Theories of Nursing Practice

Theories of
Nursing Practice
By Esther Chauluka
LEARNING OUTCOMES:
Define the following terms:
Concept
Models
Propositions
Theory
Discuss how a theory is created

Explain the classification of Nursing Theories
Describe the characteristics of Nursing
Theories
Describe the importance of Nursing Theories
Daeyang University- 2016 Intake 28/09
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 are the components of a

theory?
Concepts ideas and mental
images that help to describe
phenomena (Alligood and
Marriner-Tomey, 2002)
Definitions convey the
general meaning of the
concepts
Assumptions statements
that describe concepts
Phenomenon aspect of
reality that can be consciously
sensed or experienced
(Meleis, 1997).
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 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
2) health
3) environment
4) nursing
Types of nursing theories

Grand theories broad
and complex
Middle-range theoriesaddress specific
phenomena and reflect
practice
Descriptive theories
first level of theory
development
Prescriptive theories
address nursing
interventions and predict
their consequences
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)
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
Objectives
Some commonalities
Purpose
Concepts
Definitions
Propositions
Structured ideas
Tentative
Describe a phenomenon or occurrence
Components/Elements of
theory
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theory
theory
Characteristics of a Theory
1. Systematic, logical and coherent
(orderly reasoning,no contradictions)
2. Creative structuring of ideas
mental images of ones experiences and
create different ways of looking at a particular
event or object.
3. Tentative in nature ( change over time or
evolving but some remain valid despite
passage of time)
How does a theory develop?
How does a theory develop?

3. Research theory or inductive method
Must evolve from research findings or
empirical evidence.
4. Theory research
theories developed by other disciplines are
utilized but given unique nursing
perspective. Original theory examined and
given a new research findings.
TERMINOLOGY
METAPARADIGM
- Most abstract level of knowledge. In
nursing this is main concepts that
encompasses the subject matter and the
scope of the discipline
- Central concepts of person, environment,
health and nursing
TERMINOLOGY
Philosophy
- Knowledge level which specifies the
definitions of the metaparadigm concepts
in each of the conceptual models of
nursing.
- Nightingale is considered philosophical
approach
- Out of these philosophies theory maybe
formalized
Conceptual models
Frameworks or paradigms that provide a
broad frame of reference for the
systematic approaches to the
phenomena with which the discipline is
concerned.
-different views nursing like Roy focuses
on adaptation, King on interaction and
Abdellah on interventions
theory
Group of related concepts

that propose actions that
guide practice
Nursing theory
Group of related concepts that derived

from the nursing models. Some derive
from other nursing discipline like
LEininger which comes from anthropology
Uses of theory
1. Theory guides and improve nursing
practice
Theory provides goal for nursing care
and with goals, nursing practice is
rendered more effective and efficient.
theories help to focus the goals, making
nurses more confident about the
practice.
Uses of theory
2. Theory guides research
according to Meleis, primary use of
theory is to guide research. It validates
and modifies the theory.
3. Theory contributes to the development
of the disciplines body of knowledge
4. Theory enhances communication
Theory Development
in Nursing: Historical
Overview
Where do I begin?
Florence Nightingale
- Considered first modern nursing theorist
- First one to delineate what is considered the
nursing goal and practice domain.
- placing the client in the best condition for
nature to act upon him
- Taught about symptoms and what they
indicate, rationale for actions and trained
powers of observation and reflection
Historical Development of
Nursing Theories: Significant
Events
Nightingale until the 50s
Florence Nightingale Notes on Nursing

control of the environment to care for the individual
(ventilation, light, warm , noise absence or reduction,
cleanliness & diet )
1952 Nursing Research Journal publication
1960s nature of nursing practice was debated, defined

nursing practice, or develop nursing theory, and
created a substantive body of knowledge
Historical development
1960-1970 proliferation of conceptual
models and frameworks, and philosophy
of nursing.
Examples: Abdellah 21 nursing problems
and Halls Core, care and cure
(person,body,disease)
1969 first conference on nursing theory
Historical Development
Role of nurses where questioned;
what they do, for whom where and
when were determined.
purpose of nursing, process of theory
development was discussed
Historical Development
1980s 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.
Types of theories
According to range
Grand theory
Middle range theory
Micro theory
Types of theories: Grand

Theory
Grand Theory consist of broad conceptual frameworks
that reflect wide and expansive perspectives for
practice and ways of describing, explaining, predicting
and looking at nursing phenomena. They are the most
complex and broadest in scope.
Ex.
Hendersons The Nature of Nursing ;
Levines The Four Conservation Principles of Nursing,
Roys Adaptation Model, and
Orems Self-Care (Marriner-Tomey)
Types of Theories: Mid Range Mid Range- less complex and narrower in scope
than grand theory and micro theory.
A more workable level is the middle range.more
limited in scope and less variables, and testable.
grand theory on stress and adaptation might not
yield any interpretable guidelines on practice but if
the theory is focused on chronic lingering illness
as the stressor on family, the stress theory
becomes operational for both research and
practice purposes.
Ex. Peplaus Psychodynamic Nursing and
Orlandos Nursing Process Theory
Types of theories: Micro

theories
Micro theories- are the least complex.
They contain the least complex concepts
and are narrowest in scope. They deal
with a small aspect of reality, generally a
set of theoretical statements
Deals with specific and narrow defined
phenomena
According to Orientation or
focus of the theory
1. Client centered: Nightingale, Henderson
2. Client-nurse dynamics: Watson
3. Client-nurse environment : Leininger
Categories of nursing theories
client
nurse
`
environment
Client centered theory

Focused on the needs and problems of
clients which are met, resolved or
alleviated by nursing interventions
This category includes theories
developed by the following :
Nightingale,Abdellah,Henderson,Orem,
Pender, Roy, Levine, Hall.
Nurse client dynamics

Focus on interaction between the nurse
and client.
This category includes theories
developed by the following: Peplau,
Watson, King and Orlando
Client Nurse Environment

Dynamics
Focus on the interaction between nurse
and client in an environment that
includes broader dimensions of time and
space.
As well as culture, cultural diversity, and
universality.
Theories of Neuman and Leininger are
discussed under this category.
Framework to Analyze the

Nursing theory
1.What are the major concepts?
Person, nursing, health and environment
2. Based on Focus
Client centered, nurse-client dynamics, nurse
client-environment dynamics
-How similar and how different are their concepts
of persons, nursing, health, environment
3. Key concepts unique to the theory. Some
theories have several key concepts and it may
have sub-concepts.
Analysis of theory
Clarity How clear is this theory?
Simplicity How simple is this theory?
Generality How general is this theory?
Empirical precision
How accessible is this
theory?
Derivable consequences
How important is this
theory?
Conclusion
Theory development and evaluation are cyclical,
continuous, and dynamic process. One can not exist
without the other.
Theory evaluation including description, concept
analysis, theory critique, testing and support.
These process are based on the view that science is a
human process that includes not only valid findings but
also observation, agreements, useful solutions to
problems.
Theory evaluation is central to the development of
theory; it is the responsibility of each clinician,
academician.
REFERENCE
Taylor, C., Lillis,C.& leMOne,P. (2005).
Fundamentals of nursing: The art and
science of nursing care (5th ed).
Philadephia: Lippincott
Potter & Perry (2009). Fundamentals of
nursing (7th ed). St Louis: Mosby
MSG 016
THEORY
OF
ENVRIRONMENT
Learning Outcomes
Definition of environment
Background of Florence Nightingale
Her beliefs about nursing
Description of her theory
Application
her2016theory
Daeyang of
UniversityIntake 28/09to nursing
Who am I ?
Family Background
Born on 12th May, 1820
Founder of Modern
Nursing
Born in Florence, Italy
Daughter of wealthy
landowner, William
Nightingale
Died on 13th August, 1910
at age 90
Was so close to her father
who treated her as a friend
and companion
Historical Background
Nightingale's affluent British family belonged to
elite social circles
The father took responsibility of her education
He taught her and her sister Greek, Latin,
French, German, Italian history, philosophy and
mathematics
First helped a sick dog with a broken leg
Loved her dolls
One day she visited a hospital
THIS CHANGED
HER LIFE
Historical Background
Parents did not want her to become a nurse
She studied medicine books herself for years
She was 30 when her parents let her go to
Germany and Paris to study nursing
In Germany, she trained with Protestant
religious community with a hospital and after 3
months she was declared a nurse
Historical background
Determined to pursue her true calling despite
her parents' objections, in 1844, Nightingale
enrolled as a nursing student at the Lutheran
Hospital of Pastor Fliedner in Kaiserswerth,
Germany.
Crimean War
Broke out when Florence was 34
years old
War Russia v Turkey(Britain and
France)
Reports were coming through
about terrible conditions in hospital
In late 1854, Nightingale received a
letter from Secretary of War Sidney
Herbert, asking her to organize a
corps of nurses to tend to the sick
and fallen soldiers in the Crimea
Crimean War
arrived at Scutari, the
British base hospital in
Constantinople. The
hospital sat on top of a
large septic tank, which
contaminated water and
the hospital building
itself
Patients lay in their own

excrement on stretchers
strewn throughout the
hallways. Rodents and
bugs scurried past them.
Crimean War
The most basic supplies, such as
bandages and soap, grew increasingly
scarce as the number of ill and wounded
soldiers steadily increased.
Even water needed to be rationed.
More soldiers were dying from infectious
diseases like typhoid and cholera than
from injuries incurred in battle.
She got to work

Scrubbed the floors
Cleaned the wards
Washed the bedclothes
Made the men
comfortable
By 1854, no fewer than

18,000 soldiers had been
admitted into military
hospitals.
In the night she carried a
lamp so she was called
The Lady with the Lamp
Soldiers kissed her
shadow
Soldiers began to get better

Sitting up, cheerful and happier!
Also called her the

Angel of the
Crimea."
Within 6 months, her
work reduced the
hospitals death rate
in Scutari from
42.7% to 2.2%
Letter from Queen Victoria

Thanking Miss
Nightingale and
her ladies for all
their hard work
She was given a diamond

brooch with Blessed are
the merciful engraved on it
"Nightingale Jewel" and by
granting her a prize of
$250,000 from the British
government
In 1860 she established St.
Thomas' Hospital and the
Nightingale Training School
for Nurses. She died August
13, 1910, in London.
She was famous all

over the world
She changed
hospitals all over the
world
There is a museum
in London which
celebrates her life
and work
Nightingales definition of Concepts

Environment:
She considered environment as all that surrounds
human beings in relation to their health for example
she focused on ventilation, warmth, noise, light and
cleanliness
Man:
Did not specifically define man but defined man in
relation to his environment and the impact upon him
Health:
She did not specifically define health but she believed
health to be an innate process and combines result of
Daeyang University2016 Intake
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Nightingales Conceptual Framework
Nightingales Theory
Her main theory was focused on environment
5 essential components:
Ventilation/ Efficient drainage/ Pure/ Fresh
air - keep the air he breathes as pure as the
external air, without chilling him (Tomey, 75)
She seemed to recognize the environmental
component as a source of disease and
recovery
Light (esp direct sunlight)- light has quite as real

and tangible effects upon the human body... who
has not observed the purifying effect of light, and
especially of direct sunlight, upon the air of a
room?
Cleanliness she noted that a dirty environment
was a source of infection through organic matter it
contained. She also advocated for bathing pts on
a daily basis; also required nurses to bathe daily,
have clean clothing, and hand washing frequently
Warmth she advocated on keeping pts

warm; nurses would feel the pts extremities
to assess for heat loss
Quite environment noise created by
physical activities in the environment was to
be avoided because it could harm the pt
Sufficient food supplies
Bed and beddings- aerated beddings, never
lean against pts beddings, bed sheets free of
wrinkles,
never shake beddings, keep dry
Nightingale believed that sick poor people

would benefit from environmental
improvements that affected both their bodies
and minds.
She believed that nurses could be
instrumental in changing the social status of
the poor by improving their physical and
psychological living conditions.
Nightingales Theory
Nightingale's theory contains 3 major
relationships
1. Environment to patient
2. Nurse to environment
3. Nurse to patient
Environment vs Patient
Environment was the main factor
creating illness in a patient.
She recognized not only the
harmfulness of an environment, but
also the benefit of good environments
in preventing disease. The
environmental aspects of her theory
remain integral components of nursing
care today.
Nurse vs. Environment

Nurses manipulate the environment in
a number of ways to enhance patient
recovery.
(elimination of contamination and
contagion; exposure to fresh air, light,
warmth, and quiet)
Nurse vs Patient
Nurse to patient relationship meant that the
patient would be protected from emotional
distress, letting patients make own decisions
Nightingale did not consciously attempt to
develop what is considered a theory of
nursing; she provided the first definitions
from which nurses can develop theory and
conceptual models and frameworks that
inform professional nursing today
Nightingale beliefs about

Nursing
Physical Environment:
Nightingale believed that the provision of a
clean environment assists the patient in
reparative process towards illness/injury by
allowing nature to take its course
She emphasized on nursing a patient in a
clean environment that is free from dust,
odours, noise and good light; and also the
provision of water and warmth.
Nightingales beliefs about

nursing
Physical Environment:
Nursing is not only giving medicine but caring
for an individuals needs.
The needs are part of the physical environment
and include provision of water and warmth.
Position of the bed should be comfortable to
both patient and care givers.
Good position of the patient on the bed to
supportDaeyang
ventilation
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Nightingales beliefs about nursing

Psychological Environment:
The psychological environment deals with the
mind.
Nightingale acknowledged that the mind affect the
body.
However, would not understand how the condition
of the body
would affect the mind.

nursing
Psychological environment
Emphasized on offering activities that would
stimulate the mind and prevent boredom.
Such activities include games, being
physically available to the patients, offering
attractive food.

nursing
The social environment:
Nightingale believed that the patients
emotions would be affected by their reaction
to the physical environment.
Nightingale acknowledged that a negative
environment can cause physical stress which
eventually can lead to emotional stress.

nursing
Social environment:
Encouraged good communication with the
patients (unhurried and while seated)
Avoiding giving false hopes to the patients.

nursing
Formal education for nurses
Developed principles of nursing education
- training schools to be supported by public

funds, to be affiliated with a teaching hospital
but being independent of it
Nursing students to have a nursing home in
order to Daeyang
maintain
conduct
University- 2016 Intake 28/09

nursing
Formal Education for nurses:
Nightingale believed that nurses needed to
have formal education in order to provide
better care.
Many medical schools, hospitals, clinics,
community agencies were established
Hospital
schools of nursing were established
Nightingales Influence
Florence Nightingale's two greatest life
achievements were:
pioneering of nursing and
the reform of hospitals this was amazing considering
that most Victorian women of her age group did not
attend universities or pursue professional careers.
Her voice was strong and she served as an

effective advocate on a number of important
health issues, particularly for trained nursing
and preventive health care through proper
hygiene.
Application of the theory to nursing

education
The need for knowledgeable nurses calls for
formal training. She advocated for the
training of nurses in formal institutions and
she built a School of nursing.
This was a step in advancement of nursing
education.
Application of the theory to nursing

education
Nightingale believed in having well educated
nurses to perform the functions of a nurse
better
Today, colleges and universities have been
built with nursing as a faculty.
Application to nursing practice

Good communication to the patients- which is also
encouraged in nursing
unhurried
at same level with the patients
Tone of voice
Language
Nurses manipulate the environment in which the

patients are being nursed to that which is: free of
dust, odour, noise, good light.
This environment does not only assist the patient
Daeyang
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but also the
nurse
other
Application to practice
Positioning of patients bed is important as it
provides comfort to both the patients and the
nurses/ care givers
Good height from the floor
Some distance from other beds
The proper position of the patient on the bed
is also emphasized in nursing and is of
paramount importance is the easing of
ventilation to the patient which Nightingale
also acknowledged.
Application to practice
Cleaning of the environment, maintenance of
adequate resources
The use of nursing process till this present
day
Application of theory to nursing

research
Established presenting of results statistically
using pie and bar charts
Several studies have been done on patients
related to stress and the environment,
factors affecting patients care in hospitals.
Other studies include client exit interviews
regarding their stay in the hospitals of which
the environment is part of it.
Strengths
First theory in nursing from which other
theorists developed their theories
Founder of modern nursing
Still being used today in nursing profession
Theorist who fought for nursing education
Emphasized on infection prevention
Nightingale was an advocator of patients even
in modern nursing, nurses are patients
advocate
Weaknesses
She maintained the profession to women
only
Had no scientific base on many of her
assumptions e.g. light
She concentrated much on environment as
the only source of infection overlooking
other factors that might cause infections
Reference
Belcher, J., Bennet, A., Crane, M., Esposito,
C., Falco, S. et al (1980). Nursing theories:
base for professional nursing practice.
Englewood Cliffs: Library of Congress.
Potter, P.A. & Perry, A.G. (2009).
Fundamentals of nursing (7th Ed). St Louis:
Mosby Elsevier
Reference
Alligood, M. R., & Tomey, A. M. (2006). Nursing
Theorists and Their Work (6th ed.). Mosby, Inc.
Ignatavicius,D.D., & Workman,L.M. (2006).
Medical Surgical Nursing, Critical Thinking for
Collaborative Care (5th ed.). Elsevier Saunders.
Kearney-Nunnery, R. (2008). Advancing Your
Career: Concepts of professional nursing (4th ed.).
F. A. Davis Company
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Theories of

Discuss how a theory is created

What are the components of a

A model that explains

How does domain relate to

Types of nursing theories

So how do nurses use theory in

Daeyang University- 2016 Intake 28/09

Nursing also utilizes non-nursing

Daeyang University- 2016 Intake 28/09

Commonly used non-nursing

Daeyang University- 2016 Intake 28/09

What is the link between nursing

Current trends that influence

Daeyang University- 2016 Intake 28/09

Daeyang University- 2016 Intake 28/09

Daeyang University- 2016 Intake 28/09

How does a theory develop?

Daeyang University- 2016 Intake 28/09

How does a theory develop?

Group of related concepts

Daeyang University- 2016 Intake 28/09

Group of related concepts that derived

Daeyang University- 2016 Intake 28/09

Florence Nightingale Notes on Nursing

1960s nature of nursing practice was debated, defined

Daeyang University- 2016 Intake 28/09

Daeyang University- 2016 Intake 28/09

Daeyang University- 2016 Intake 28/09

Types of theories: Grand

Daeyang University- 2016 Intake 28/09

Types of theories: Micro

Daeyang University- 2016 Intake 28/09

Daeyang University- 2016 Intake 28/09

Categories of nursing theories

Daeyang University- 2016 Intake 28/09

Client centered theory

Daeyang University- 2016 Intake 28/09

Nurse client dynamics

Daeyang University- 2016 Intake 28/09

Client Nurse Environment

Framework to Analyze the

Daeyang University- 2016 Intake 28/09

Daeyang University- 2016 Intake 28/09

Daeyang University- 2016 Intake 28/09

Daeyang University- 2016 Intake 28/09

Daeyang University- 2016 Intake 28/09

Patients lay in their own

Daeyang University- 2016 Intake 28/09

She got to work

Daeyang University- 2016 Intake 28/09

By 1854, no fewer than

Soldiers began to get better

Also called her the

Daeyang University- 2016 Intake 28/09

Letter from Queen Victoria

Daeyang University- 2016 Intake 28/09

She was given a diamond

She was famous all

Daeyang University- 2016 Intake 28/09

Nightingales definition of Concepts

Daeyang University- 2016 Intake 28/09

Nightingales Conceptual Framework