procedure, series of events, or group of circumstances.

Concept Provides a way to identify and categorize phenomena.

Definition Used to convey the overall idea of the principles of the theory.

Assumption This describes the characteristics, definitions, purpose, connections,

and organization of a theory.

DIFFERENT TYPES OF THEORIES

Factor-Isolating Theories, otherwise known as Descriptive Theories, are the
foundation for theory development. They help to identify and explain major concepts
of a phenomenon without detailing the relationship between them. These theories are
based on the five senses and their corresponding meanings. For instance, descriptive
research may be used to explore Filipino nursing practices, such as the use of herbal
medicines and other alternative forms of treatment.
Factor-Relating Theories, also known as Explanatory Theories, provide an
explanation of the relationships between concepts and propositions. These theories
are used to understand the cause and effect of concepts, such as in a research study
about the factors affecting newborns in failing to thrive.
Situation-Relating Theories, also referred to as Predictive Theories, are
developed when the associations between concepts in a given situation can accurately
predict future results. This type of theory is generated and tested through
experimental research. An example is a theoretical model based on the consequences
of unsanitary environmental conditions on the recovery of post-operative patients.
 Laurente's (1996) theory is an example of Prescriptive Theories, otherwise
known as Situation-Producing Theories, which evaluate the effectiveness of a
particular nursing action. This kind of theory is regularly employed in assessing
novel nursing interventions. For instance, it can be used to ascertain the efficacy of
nursing management in alleviating uneasiness among patients in the emergency room.

BOX 1.b CLASSIFICATION OF THEORY ACCORDING TO

FUNCTION (Dickoff and James, 1968)

Descriptive To understand the fundamentals and operations of a field.

Explanatory To investigate the connection between properties and their impact on

the field.

Predictive Calculating the correlations between properties and how they

manifest.

Prescriptive Identifying the circumstances under which relationships take place.

CONCEPTS
Concepts are the fundamental building blocks of theories. They can originate from
empirical phenomena or from a person's mental abstraction of something that is not
physically observable, such as charity, caring, or patience. Concepts enable individuals
to comprehend phenomena more effectively, as they help to give meaning to words.
There are two types of concepts:

 Abstract concepts are intangible and cannot be directly observed. They

exist independently of time and place, and examples include love, care, and
freedom.
 Concrete concepts are those which can be experienced firsthand. Examples
include nurse, mother, and pain.
 Concepts can be employed to create either a conceptual or
an operational definition. Conceptual definitions are the interpretations of a term
based on how a certain theory or relevant literature defines it. Examples of this
include roles/concepts of nurse, patient care, and surroundings. Operational
definitions, on the other hand, are interpretations of a term based on the method of
how it was measured or how the person arrived at that perception. An example of this
type is the importance of pain perception and practiced nursing intervention.

DEFINITIONS OF A CONCEPT

CONCEPTUAL DEFINITION
OPERATIONAL DEFINITION

Similar to a definition found in literary

sources such as dictionaries, encyclopedias, This outlines the exact process of determining and
and journals. evaluating the concept, as well as identifying any relevant
procedures and operations.

EXAMPLE 1: HOSPITAL STAY

The duration of a person's hospitalization. The length of stay for a client at the hospital, starting with
admission day and ending with discharge.

EXAMPLE 2: AMBULATION

To traverse or travel from one place to Walking six steps unaided.

another.

CONCEPTUAL MODELS AND THEORETICAL MODELS

Theoretical models or frameworks are well-developed systems of concepts that
can be tested.
Conceptual models or frameworks are ways of representing an individual's or
researcher's understanding or interpretation of a certain concept, phenomenon, or
theory. These representations can be in the form of diagrams or narratives, which
show how different ideas are connected to one another.

OPERATIONAL DEFINITION

CONCEPTUAL THEORETICAL

This is a map which has been This is a pre-existing framework of ideas

constructed by combining various which have been researched and documented
concepts and theories to be used for in the literature, providing a ready-made
study. roadmap for study.

WHAT ARE NURSING PARADIGMS?

Nursing Paradigms demonstrate the close connection between current theoretical
works in Nursing. Many theories in nursing currently revolve around four major
concepts (metaparadigms: derived from the Greek words "meta" - with and
"paradeigma" - pattern):
 Person. Individuals, families, and communities who are recipients of nursing care.
For instance, Nightingale suggested that a person's physical, intellectual, and spiritual
aspects are not able to control the environment to improve health, which implies that
they must rely on being cared for.
Environment. Nightingale's theory has highlighted the importance of physical
environment, such as ventilation, warmth, noise, light, and cleanliness, in influencing a
person's life both externally and internally.
Client. The overall health and wellbeing of the client is the aim of all nursing
activity as per Nightingale's definition of nursing which is "a profession for women (a
calling) with the goal to discover and use the laws governing health in the service of
humanity.
Nursing. The nurse is responsible for providing care and support to their clients, as
exemplified by Nightingale's belief that manipulating the environment can help
promote wellbeing.
The four major concepts that form the basis of nursing, known
as metaparadigm, guide the understanding and direction of the nursing profession.
This includes the knowledge base, theory, philosophy, research, practice, and
educational experience and literature that are associated with the field. Depending on
the perspective of different nursing theorists, these concepts may vary.
However, metaparadigm is the highest level of knowledge.

PHILOSOPHY IN NURSING
Philosophy is the next level of understanding after metaparadigm, wherein it
explains the definition of metaparadigm concepts in the various Nursing conceptual
models. It further clarifies the meaning of phenomena through careful analysis,
logical reasoning, and sound argumentation.
Nursing philosophies, such as Nightingale's, are considered to be a form of
philosophy in and of themselves. From these philosophies, theories can be derived,
such as those from Watson and Benner. Philosophies have been a key factor in the
growth of knowledge in Nursing, particularly in the realm of human sciences.

SCIENCE
Science, derived from the Latin word 'scientia', meaning "knowledge," can refer
to any type of systematic knowledge or practice in a field of study. In a more general
sense, science is a system of obtaining knowledge using the scientific method.
Additionally, it is the accumulated body of knowledge that has been acquired from
research.
The scientific method is composed of several steps:

1. Observation
 Combining of understanding and/or experience by a rational/thinking
individual.
Example: Carlo, a nurse-researcher, conducts an investigation into a
particular nursing phenomenon.

2. Gathering data

Gathering information and acknowledging information relevant to a specific

scientific inquiry or issue.
Example: Dave assists his colleague in accumulating information using a
variety of techniques.

3. Forming hypothesis

An effort to interpret or propose an understanding of a phenomenon.

Example: They both hypothesize, using their intelligence to try and
understand the phenomenon.

4. Experimental investigation

A series of tests conducted to answer the question posed by the hypothesis

statement.
Example: They carry out a survey and interview, then analyze the data using
statistics.

5. Conclusion or Theoretical explanation

This is an explanation of natural phenomena or a scientific inquiry based on

experimental research.
Example: After examining the results, they formed a conclusion. As further
information is made available, the research has been reassessed and
confirmed.

KNOWLEDGE
Knowledge can be viewed as:

 The knowledge, abilities and expertise that an individual has gained through
different life experiences, or through structured/unstructured learning,
including formal education, self-learning and vocational training.
 A concise comprehension of a topic or concept.
 What is recognized within a particular field of discipline or study.
 Gaining knowledge through experience of a fact or situation.
 No universally accepted system for categorizing knowledge exists.
 Knowledge acquirement involves several cognitive processes.

TYPES OF COGNITIVE PROCESS

PERCEPTION Gaining insight into sensory information.

ASSOCIATION Merging two or more concepts/ideas to create a fresh concept

or to make a comparison.

LEARNING Gaining knowledge, abilities, data, and principles.

REASONING The process of reasoning to arrive at a conclusion.

COMMUNICATIO Transmitting data from one party to another via various

N means of communication.

SOURCES OF KNOWLEDGE
Knowledge can be derived from a variety of sources that can be broken down into
three types: traditional, authoritative, and scientific.

 Traditional knowledge is a nursing practice that has been passed down

from one generation to the next. When asked why it is practiced this way,
the answer is often simply “It’s always been practiced this way.” An
example of traditional knowledge that has had an impact on nursing practice
is the routine changing of bed linens, even when they aren't soiled. This is
often seen in Intensive Care Unit (ICU) settings, even though there is no
research data to back it up. This practice is still adopted by hospitals as an
important part of providing quality patient care.
 Authoritative knowledge is one where a person of authority is considered
to be an expert in a particular subject and their knowledge is accepted
as true. An example of this could be seen in a clinical setting, where a nurse
supervisor with experience in a procedure is teaching a novice nurse how to
properly insert a urinary catheter. The novice nurse will accept the
knowledge as valid due to the authoritative figure, as long as the perceived
expertise is maintained.
 Scientific method is used to gain knowledge, such as the rationale behind
providing a Tepid Sponge Bath (TSB) to a patient with fever. This is an
example of the knowledge that is derived from scientific research, which is
tested and measured objectively. The underlying principle of this procedure
 is based on basic physics, demonstrating the importance of scientific
knowledge.

The three sources of knowledge are integral to the accumulation of knowledge that
characterizes the nursing profession. Nonetheless, each source has its own strengths
and weaknesses.

Types of TRADITIONAL and

Knowledge AUTHORITATIVE SCIENTIFIC

ADVANTAGES  Easy to implement.  Methodical and

precise.
 Theories
formulated by this
method are more
objective than
knowledge
acquired through
other means.

DISADVANTAGE  Based on subjective  It takes both time

S evidence. and effort to
generate
 This has a limited
trustworthy
application in many
outcomes.
different contexts.
 Evidence-based
practice and research
 Types of TRADITIONAL and
Knowledge AUTHORITATIVE SCIENTIFIC

are the primary

focus in nursing
practice, providing a
scientific basis for
decision-making.

PHENOMENON
A phenomenon can be described as the physical and observable responses of an
individual to their environment, which may include cries of pain and expressions of
distress. It involves the use of one's senses to observe and assess the behaviors and
influences that shape these behaviors.

In Nursing, phenomena can be:

 Clinical or environmental setting of nursing - health center.

 Disease process - a peptic ulcer.
 Client's behavior - monitoring activity around the area of injury.
 Interventions - providing care to a client in pain
 Practices - relevant to nursing theories and metaparadigms are four key
concepts: person, nursing, health, and environment.

KEY POINTS

 An event which can be seen or experienced is known as a phenomenon.

 Concepts are the foundational elements of theories which can be either

empirical or abstract.

 A conceptual model is based on an individual's perspective.

 A conceptual framework or model can also be referred to as a paradigm.

 The four key concepts in the metaparadigm of nursing are the person,
health, environment/situation, and nursing. These components are essential
for developing nursing theory.

 It is accepted that assumptions are taken to be true by theorists.

 Propositions express the connections between concepts, indicating how they
relate to one another.

 A statement that can be tested to determine if there is a relationship is

known as a hypothesis.

 The application of systematic techniques to investigate a subject and

generate an overall understanding is referred to as research.

 Induction involves drawing a general conclusion from particular pieces of

evidence or specific examples.

 Making deductions involves drawing general conclusions from specific

concepts.