THEORY

► ‘What is nursing knowledge?’

► This is a complex question, the answer
to which helps define nurses as a
profession.
► It is also difficult to answer because
nursing is dynamic, evolving and a
relatively new profession.
► However, as knowledge is central to the
issue of professional accountability it is
vital to attempt to answer the question.
 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. Knowledge is basically
what classifies us as a profession because
having a ‘unique body of knowledge’ is one
of the things that defines a profession in
society.
► For individual nurses today there are practical
reasons for identifying nursing knowledge.
With increasing accountability there is a
growing expectation that nurses explore their
profession’s beliefs, discarding those without
merit and consequently developing adequate
knowledge to care for their patients in a
competent manner. Nursing knowledge will,
for example, enable them to justify actions or
indeed stop unsafe or poor practices. Nursing
knowledge can literally mean the difference
between life and death for some patients.
► In terms of practice, all suitable
knowledge should be incorporated
appropriately into care. A vital part of this
is that nurses evaluate what they are told
or what they read or observe in practice.
It is crucial that they question practices
and do not undertake care for which they
do not understand the rationale.
► Most nurses should now understand the
implications of professional accountability.
This is a responsibility, yet part of the
richness and the reward of nursing
originates in the need for the wide variety
of knowledge required in order to provide
excellent care. There is the added
challenge of the need for continuous
professional development as nursing
knowledge is constantly evolving.
 Knowledge in practice
► Describing nursing knowledge is a complex
exercise partly because, as Benner (1984)
identified, it is often ‘embedded in practice’.
► Certainly from experience of practice it is clear
that the culture and accepted practices and beliefs
of nursing in practice play a profound role in
shaping what nurses describe as knowledge and in
the way knowledge is disseminated. In order to
educate nurses and to establish and maintain
ourselves as a profession we must try to identify
what nursing knowledge is and express this. In
doing this it is important not to confuse opinion
and beliefs with nursing knowledge.
 Practical versus theoretical
► There is a conflict for nurses between this
practical experiential knowledge (practice
knowledge) and propositional knowledge
(theoretical knowledge). This clear
distinction between the two main types of
knowledge is often referred to as the
‘know-how’ and the ‘know that’ (Ryle,
1947).
► ‘Know-how’ knowledge is often gained
through personal experience. It is usually
not articulated but is learnt during
practice, which equates with the art of
nursing.

► ‘Know that’ is knowledge that usually

comes from theory and research. It is
generally more easily communicated
verbally and could be described as the
science of nursing.
 THEORY
► What is a theory?
- An organized system of accepted
knowledge that is composed of:
a. concepts
b. propositions
c. definitions
d. assumptions
intended to explain a set of fact, event or
phenomena
► A creative and rigorous structuring of
ideas that projects a tentative,
purposeful and systematic view of
phenomena (Chin and Kramer)
- 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. (Power and
Knapp, 1995)
- These systematic organized perspective
serve as guides for nursing action in
administration, education, research, and
- An expectation of what should happen,
barring unforeseen circumstances.
- An explanation for some phenomena
that is based on observation,
experimentation and reasoning.
- A comprehensive of a given set of data
that has been repeatedly confirmed by
observation and experimentation and has
gained general acceptance within the
scientific community but has not been yet
decisively proven.
Characteristics of a theory
1. Interrelating concepts in such a way as to
create a different way of looking at a
particular phenomenon.
2. Logical in nature
3. Generalizable
4. Basis for hypothesis that can be tested
5. Increasing the general body of knowledge
within the discipline through the research
implemented to validate them
6. Used by practitioners to guide and
improve their practice
7. Consistent with other validated
theories, laws, and principles but will
leave open unanswered questions that
need to be investigated.
What is the difference between the
conceptual and the theoretical framework?
► CONCEPTUAL ► THEORETICAL
FRAMEWORK FRAMEWORK
⬥ A conceptual framework is ⬥ Theoretical framework,
the researcher’s idea on how which lies on a much broader
the research problem will scale of resolution.
have to be explored.
⬥ Theoretical framework dwells
⬥ Conceptual framework, on on time tested theories that
the other hand, embodies the
specific direction by which embody the findings of
the research will have to be numerous investigations on
undertaken. how phenomena occur.
⬥ Statistically speaking, the ⬥ Theoretical framework
conceptual framework provides a general
describes the relationship representation of
between specific variables relationships between
identified in the study. things in a given
⬥ It also outlines the input, phenomenon.
process and output of the
whole investigation.
⬥ The conceptual
framework is also called
the research paradigm.
THEORETICAL FRAMEWORK – Proposed by
Lydia Hall, a nurse Theorist

The Person
Social Sciences
Therapeutic use of self
“The Core”

The Disease
Pathological and
The Body Therapeutic Sciences
Natural and Biological Seeing the patient and
family through the
Sciences medical care
Intimate bodily care
“The Cure”
“The Care”
Conceptual Framework

FOOD TASTE

SPEED OF COSTOMER
SERVICE SATISFACTION

STAFF
PERFORMANCE
 Physical Lowered
PERSON Fitness Blood
Exercises Pressure
Looking at this set of pictures, what theme do
you think all the pictures have in common?
What about this set of pictures?
What theme does exactly you could
describe?
 THEORY
► A. CONCEPT
A mental idea of a phenomenon.
A comprehensive idea or generalization.
A unit of thought.
A general idea formed in the mine
Something understood or retained in the mind,
from experience, reasoning, and/or imagination;
generalization or abstraction of a particular set of
instances or occurrences.
Types of Concepts
1. Abstract Concepts
a. Are directly observed or intangible.
b. It is independent of time and place.
Examples;
LOVE CARE FREEDOM HAPPINESS
EDUCATION SELF EXPRESSION
PEACE OF MIND and etc….
Types of Concepts

2. Concrete Concept
a. Are directly observed and tangible
b. Refers to a physical object in the
real world,
c. objects or events that are available to
the senses
Examples:
MOTHER NURSE ENGINEER BOOK PEN
PAPER and etc…..
Ex. 1: Take love as an example. You've heard
and used that word since you were three or
four years old. Does it mean to you now, what
it meant to you when you were five? when
you were ten? when you were fourteen (!)?
I'm sure you'll share my certainty that the
word changes meaning when we marry, when
we divorce, when we have children, when we
look back at lost parents or spouses or
children. The word stays the same, but the
meaning keeps changing.
► If you ask me what I mean by the word
spoon, I can pick up a spoon and show
it to you. Can you see the spoon I’m
holding.

► I can't pick up a freedom and show it to

you
► B. PROPOSITION
- are statements that describe the relationship
between the concepts.
- Explains the relationship of different concepts.
e.g. Children who do not want to stay in the hospital
because of their fear of injections.
- Is a declarative sentence that is either true or
false.
e.g. 1. The grass is green; The Moon is green
2. 1 + 0 = 1; 0 + 0 =2
The first proposition has the truth value of "true" and the
second "false".
► C. DEFINITION
Is composed of various descriptions which
convey a general meaning and reduces the
vagueness in understanding a set of concepts.
e.g. Interpersonal systems – is defined as two or
more individuals in interaction.
Social Systems – is defined as large groups
with common interest or goals.
Personal system as individuals; that
individuals are open, total, unique system in
constant interaction with the environment.
► D. ASSUMPTION
Assumptions are accepted as truths and are based on
values and beliefs. These are statements that explain
the nature of concepts, definitions, purpose,
relationships, and structure of a theory.
e.g. That all patients who are not able to take good care of
themselves need nurses.
People are aware of the experiences that most affect
their life choices.
People in underserved areas feel underserved.
► ASSUMPTIONS
Assumptions about people and nursing
Nursing exists to serve people.
It is the direct and overriding responsibility to
the society.
The safe practice of nursing depends on the
nature and amount of scientific nursing
knowledge the individual brings to practice.
People need knowledgeable nursing.
 Assumptions of Martha Rogers - The Science of
Unitary Human Beings
1. Human being is considered as whole which cannot be viewed as
subparts.
2. The life process of human is irreparable and one way
i.e. from birth to death.
3. Health and illness are the continuous expression of the life
process.
4. The energy flows freely between the individual and environment.
5. Human being possesses the ability to think, imagine, sense, feel,
and can use language for expression.
6. Human beings have the ability to adapt according to the new
changes in the environment.
 Is any important fact presumed to be true
but not actually verified (Gay, 1976). It does
not need testing, unlike the hypothesis.
e.g. That the interviewee answered the
interview questions accurately

That the respondents rated some

situation truthfully.
► E. PHENOMENON
Is an aspect of reality that can be
consciously sensed or experienced.
Nursing theories focus on the phenomena of
nursing and nursing care.
e.g. caring, self-care, and client responses
to stress.
As a sets of empirical data or experiences that
can be physically observed or tangible.
e.g. crying or grimace when in pain
In nursing phenomena can be:
o Clinical or environmental setting of nursing
– Health center; etc.
o Disease process – stomach ulcer; and more
o Client’s behavior – guarding behavior at the
pain site
o Interventions – care of the client in pain
► F. Models
❖ Representations of the interaction
among and between the concepts
showing patterns.
❖ The terms ‘model’ and ‘theory’ are often
wrongly used interchangeably, which
further confounds matters.
❖ In nursing, models are often designed by
theory authors to depict the beliefs in
their theory (Lancaster and Lancaster
1981).
► Con’t F. Models
❖ They provide an overview of the thinking
behind the theory and may demonstrate how
theory can be introduced into practice, for
example, through specific methods of
assessment.

❖ Models are useful as they allow the concepts

in nursing theory to be successfully applied
to nursing practice (Lancaster and Lancaster
1981). Their main limitation is that they are
only as accurate or useful as the underlying
theory.
Types of theories
► 1. Metatheories.
Are theories whose subject matters are
some other theories. These are theories
about theories.
► 2. Grand theories
Are broad in scope and complex and
therefore require a further specification
through research before they can be fully
tested. (Chinn and Kramer,1999)
► 3. Middle-Range Theories
Have more limited scope, less abstraction,
address specific phenomena or concepts and
reflects practice (administration, clinical or
teaching).
The phenomena or concepts tend to cross
different nursing fields, and reflect a wide
variety of nursing care situations,
e.g. quality of life, uncertainty in illness,
social support, incontinence, caring.
► 4. Descriptive Theories
They describe the phenomena, speculate on
why phenomena occur, and describe the
consequences of phenomena. This theory help
explains patient assessments.
► 5. Prescriptive Theories
Address nursing interventions and predict
the consequence of a specific nursing
intervention and carried out.
Are action oriented, which test the validity
and predictability, of nursing intervention.
 WHAT IS NURSING THEORY
► Is a group of interrelated concepts that are
developed from various studies of discipline and
related experiences.
► A body of knowledge that describes or explains
nursing and is used to support nursing practice.
► Is a set of concepts, definitions, relationships, and
assumptions or propositions derived from nursing
models or from other disciplines and project a
purposive systematic view of phenomena
Uses theory in everyday practice:
► Organize patient data
► Understand patient data
► Analyze patient data
► Make decisions about nursing interventions
► Plan patient care
► Predict outcomes of care
► Evaluate patient outcomes (Alligood, 2001)
Purposes of Theories
A. In Practice
► Assist nurses to describe, explain, and
predict everyday experience.
► Serve to guide assessment, intervention,
and evaluation of nursing care.
► Provide a rationale for collecting reliable
and valid data about the health status of
clients, which are essential for effective
decision making and implementation.
► Help to establish criteria to measure the
quality of care.
► Help build a common nursing terminology to
use in communicating with other health
professionals. Idea are developed and well
defined.
► Enhance autonomy (independence and
self-governance) of nursing by defining its
own independent functions.
B. In Education
► Provide general focus for curriculum design.
► Guide curricular decision making
C. In Research
► Offer a framework for generating knowledge and
new ideas.
► Assist in discovering knowledge gaps in specific
field of study.
► Offer a systematic approach to identify
questions for study, select variables, interpret
findings and validate nursing interventions.
What is paradigm?

► Paradigm: refers to a pattern of

shared understandings and
assumptions about reality and the
world.
Nursing Meta-paradigm

► Nursing has identified its domain in a

paradigm that includes four linkages:
also known as Nursing Meta-paradigm
1) person/client
2) health
3) environment
4) nursing
► 1. Person
Person (also referred to as Client or Human Beings)
is the recipient of nursing care and may include
individuals, patients, groups, families, and communities.

► 2. Environment
Environment (or situation) is defined as the internal
and external surrounds that affect the client. It includes
all positive or negative conditions that affect the
patient, the physical environment, such as families,
friends, and significant others, and the setting for where
they go for their healthcare.
► 3. Health
Health is defined as the degree of wellness or
well-being that the client experiences. It may have
different meanings for each patient, the clinical
setting, and the health care provider.

► 4. Nursing
The attributes, characteristics, and actions of the
nurse providing care on behalf of or in conjunction
with, the client. There are numerous definitions of
nursing, though nursing scholars may have difficulty
agreeing on its exact definition, the ultimate goal of
nursing theories is to improve patient care.
 You’ll find that these four concepts are used
frequently and defined differently throughout
different nursing theories. Each nurse theorist’s
definition varies in accordance with their
orientation, nursing experience, and different
factors that affect the theorist’s view of nursing.
The person is the main focus but how each
theorist defines the nursing metaparadigm gives
a unique take specific to a particular theory. To
give you an example, below are the different
definitions of various theorists on the nursing
metaparadigm: