Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur

College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingyc@yahoo.com
CP# 09177148749, 09175785986

THEORECTICAL FOUNDATION IN NURSING

Nursing theories are the creative products of nurses who seek (or sought) to thoughtfully
describe the many aspects of nursing in ways that could be studied, evaluated, and used by other nurses. In
other words, theory is an attempt to explain patterns and relationships found in nursing phenomena. Nurse
theorists are people who are or have been nurses, have thought deeply about how one might describe the
phenomenon of nursing, and then have tried in their own way, from their own perspective, to record their
thoughts and observations based on professional and personal experiences. Each theory is as unique as the
individual(s) who created it.

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MODULE DESCRIPTION NCM 100: THEORECTICAL FOUNDATION IN NURSING
This course introduces the student to the profession of nursing as a practice
discipline. Major worldviews influencing nursing practice will be addressed, with the
inclusion of both nursing and non-nursing theories. The central concepts of health,
person, environment, nursing, and caring will be explored. Theoretical emphasis will
be placed on theories related to the development of therapeutic relationships, modes
of effective communication, and nursing therapeutics.
The student will study theory and its utility as the basis for professional nursing practice.
Related issues, such as the history of nursing theory development and its influence on the development of
nursing knowledge, will also be addressed. The major paradigms influencing current nursing practice will
be studied. The merits of the use of a theoretical framework to direct the processes of assessment, clinical
judgment, systematic care planning and evaluation will be explored.

______________________________________________________________________________
COURSE LEARNING OUTCOMES
At the end of the first year, given stimulated situations in selected settings, the
learners demonstrate basic nursing skills in rendering safe and appropriate care
utilizing the nursing process.
1. Apply knowledge of nursing and related theories in the practice of nursing.
2. Apply guidelines and principles of evidence- based practice in the application of nursing and related
theories.
3. Communicate effectively in speaking, writing, and presenting using appropriate nursing theories.
4. Work effectively in collaboration with inter-, intra-, and multi- disciplinary and multi- cultural teams in
relation to nursing theories.
5. Explain management and leadership concepts and principles in selected theories.
6. Engage in lifelong learning with a passion to keep current with national and global development in
general and nursing and other relevant theories in particular.
7. Demonstrate responsible citizenship and pride in being a Filipino.
8. Apply techno- intelligent care system and processes in understanding nursing theories.
9. Adopt the nursing core values in the application of the nursing theories.
____________________________________________________________________________

Pretest will be conducted in the Google Classroom

TOPIC 1: INTRODUCTION TO NURSING THEORIES

What is a theory?
Ø Helps us to organize our thoughts and ideas.
Ø A set of concepts, definitions, relationships, and assumptions that project a
systematic view of phenomena.
Ø It may consist of one or more relatively specific and more concrete concepts and
propositions that purport to account for, or organize some phenomenon (Barnum, 1988)
Ø Theory gives planners tools for moving beyond intuition to design and evaluate health
behavior and health promotion interventions based on understanding of behavior (Robert
T. Croyle (2005).

What are the components of a theory?

1. Concepts – ideas and mental images that help describe phenomena (Alligood and Marriner-
Tomey, 2002). Building blocks of a theory.
Types:
a. Empirical concepts- Knowledge derived from investigation, observation,
experimentation, or experience (e.g. justice, beauty, truth)
b. Inferential concepts- indirectly observable concepts (e.g. pain, dyspnea, temperature)
c. Abstract concepts- concepts that are not clearly observable directly and indirectly; aka
non- observable concepts (e.g. social support, personal role, and self- esteem)
2. Definitions - convey the general meaning of the concepts
3. Assumptions – statements that describe concepts.
4. Phenomenon – aspect of reality that can be consciously sensed or experienced (Meleis, 1997).
5. Propositions- describe the relationship or connection that exist among the concepts of the
theory. A statement that proposes a relationship between concepts, and represents the theorists
view of which concepts fit together.
What is a Paradigm?
A model that explains the linkages of science, philosophy, and theory accepted and applied
by the discipline (Alligood and Marriner – Tomey, 2002)
 What is a metaparadigm? - The most global perspective of a discipline and acts as
“encapsulating unit” or framework within which the more restricted structures develop.

What is a domain? - The view or perspective of the discipline. It contains the subject,
central concepts, values and beliefs, phenomena of interest, and the central problems of
the discipline

How does domain relate to nursing theory?

- Nursing has identified its domain in a paradigm that includes four linkages:
1). person/client – the one receiving nursing care
2). health- the part of the health-illness continuum where the person is at the
time of interaction
3). environment – place where the person exists
4). nursing – nursing actions

Types of Nursing Theories

Grand theories: broad and complex
Middle range theories: address specific phenomena and reflect practice
Descriptive theories: 1st level of theory development
Prescriptive theories: address nursing interventions and predict their consequences.

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 So how do nurses use theory in everyday practice?
• Organize, understand and analyze patient data
• Make decisions about nursing interventions
• Plan patient care
• Predict outcomes of care
• Evaluate patient outcome
(Alligood, 2001)

How do student nurses begin to use nursing theory?

By asking yourself two very important questions
ü What is the nature of knowledge needed for the practice of
nursing?
ü What does it mean to me to practice nursing?

Nice to
Nursing also utilizes non- nursing theories---- TLC
KNOW

Importance of nursing theories:

• Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn
and Jacobs1978).
• It should provide the foundations of nursing practice, help to generate further knowledge
and indicate in which direction nursing should develop in the future (Brown 1964).
• Theory is important because it helps us to decide what we know and what we need to
know (Parsons1949).
• It helps to distinguish what should form the basis of practice by explicitly describing
nursing.
• The benefits of having a defined body of theory in nursing include better patient care,
enhanced professional status for nurses, improved communication between nurses, and
guidance for research and education (Nolan 1996).
• The main exponent of nursing – caring – cannot be measured, it is vital to have the theory
to analyze and explain what nurses do.
• As medicine tries to make a move towards adopting a more multidisciplinary approach to
health care, nursing continues to strive to establish a unique body of knowledge.
• This can be seen as an attempt by the nursing profession to maintain its professional
boundaries.
The characteristics of theories:
Theories are:
• Interrelating concepts in such a way as to create a different way of looking at a particular
phenomenon.
• Logical in nature.
• Generalizable.
• Bases for hypotheses that can be tested.
• Increasing the general body of knowledge within the discipline through the research
implemented to validate them.
• Used by the practitioners to guide and improve their practice.
• Consistent with other validated theories, laws, and principles but will leave open
unanswered questions that need to be investigated.

Basic processes in the development of nursing theories

Nursing theories are often based on & influenced by broadly applicable processes & theories.
Following theories are basic to many nursing concepts.
General System Theory

ü It describes how to break whole things into parts & then to learn how the parts work
together in “systems”. These concepts may be applied to different kinds of systems, e.g.
Molecules in chemistry, cultures in sociology, and organs in Anatomy & Health in
Nursing.
Adaptation Theory
ü It defines adaptation as the adjustment of living matter to other living things & to
environmental conditions.
ü Adaptation is a continuously occurring process that effects change & involves interaction
& response.
ü Human adaptation occurs on three levels: The internal ( self); the social ( others) and The
physical( biochemical reactions)
Developmental Theory
ü It outlines the process of growth & development of humans as orderly & predictable,
beginning with conception & ending with death.
ü The progress & behaviors of an individual within each stage are unique.
ü The growth & development of an individual are influenced by heredity, temperament,
emotional, & physical environment, life experiences & health status.

Common concepts in nursing theories

Four concepts common in nursing theory that influence & determine nursing practice are:
ü The person (patient).
ü The environment
ü Health
ü Nursing (goals, roles, functions)
 ü Each of these concepts is usually defined & described by a nursing theorist, often
uniquely; although these concepts are common to all nursing theories. Of the four
concepts, the most important is that of the person. The focus of nursing, regardless of
definition or theory, is the person.

Classification of nursing theories:

A. Depending On Function (Polit et al 2001)

1. Descriptive-to identify the properties and workings of a discipline
2. Explanatory-to examine how properties relate and thus affect the discipline
3. Predictive-to calculate relationships between properties and how they occur
4. Prescriptive -to identify under which conditions relationships occur
B. Depending on the Generalizability of their principles
1. Metatheory: the theory of theory. Identifies specific phenomena through abstract
concepts.
2. Grand theory: provides a conceptual framework under which the key concepts represents
an extremely complex phenomena.
C. Principles of the discipline can be identified.
1. Middle range theory: is more precise and only analyses a particular situation with a
limited number of variables.
2. Practice theory: explores one particular situation found in nursing. It identifies explicit
goals and details how these goals will be achieved.
D. Based on the philosophical underpinnings of the theories
1. “Needs “theories.
2. “Interaction” theories.
3. “Outcome “theories.
4. Humanistic theories.

1. “Needs” theories
These theories are based around helping individuals to fulfill their physical and mental
needs. Needs theories have been criticized for relying too much on the medical model of health
and placing the patient in an overtly dependent position
2. “Interaction” theories
As described by Peplau (1988), these theories revolve around the relationships nurses
form with patients. Such theories have been criticized for largely ignoring the medical model of
health and not attending to basic physical needs.
3. “Outcome” theories"
Outcome theories portray the nurse as the changing force, who enables individuals to
adapt to or cope with ill health. Outcome theories have been criticized as too abstract and
difficult to implement in practice.
4. “Humanistic” Theories
Humanistic theories developed in response to the psychoanalytic thought that a
person’s destiny was determined early in life. Humanistic theories emphasize a person’s capacity
for self-actualization. Humanists believe that the person contains within himself the potential for
healthy & creative growth.
 Carl Rogers developed a person –centered model of psychotherapy that emphasizes the
uniqueness of the individual.
The major contribution that Rogers added to nursing practice is the understandings that
each client is a unique individual, so, person-centered approach now practice in nursing.

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.

Historical Overview: Theory Development in Nursing

Significant Events:
Where do I begin?
Florence Nightingale
Ø Considered 1st modern nursing theorist
Ø 1st one to delineate what is considered the nursing goal and the practice domain
Ø “ placing the client in the best condition for nature to act upon him”
Ø Taught about symptoms and what they indicate, rationale for actions and trained powers
of observation and reflection
• Nightingale until the 50’s
• Florence Nightingale Notes on Nursing control of the environment to care for the
individual ( ventilation, light, warm, noise absence or reduction, cleanliness &
diet)
ü 1952 Nursing Research Journal Publication; many nursing theories have
been systematically developed to help describe, explain, and predict
phenomena of concern in nursing
ü 1960’s nature of nursing practice was debated, defined nursing practice, or
develop nursing theory, and created a substantive body of knowledge.
• 1960-1970 proliferation of conceptual models and frameworks, and philosophy of
nursing. (examples: Abdellah 21 nursing problems and Hall’s Core, care and cure
– person, body, disease
• 1969 1st conference on nursing theory
ü Role of nurses were questioned; what they do, for whom, where and when
were determined.
ü Purpose of nursing, process of theory development was discussed
ü Brought leading scholars and theorists to discuss and debate on issues
regarding nursing science and theory development.
• 1980’s characterized by acceptance of the significance of theory in nursing. Less
debates on whether or not to use theory, practice theory or borrowed ones. More
and more publication up to the present.

Stages of Theory Development (Kidd and Morrison, 2004)

1. Silent knowledge stage
- Blind obedience to medical authority
- Training schools were hospital based, emphasis on carrying out physician’s orders and few
books, depended on physician’s diagnosis, exploited as workers and as students.
- persisted for more than 80 years
2. Received knowledge stage
- Learning through listening to others
- Nursing now challenged to be in the university as opposed to apprenticeship that happens to
most hospital programs
- Nurses acquired non nursing degrees relying on the authority of educators, sociologist,
psychologist, physiologists and anthropologist to provide answers to nursing problems.
3. Subjective knowledge stage
- Authority was internalized and a new sense of self emerged
- Negative attitude toward borrowed sciences or theories
- Defining on nursing and developing theories about and for nursing
- Researched focused on the nurse rather on the clients and clinical situation
4. Procedural knowledge stage
- Includes both separate and connected knowledge
- Proliferation of approaches to theory development applying theory in practice was frequently
underemphasized
- Emphasis was on procedures used to acquire knowledge (methodology, statistical procedures)
5. Constructed knowledge
- Integration of different types of knowledge (intuition, reason and self- knowledge)
- Nursing theory based on empirical studies, theoretical literature client reports, clinical
experiences and nurses scholar intuition.

Florence Nightingale’s Influence on Knowledge Development in Nursing

§ Described nursing as both an art and a science.
§ Stressed the importance of caring for the ill person rather than the illness
§ Viewed person’s health as the direct result of environmental influences (cleanliness,
light, pure air, pure water, efficient drainage.
§ The turn of the 20th century marked the beginning of hospital based schools of nursing.
§ Nightingales principles were incorporated into modern nursing theory.

Knowledge Development in Nursing

§ Paradigm- particular viewpoint/perspective
§ Metaparadigmn- major concepts in a discipline that names the phenomena of concern
§ Metaparadigm in Nursing- person, health, environment, nursing
§ Two individuals with different paradigmatic views can look at the same phenomenon and
view the phenomenon differently.
§ A paradigm shift refers to the acceptance of the competing paradigm or a shifting away
from one worldview toward another worldview
§ Members of discipline cannot subscribe to two competing paradigms at the same time
§ Four levels of Knowing/Nursing knowledge ( Carper, 1978)
- According to Chinn and Kramer (1995)
- Knowing refers to the individual human processes of experiencing and
comprehending the self and the world in ways that can be brought to some level of
conscious awareness
 - Knowledge, in contrast, is defined as knowing that can be shared or communicated
with others.
Ø Empirical – the science of nursing
Ø Aesthetic- the art of nursing
Ø Personal- intra and interpersonal nature of nursing
Ø Ethical- the moral component of nursing
Philosophies of knowledge
There are three dominant philosophical views on how knowledge develops.
ü Rationalism: “reason” emphasizes that reason play in the development of knowledge
and the discovery of truth.
ü Empiricism: believes that knowledge is derived entirely from sensory experience.
ü Historicism: recognizes that we are all influenced by our history and the experiences,
values and beliefs we acquired.

Significance of theory for nursing as a discipline

Discipline is specific to academia and a branch of education, a department of learning or field/
domain of knowledge.
Profession refers to specialized field of practice, which is founded upon the theoretical structure
of the science or knowledge of that discipline and the accompanying practice abilities.
1. University baccalaureate programs proliferated, masters programs in nursing were developed,
and the curricula began to be standardized through the accreditation process.
2. Attention to the importance of nursing conceptualizations for the research process and the role
of a conceptual framework in the purpose and design of research production of science and
nursing theoretical works also began to publish.
3. Works began to be recognize for their theoretical nature, such as Henderson, Nightingale and
etc.
4. New nursing doctoral programs were beginning to open and they reopened the discussion of
the nature of nursing science. This becomes the first classic reference for nursing as discipline
and for distinguishing between the discipline and profession.
5. Fawcett’s conceptualization of metaparadigm of nursing and unifying conceptual-theoretical
structure of knowledge recognize works of major nursing theorist as conceptual framework and
paradigms of nursing.
6. MAJOR SIGNIFICANCE IS--THE DISCIPLINE IS DEPENDENT UPON THEORY
• 6.1. Theoretical works have taken nursing to a higher level.
• 6.2. The emphasis has shifted from a focus on knowledge about how nurses function,
which concentrated on the nursing process, to focus on what nurses know and how they
use knowledge to guide their thinking and decision making while concentrating on the
patient
• Nursing is recognize as a profession today ( Bixer and Bixler AJN 1959)
ü Utilizes in its practice a well-defined and well-organized body of specialized knowledge
that is on the intellectual level of the higher learning.
ü Constantly enlarges the body of knowledge it uses and improves its techniques of
education and service by the use of the scientific method.
ü Entrusts the education of its practitioners to institution of higher education.
ü Applies its body of knowledge in practical services that are vital to human and social
welfare.
ü Functions autonomously in the formulation of professional policy and in the control of
professional activity thereby.
ü Attracts individuals of intellectual and personal qualities who exalt service above
personal gain and who recognizes their chosen occupation as a life work.
ü Strives to compensate its practitioners by providing freedom of action, opportunity for
continuous professional growth and economic security.

KEYPOINTS:

• Theory and practice are related.

• A theory presents a systematic way of understanding events or
situations.
• It is a set of concepts, definitions, and propositions that explain or
predict these events or situations by illustrating the relationships between variables.
• Theories must be applicable to a broad variety of situations. They are, by nature, abstract,
and don’t have a specified content or topic area. Like empty coffee cups, theories have
shapes and boundaries, but nothing inside. They become useful when filled with practical
topics, goals, and problems. [Robert T. Croyle (2005)].
• The study and use of nursing theory in nursing practice must have roots in the everyday
practice of nurses (Gordon, Parker, and Jester, 2001).
• 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, FAAN1989, Former Editor, Nursing Management.
• Nursing is always in a state of change.
• Nursing knowledge continues to expand in a multiplicity of ways
• New theories will come from a global perspective and international nursing leaders in the
21st century.
• Nursing theoretical works represents the most comprehensive ideas and systematic
knowledge about nursing; therefore theory is vital to both the discipline and the
profession.

A link will be sent by the Instructor

 Activity:
1. Kindly give an examples of each type of theories (5 points)
2. Recall some of the commonly used non nursing theories. (5 points)
3. Distinguish and provide examples of each levels of knowing in
nursing (20 points)
4. Explain and illustrate the relationship between nursing research, nursing theory and nursing
practice. (20 points)
Note: Answers should be succinct.

References:

1. Robert T. Croyle (2005). Theory at a Glance: Application to Health Promotion and

Health Behavior (Second Edition). U.S. Department of Health and Human Services,
National Institutes of Health.
2. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed.
Norwalk, Appleton & Lange.
3. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia.
Lippincott Williams& wilkins.
4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed.
Philadelphia, Lippincott.
5. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed.
Philadelphia, Lippincott.
6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process &
Practice 3rd ed. London Mosby Year Book.
7. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories
to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15

Reflection:
- Appraise/Evaluate the Significance of Metaparadigmn in
nursing
- Title of the Activity: One Page Paper on Nursing
Metaparadigm
- Double space, New Times Roman, Font size 12
- Consist of 3 paragraphs ( intro, body and conclusion)
- Please provide reference at least 2
- Rubrics:
Content – 60%
Relevance – 30%
Timeliness – 10%