WHAT ARE 

NURSING
THEORIES?

THEORETICAL FOUNDATION OF NURSING OVERVIEW

 OBJECTIVES:

In this seminar of nursing theories, the student

will be able:
• To understand what comprises a nursing theory.
• To identify the importance, purpose, history, types
or classifications of nursing theories.
OUTLINE:

• Nursing Theories?
• Differentiation of Terms
• History of Nursing Theories
• The Nursing Metaparadigm
• Purposes of Nursing Theories
• Classification of Nursing Theories
• Other Ways of Classifying Nursing Theories
• Criteria for Evaluating Theoretical Work
 WHAT ARE NURSING THEORIES?

• Nursing theories are organized bodies of knowledge to

define what nursing is, what nurses do, and why do they
do it.
• Nursing theories provide a way to define nursing as a
unique discipline that is separate from other disciplines
(e.g., medicine).
 WHAT ARE NURSING THEORIES?
 
• It is a framework of concepts and purposes intended to guide the
practice of nursing at a more concrete and specific level.
• Nursing is a unique discipline and is separate from medicine. It has
its own body of knowledge on which delivery of care is based.
 DIFFERENTIATION OF TERMS
 

• Philosophy. 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.
 DIFFERENTIATION OF TERMS

• Phenomenon: A term given to describe an idea or responses 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
• 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 are statements that explain the nature of concepts, definitions,
purpose, relationships, and structure of a theory.
 DIFFERENTIATION OF TERMS
 

• Concept. Concepts are often called the building blocks of theories. They are
primarily the vehicles of thought that involve images.
• Models. Models are representations of the interaction among and between the
concepts showing patterns. They present an overview of the thinking behind the
theory and may demonstrate how theory can be introduced into practice.
• Conceptual framework. A conceptual framework is a group of related ideas,
statements, or concepts. It is often used interchangeably with the conceptual
model and with grand theories.
 DIFFERENTIATION OF TERMS
 

• Proposition. Propositions are statements that describe the

relationship between the concepts.
• Domain. Domain is the perspective or territory of a profession or
discipline.
• Process. Processes are a series of organized steps, changes or
functions intended to bring about the desired result.
 DIFFERENTIATION OF TERMS
 

• Paradigm. A paradigm refers to a pattern of shared understanding and

assumptions about reality and the world; worldview or widely accepted value
system.
• 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.
HISTORY OF NURSING THEORIES

THE FIRST NURSING THEORIES APPEARED IN THE LATE 1800S WHEN A

STRONG EMPHASIS WAS PLACED ON NURSING EDUCATION.

• In 1860 , Florence Nightingale defined nursing in her “

Environmental Theory” as “the act of utilizing the environment of the
patient 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.
HISTORY OF NURSING THEORIES

• In 1952, Hildegard Peplau introduced her Theory of Interpersonal

Relations that puts emphasis on 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”

that 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 the professional function of nursing 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.
 HISTORY OF NURSING THEORIES

• 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 states in her theory that nursing care is required if the
client is unable to fulfill biological, psychological, developmental, or social needs.
• In 1971, Imogene King‘s Theory of Goal attainment states that the nurse is
considered part of the patient’s environment and the nurse-patient relationship is
for meeting goals towards good health.
HISTORY OF NURSING THEORIES

• 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
who strives to 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.
 THE NURSING METAPARADIGM

• There are four major concepts that are frequently interrelated and
fundamental to nursing theory: person, environment, health, and
nursing. These four are collectively referred to as metaparadigm for
nursing.
• Person, Nursing, Environment, and Health – the four main concepts
that make up the nursing metaparadigm
PURPOSES OF NURSING THEORIES

• The primary purpose of theory in the profession of nursing is to

improve practice by positively influence the health and quality of life
of patients.
• Nursing theories are also developed to define and describe nursing
care, guide nursing practice, and provide a basis for clinical decision
making. The accomplishments of nursing in the past led to the
recognition of nursing in academic discipline, research, and profession.
 IN ACADEMIC DISCIPLINE

• Much of the earlier nursing programs identified the major concepts in

one or two nursing models, organized the concepts and build an entire
nursing curriculum around the created framework.
• The purpose was to explain the fundamental implications of the
profession and to enhance the status of the profession.
 IN RESEARCH

• 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.
• To improve the nursing profession’s ability to meet the societal duties and responsibilities,
there need to be a continuous reciprocal and cyclical connection with theory, practice, and
research. This will help connect the perceived “gap” between theory and practice and
promote the theory-guided practice.
 IN PROFESSION

• In a clinical setting, its primary contribution has been the facilitation

of reflecting, questioning, and thinking about what nurses do. Because
nurses and nursing practice are often subordinate to powerful
institutional forces and traditions, the introduction of any framework
that encourages nurses to reflect on, question, and think about what
they do provide an invaluable service.
 CLASSIFICATION OF NURSING THEORIES

• There are different ways to categorize nursing theories. They are

classified depending on:
• Levels of abstraction
• Goal orientation.
• Function,
THERE ARE THREE MAJOR CATEGORIES WHEN CLASSIFYING
NURSING THEORIES BASED ON THEIR LEVEL OF ABSTRACTION:
- GRAND THEORY
- MIDDLE-RANGE THEORY
- PRACTICE-LEVEL THEORY.
1- Address the nursing metaparadigm components of
person, nursing, health, and environment.

2- Grand theories are abstract, broad in scope, and

complex, therefore requiring further research for
clarification.

3- Grand nursing theories do not provide guidance for

specific nursing interventions but rather provide a
general framework and ideas about nursing.

4- Grand nursing theorists develop their works based

on their own experiences and the time they were
living explaining why there is so much variation
among theories.
Middle-Range Nursing Theories
1- More limited in scope (as compared to grand
theories) and present concepts and propositions at a
lower level of abstraction. They address a specific
phenomenon in nursing.

2- Due to the difficulty of testing grand theories,

nursing scholars proposed using this level of theory.

3- Most middle-range theories are based on the works

of a grand theorist but they can be conceived from
research, nursing practice, or the theories of other
disciplines.
Practice-Level Nursing Theories

1- Practice nursing theories are situation specific

theories that are narrow in scope and focuses on a
specific patient population at a specific time.

2- Practice-level nursing theories provide frameworks

for nursing interventions and suggest outcomes or the
effect of nursing practice.

3- Theories developed at this level have a more direct

effect on nursing practice as compared to more abstract
theories.

4- These theories are interrelated with concepts from

middle-range theories or grand theories.
 BY GOAL ORIENTATION

• 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. Descriptive theories are not action
oriented or attempt to produce or change a situation. There are two types of descriptive
theories: factor-isolating theory and explanatory theory.
• Factor-Isolating Theory: Also known as category-formulating or labeling theory. Theories
under this category describe the properties and dimensions of phenomena.
• Explanatory Theory: Explanatory theories describe and explain the nature of relationships of
certain phenomena to other phenomena.
 BY GOAL ORIENTATION

• Prescriptive Theories
Address the nursing interventions for a phenomenon, guide practice change, and
predict consequences.
Includes propositions that call for change.
In nursing, prescriptive theories are used to anticipate the outcomes of nursing
interventions.
 OTHER WAYS OF CLASSIFYING NURSING THEORIES

• Classification According to Meleis

Afaf Ibrahim Meleis (2011), in her book Theoretical Nursing: Development and
Progress, organizes the major nurse theories and models using the following
headings: needs theories, interaction theories, and outcome theories. These
categories indicate the basic philosophical underpinnings of the theories.
• Needs-Based Theories. The needs theorists were the first group of nurses who thought of giving nursing care
a conceptual order. Theories under this group are based on helping individuals to fulfill their physical and
mental needs. Theories of Orem, Henderson, and Abdella are categorized under this group. Need theories
are criticized for relying too much on the medical model of health and placing the patient in an overtly
dependent position.

• Interaction Theories. These theories placed the emphasis of nursing on the establishment and maintenance of
relationships and highlight the impact of nursing on patients and how they interact with the environment,
people, and situations. Theories of King, Orlando, and Travelbee are grouped under this category.

• Outcome Theories. These theories describe the nurse as controlling and directing patient care by using their
knowledge of the human physiological and behavioral systems. Nursing theories of Johnson, Levine,
Rogers, and Roy belong to this group.
 OTHER WAYS OF CLASSIFYING NURSING THEORIES

• Classification According to Alligood

• In her book, Nursing Theorists and Their Work, Raile Alligood (2017)

categorized nursing theories into four headings: nursing philosophy, nursing
conceptual models, nursing theories and grand theories, and middle-range
nursing theories.
• Nursing Philosophy. 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.
• Nursing Conceptual Models. 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.
• 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.
• Middle-Range Theories. Are precise and answer specific nursing practice questions. They address the specifics
of nursing situations within the perspective of the model or theory from which they are derived. Examples of
Middle-Range theories are that of Mercer, Reed, Mishel, and Barker
 CRITERIA FOR EVALUATING THEORETICAL WORK
 

• Clarity– “How clear is this theory?”

Words often have multiple meanings within and across disciplines; therefore words should be defined carefully and specifically
to the framework (philosophy, conceptual model, or theory) from which it is derived.
Diagrams and examples may facilitate clarity and should be consistent.
• Simplicity- “How simple is the theory?”
Theory should have as few concepts as possible with simplistic relations to aid clarity.
“The most useful theory provides the greatest sense of understanding.”
Generality- “How general is this theory?”
To determine the generality of theory, the scope of concepts and goals within the theory are examined.
The broader the scope, the greater the significance of the theory.”
 CRITERIA FOR EVALUATING THEORETICAL WORK
 

• Empirical precision- “How accessible is the theory?”

Empirical precision is linked to the testability and ultimate use of a theory and it refers to the ”extent that the
defined concepts are grounded in observable reality”.
. Derivable Consequences- “How important is this theory?” 
Propose that if research, theory, and practice are to be meaningfully related, then nursing theory should lend
itself to research testing and research testing should lead to knowledge that guides practice.
Indicates that to be considered useful, “it is essential for theory to develop and guide practice.
REFERENCES

• Alligood, M. R. (2018). Nursing theorists and their work (9th Ed.). St

Louis, Mo: Mosby. ISBN: 9780323402248
• Meleis, A. I. (2012). Theoretical nursing: Development and progress. 5th
edition. Lippincott Williams & Wilkins.
• Nueseslabs. (2020). Nursing Theories and Theorists. retrieved from
https://nurseslabs.com/nursing-theories/