Introduction to Nursing Theories

Arlene L. Galon, RN MAN

 Learning
Outcomes:
After 1.5 hours of lecture-discussion,
the level I students will be able to:
1. 1. Define related terms:
a. Philosophy
b. Theory
c. Concept
d. Conceptual Framework
e. Domain
f. Models
g. Propositions
h. Process
i. Paradigm
j. Metaparadigm

2. Describe Nursing Theories.

 Learning
Outcomes:
3. Trace the history of nursing
theories.
4. Discuss the components of the
metaparadigm for nursing.
5. Enumerate the components of
nursing theories
6. Identify the role of nursing theory
in nursing education, research
and clinical practice
7. Compare the different ways of
classifying nursing theories
a. By Abstraction
b. By Goal orientation
c. By Other ways.
8. Name commonly used non-
nursing theory.
 Defining Terms
• The development
of nursing theory
demands an
understanding of
selected
terminologies, def
initions, and
assumptions.
 Defining Terms:

• Philosophy. These are beliefs and values that define a way of

thinking and are generally known and understood by a group or
discipline.

• Theory. A belief, policy, or procedure proposed or followed as

the basis of action. It refers to a logical group of general
propositions used as principles of explanation. Theories are also
used to describe, predict, or control phenomena.
 Defining Terms:

Models. Models are

Concept. Concepts are often
called the building blocks of
theories. They are primarily the
vehicles of thought that involve
images.
representations of the interaction
among and between the
concepts showing patterns. They
present an overview of the
theory’s thinking and may
demonstrate how theory can be
introduced into mpractice

Conceptual framework. A
conceptual framework is a group
of related ideas, statements, or Proposition. Propositions are
statements that describe the
concepts. It is often relationship between
used interchangeably with the concepts.
the conceptual model and
with grand theories.

Domain. The domain is the

perspective or territory of a
profession or discipline.
 Defining Terms:

• Process. Processes are organized steps, changes, or functions

intended to bring about the desired result.
• Paradigm. A paradigm refers to a pattern of shared understanding
and assumptions about reality and the world, worldview, or widely
accepted value system; A model that
explains the linkages of science, philosophy, and theory accepted ad
applied by the discipline (Alligood and Marriner – Tomey, 2002)

• Metaparadigm. A metaparadigm is the most general statement of

discipline and functions as a framework in which the more restricted
structures of conceptual models develop. Much of the theoretical
work in nursing focused on articulating relationships among four
major concepts: person, environment, health, and nursing.
As a profession, nursing is involved in identifying its own
unique body of knowledge essential to nursing practice.

To identify this knowledge base, nurses must develop and

recognize concepts and theories specific to nursing.
 What is a theory?
• A set of concepts,
definitions, relationships,
and assumptions that
project a systematic view
of a phenomena
• It may consist of one or
more relatively specific
and concrete concepts
and propositions that
purport to account for, or
organize some
phenomenon (Barnum,
1988)
 What is a theory?
• A group of related
concepts that propose
actions that guide
practice.
• Systematic way of looking
at the world in order to
describe, explain, predict
and control it
What are
Nursing
Theories?
" Nursing, as a profession, is committed to
recognizing its own unparalleled body of
knowledge vital to nursing practice—nursing
science. To distinguish this foundation of
knowledge, nurses need to identify,
develop, and understand concepts and
theories in line with nursing. As a science,
nursing is based on the theory of what
nursing is, what nurses do, and why.
Nursing is a unique discipline and is
separate from medicine. It has its own body
of knowledge on which delivery of care is
based."
• Theory-guided, evidence-based practice
is the hallmark of any professional
discipline.
• Nursing is a professional discipline
(Donaldson & Crowley, 1978)
 History of Nursing Theories:

• In 1860, Florence Nightingale defined nursing in her

“Environmental Theory” as “the act of utilizing the patient’s
environment to assist him in his recovery.”
• In the 1950s, there is a consensus among nursing scholars that
nursing needed to validate itself through the production of its own
scientifically tested body of knowledge.
• In 1952, Hildegard Peplau introduced her Theory of Interpersonal
Relations that emphasizes the nurse-client relationship as the
foundation of nursing practice.
• In 1955, Virginia Henderson conceptualized the nurse’s role as
assisting sick or healthy individuals to gain independence in meeting
14 fundamental needs. Thus her Nursing Need Theory was
developed.
 History of Nursing Theories:

• In 1960, Faye Abdellah published her work “Typology of 21 Nursing

Problems,” which shifted the focus of nursing from a disease-centered
approach to a patient-centered approach.
• In 1962, Ida Jean Orlando emphasized the reciprocal relationship between
patient and nurse and viewed nursing’s professional function as finding out and
meeting the patient’s immediate need for help.
• In 1968, Dorothy Johnson pioneered the Behavioral System Model and
upheld the fostering of efficient and effective behavioral functioning in the
patient to prevent illness.
• In 1970, Martha Rogers viewed nursing as both a science and an art as it
provides a way to view the unitary human being, who is integral with the
universe.
• In 1960, Faye Abdellah published her work “Typology of 21
Nursing Problems,” which shifted the focus of nursing from a disease-centered
approach to a patient-centered approach.
 History of Nursing Theories:

• In 1962, Ida Jean Orlando emphasized the reciprocal relationship between

patient and nurse and viewed nursing’s professional function as finding out and
meeting the patient’s immediate need for help.
• In 1968, Dorothy Johnson pioneered the Behavioral System Model and
upheld the fostering of efficient and effective behavioral functioning in the
patient to prevent illness.
• In 1970, Martha Rogers viewed nursing as both a science and an art as it
provides a way to view the unitary human being, who is integral with the
universe.
• In 1971, Dorothea Orem stated in her theory that nursing care is required if
the client is unable to fulfill biological, psychological, developmental, or social
needs.
 History of Nursing Theories:

• In 1971, Imogene King‘s Theory of Goal attainment stated that the

nurse is considered part of the patient’s environment and the nurse-
patient relationship is for meeting goals towards good health.
• In 1972, Betty Neuman, in her theory, states that many needs exist,
and each may disrupt client balance or stability. Stress reduction is
the goal of the system model of nursing practice.
• In 1979, Sr. Callista Roy viewed the individual as a set of
interrelated systems that maintain the balance between these
various stimuli.
• In 1979, Jean Watson developed the philosophy of caring,
highlighted humanistic aspects of nursing as they intertwine with
scientific knowledge and nursing practice.
What is a
domain?
How does domain
relate to nursing
theory?
• Nursing has identified its
domain in a paradigm that
includes four linkages:
• 1) person/client
• 2) health
• 3) environment
• 4) nursing

We refer to this as Nursing

Metaparadigm
The Nursing Metaparadigm:

Four major concepts are frequently interrelated and

fundamental to nursing theory: person, environment,
health, and nursing.
 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.
 Environment

Environment (or situation) is

defined as the internal and
external surroundings 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.
 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.
 Nursing
The nurse’s attributes,
characteristics, and actions
provide 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.
What are the Components of Nursing Theories?

Phenomenon- A term given to describe an idea or response about an event,

a situation, a process, a group of events, or a group of situations.
Phenomena may be temporary or permanent. Nursing theories focus on the
phenomena of nursing.

Concepts
Interrelated concepts define a theory. Concepts are used to help describe or
label a phenomenon. They are words or phrases that identify, define, and
establish structure and boundaries for ideas generated about a particular
phenomenon. Concepts may be abstract or concrete.
• Abstract Concepts. Defined as mentally constructed independently of a
specific time or place.
• Concrete Concepts. Are directly experienced and related to a particular
time or place.
What are the Components of Nursing Theories?

Definitions
Definitions are used to convey the general meaning of the concepts of the
theory. Definitions can be theoretical or operational.
• Theoretical Definitions. Define a particular concept based on the
theorist’s perspective.
• Operational Definitions. States how concepts are measured.

Relational Statements
Relational statements define the relationships between two or more
concepts. They are the chains that link concepts to one another.

Assumptions
Assumptions are accepted as truths and are based on values and beliefs.
These statements explain the nature of concepts, definitions, purpose,
relationships, and structure of a theory.
 Role of Nursing
Theory
• Links among nursing theory,
education, research, and clinical
practice
• Contributes to knowledge
development
• May direct education, research, and
practice
In Education
• In 1970 s and 80 s, nursing
programs:
➢ Identified major
concepts
➢ Organized concepts into
conceptual framework
➢ Built curriculum around
framework
➢ Elucidated central
meanings of the
profession
➢ Improved status of the
profession
In Research
• Identifies philosophical
assumptions or conceptual
frameworks
• The development of theory is
fundamental to the research
process, where it is necessary
to use theory as a framework
to provide perspective and
guidance to the research
study.
• Theory can also be used to
guide the research process by
creating and testing
phenomena of interest.
• Midlevel (mid-range) theories
focus on the exploration of
concepts.
• Pain, self-esteem, and learning
In Clinical
Practice
• Primary contribution in reflecting,
questioning, and thinking about what
nurses do
• Evidence-Based Practice involves the
recognition of which knowledge is
appropriate for application to client
care. Practice theories, those
that describe the relationships
amongst variables as applied to
specific clinical situations (Theory of
postpartum depression), are important
contributors to Evidence-Based
Practice.
• Debates about the role of theory in
practice is evidence that nursing is
maturing both as academic discipline
and clinical profession.
 Simply put, Why are Nursing Theories
Important?
• Nursing theories help recognize what should set the foundation of
practice by explicitly describing nursing.
• By defining nursing, a nursing theory also helps nurses understand their
purpose and role in the healthcare setting.
• Theories serve as a rationale or scientific reasons for nursing
interventions and give nurses the knowledge base necessary for acting
and responding appropriately in nursing care situations.
• Nursing theories provide the foundations of nursing practice, generate
further knowledge, and indicate which direction nursing should develop in
the future (Brown, 1964).
• By providing nurses a sense of identity, nursing theory can help patients,
managers, and other healthcare professionals to acknowledge and
understand the unique contribution that nurses make to the healthcare
service (Draper, 1990)
 Simply put, Why are Nursing Theories
Important?
• Nursing theories prepare the nurses to reflect on the assumptions
and question the nursing values, thus further defining nursing and
increasing the knowledge base.
• Nursing theories aim to define, predict, and demonstrate nursing
phenomenon (Chinn and Jacobs, 1978).
• It can be regarded as an attempt by the nursing profession to
maintain and preserve its professional limits and boundaries.
• In many cases, nursing theories guide knowledge development and
directs education, research, and practice, although each influences
the others. (Fitzpatrick and Whall, 2005).
What are the purposes of
nursing theory?
• It guides nursing
practice and
generates knowledge
• It helps to describe or
explain nursing
• Enables nurses to
know WHY they are
doing WHAT they are
doing
Classification of
Nursing Theories
By Abstraction

There are three major categories when

classifying nursing theories based on
their level of abstraction: grand theory,
middle-range theory, and practice-level
theory.

I. Grand Nursing
Theories
II. Middle-Range
Nursing Theories
III. Practice-Level
Nursing Theories
By Abstraction

I. Grand Nursing Theories

• Grand theories are abstract, broad in scope,
and complex, therefore requiring further
research for clarification.
• Grand nursing theories do not guide specific
nursing interventions but rather provide a
general framework and nursing ideas.
• Grand nursing theorists develop their works
based on their own experiences and their
time, explaining why there is so much
variation among theories.
• Address the nursing metaparadigm
components of person, nursing, health, and
environment.

II. Middle-Range Nursing Theories

III. Practice-Level Nursing Theories
By Abstraction

I. Grand Nursing Theories

II. Middle-Range Nursing Theories
• More limited in scope (compared to grand
theories) and present concepts and
propositions at a lower level of abstraction.
They address a specific phenomenon in
nursing.
• Due to the difficulty of testing grand
theories, nursing scholars proposed using
this level of theory.
• Most middle-range theories are based on a
grand theorist’s works, but they can be
conceived from research, nursing practice,
or the theories of other disciplines.

III. Practice-Level Nursing Theories

By Abstraction

I. Grand Nursing Theories

II. Middle-Range Nursing Theories
III. Practice-Level Nursing Theories
• Practice nursing theories are situation-
specific theories that are narrow in scope
and focuses on a specific patient population
at a specific time.
• Practice-level nursing theories provide
frameworks for nursing interventions and
suggest outcomes or the effect of nursing
practice.
• Theories developed at this level have a
more direct effect on nursing practice than
more abstract theories.
• These theories are interrelated with
concepts from middle-range theories or
grand theories.
 Descriptive Theories
• Descriptive theories are the first level
of theory development. They describe
the phenomena and identify its
properties and components in which it
occurs.
By Goal • Descriptive theories are not action-
oriented or attempt to produce or
Orientation: change a situation.
• There are two types of descriptive
theories: factor-isolating
Descriptive theory and explanatory theory
➢ Factor Isolating Theory
or ✓ Also known as category-formulating or
labeling theory.
✓ Theories under this category describe the
Prescriptive properties and dimensions of phenomena.
➢ Explanatory Theory
✓ Explanatory theories describe and explain the nature
of relationships of certain phenomena to other
phenomena.
 Prescriptive Theories
• Address the nursing interventions for
By Goal a phenomenon, guide practice
change, and predict consequences.
Orientation: • Includes propositions that call for
change.
• In nursing, prescriptive theories are
Descriptive used to anticipate the outcomes of
or nursing interventions.

Prescriptive
Other Ways of Classifying Nursing Theories:

Afaf Ibrahim Meleis

Classification According to Meleis (2011), in her
book Theoretical Nursing:
Development and
Needs-Based Theories. The needs theorists were the first group of nurses Progress, organizes the
who thought of giving nursing care a conceptual order. Theories under this major nurse theories and
group are based on helping individuals to fulfill their physical and mental needs.
Theories of Orem, Henderson, and Abdella are categorized under this group. models using the
Need theories are criticized for relying too much on the medical model of health following headings:
and placing the patient in an overtly dependent position.
needs theories,
Interaction Theories. These theories emphasized nursing on the interaction theories, and
establishment and maintenance of relationships. They highlighted the impact of outcome theories. These
nursing on patients and how they interact with the environment, people, and
situations. Theories of King, Orlando, and Travelbee are grouped under this categories indicate the
category. basic philosophical
underpinnings of the
Outcome Theories. These theories describe the nurse as controlling and theories.
directing patient care using their knowledge of the human physiological and
behavioral systems. The nursing theories of Johnson, Levine, Rogers,
and Roy belong to this group.
Other Ways of Classifying Nursing Theories:
Classification According to Aligood
Nursing Philosophy: It is the most
abstract type and sets forth the
meaning of nursing phenomena
through analysis, reasoning, and
logical presentation. Works of
Nightingale, Watson, Ray, and Benner
are categorized under this group.
Grand Nursing Theories. Are works
derived from nursing philosophies,
conceptual models, and other grand
theories that are generally not as
specific as middle-range theories.
Works of Levine, Rogers, Orem, and
King are some of the theories under
this category.
Nursing Conceptual Models. These
are comprehensive nursing theories
that are regarded by some as
pioneers in nursing. These theories
address the nursing metaparadigm
and explain the relationship between
them. Conceptual models of Levine,
Rogers, Roy, King, and Orem are
under this group.
Middle-Range Theories. Are precise
and answer specific nursing practice
questions. They address the specifics
of nursing situations within the
model’s perspective or theory from
which they are derived. Examples of
Middle-Range theories are that of
Mercer, Reed, Mishel, and Barker.
“The study and use of
nursing theory in nursing
practice must have roots in
the everyday practice of
nurses (Gordon, Parker, and
Jester, 2001).
So how do nurses
use 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)
How do student
nurses begin to use
nursing theory?

• By asking yourself two very

important questions…..
 Student nurse questions

• What is the nature of • What does it mean to me

knowledge needed for the to practice nursing?
practice of nursing?
Nursing also
utilizes non-
nursing theories
Commonly Used
Non-Nursing
theories • Systems theory
• Basic Human Needs
theory
• Health and Wellness
Models
• Stress and
Adaptation
• Developmental
Theories
• Psychosocial
Theories
What is the link between nursing
theory and the research
process?
• Theory provides direction
for nursing research
• Relationships of
components in a theory
help to drive the research
questions for
understanding nursing
• Chinn and Kramer
(2004), indicate a spiral
relationship between the
two
Current trends that
influence nursing
theory
• Medical science
• Nursing education
• Professional nursing
organizations
• Evolving research
approaches
• Global concerns
• Consumer demands
• Technologies
 “ Practicing nurses who despise theory are
condemned to performing a series of tasks - either
at the command of a physician or in response to
routines and policies.”
Leah Curtin, RN, MS, FAAN (1989)
Former Editor, Nursing Management