INTRODUCTION TO NURSING THEORY

Ms. Blesson thomas

Associate.prof.
mbcon
INTRODUCTION
 
The foundation of any profession is the development of a
specialized body of knowledge.

1. In the past, the nursing profession relied on theories

from other disciplines, such as medicine, psychology,
and sociology, as a basis for practice.

2. For nursing to define its activities and develop its

research, it must have its own body of knowledge.
3. This knowledge can be expressed as conceptual
MODELS and THEORIES.
 Nursing theories and models provide information about:

1. Definitions of nursing and nursing practice.

2. Principles that form the basis for practice.
3. Goals and functions of nursing.
4. Clarifies the scope of nursing practice.
CONCEPT
Concepts are ideas that gives meaning to our sense
perceptions , permits generalizations and tend to
be stored in our memory for recall and use at later
time and different situations.

According to chinn and jacobs concepts is a complex

mental formulation of an object , property or event,
that is derived from individual perception and
experience.
Nursing theories and models are derived from concepts:  
1. Concept is an idea of an object, property, or event.

2. Concepts are basically vehicles of thought involving

mental images.  
3. In Nursing, concepts have been borrowed from other
discipline (adaption, culture, homeostasis) as well as
developed directly from nursing practice and research
(maternal-infant bonding, health-promoting
behaviours).
4. Concepts are building blocks of theory.

5. Propositions are statements that explain the

relationship between the concepts.
 TYPES OF CONCEPTS:
 
1. Empirical or concrete concepts: These are directly
observable objects, events, or properties, which can be
seen, felt or heard e.g color of the skin, communication
skill, presence of lesion, wound status etc., These are
limited by time and space (it can be viewed/measured
only specific period & specific setting and variable).  
2. Inferential concepts: These are indirectly observable
concepts, e.g pain, Dyspnea and temperature.
3. Abstract Concepts: These concepts are not clearly
observable directly or indirectly (known as “Non -
observable concepts directly”).E.g. social support,
Personal Role, Self-esteem etc.
CONCEPTUAL FRAMEWORK : CONCEPT WITH
FRAMEWORK
 In conceptual frame work Problem is being investigated and is fit
into an existing theoretical framework, which guides the study
and enriches the value of its findings.
Guidelines for writing about a research study’s theoretical
framework
1. Introduce the framework.

2. Briefly explain why it is a good fit for the research problem

area.
3. At the end of the literature review thoroughly describe the
framework and explain its application to the present study.
4. Describe how the framework has been used in studies about
similar problems.
5. In the study’s methodology section
--- explain how the framework is being operationalized in the
study’s design.
--- explain how data collection methods reflects the concepts
in the framework.
7. In the study’s discussion section
--- describe how study findings are consistent with the
framework.
---offer suggestions for practice and further research that are
congruent with the framework’s concepts and proposition.
 THEORIES
 
1. Are set of logically interrelated concepts that
provide a systematic explanatory and predictive
view of phenomena  
2. Can begin as an untested premise (hypothesis)
that becomes a theory when tested and
supported or can progress in a more inductive
manner
3.  Are tested and validated through research and
provide direction for this research
4.  Nursing theory is a framework designed to
organize knowledge and explain phenomena in
nursing.
 CHARACTERISTICS
 
Must be logical, relatively simple, and generalizable.
 
Are composed of concepts and prepositions.
 
Interrelateconcepts to create a specific way of looking at a particular
phenomenon.

Provide the bases for testable hypotheses.

 
Must be consistent with other validated theories, laws, and principles
but have open unanswered questions for investigation.
 
Can consist of separate theories about the same phenomenon that
interrelate the same concepts but describe and explain them differently
 Contribute to and assist in increasing the general body of
knowledge within a profession through research implemented to
validate them.  
 Can be used by nurses to guide and improve their practice.
  Facilitate communication and systematic thinking among nurses
regarding professional convictions, moral/ethical structure to
guide nurses actions,

 It facilitates coordinated and less fragment care.

 
 The main exponent of nursing – caring – cannot be measured, it
is vital to have the theory to analyze and explain what nurses do.
 MODELS
 Conceptual Model is a set of interrelated concepts that
symbolically represents mental image or phenomenon.
Model deals with highly abstract concepts than theory.

General information
1. Describe a set of ideas that are connected to illustrate a
larger, more general concept.
2. Are a symbolic depiction of reality
3. Provide a schematic representation of some relationships
among PHENOMENA
4. Use symbols or diagrams to represent an idea
 CHARACTERISTICS
1. Attempt to describe, explain, and sometimes predict
the relationships among phenomena.
2. Are composed of empirical, inferential, and abstract
concepts.
3. Provide an organized framework for nursing
assessment, planning, intervention, and evaluation.
4. Facilitate communication among nurses and
encourage a unified approach to practice, teaching,
administration, and research
 METAPARADIGM
 Conceptual models and theories in nursing are based
on the nursing metaparadigm.
 Metaparadigm is the most global conceptual or
philosophical framework of a discipline or profession

 The nursing metaparadigm comprises four concepts :

person, environment, health, and nursing.
1.  Person refers to the recipient of nursing care,
including physical. mental and social.
2. Environment refers to all the internal and external
conditions, circumstances, and influences affecting
the person  
3. Health refers to the degree of wellness or illness
experienced by the person  
4. Nursing refers to the actions, characteristics, and
attributes of the individual providing the nursing care.
CLASSIFICATION OF NURSING
THEORIES AND MODELS

Nursing theories can be classified based on

 Range/scope or abstractness

 Purpose of the theory

 Philosophical underpinnings.

 
BASED ON RANGE/SCOPE/GENERALIZATION
AND LEVEL OF ABSTRACTNESS:
 Metatheory
 Grand Theories

 Middle RangeTheories

 Practice Theories/Micro theories/prescriptive theories

BASED ON THE PHILOSOPHICAL
UNDERPINNINGS OF THE THEORIES:

1. “Needs” theories
 Are based around helping
individuals to fulfill their
physical and mental needs.
2.“Interaction”
theories
 As described by
Peplau (1988),
these theories
revolve around
the relationships
nurses form with
patients.
3. “Outcome” theories"
 Outcome theories portray the nurse as the changing force,
who enables individuals to adapt to or cope with ill
health.
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.
Based on Purposes or function of theory

 Descriptive-to identify the properties and workings of a

discipline

 Explanatory-to examine how properties relate and thus

affect the discipline.

 Predictive-to
calculate relationships between properties
and how they occur.

 Prescriptive -to
identify under which conditions
relationships occur betweenproperties and discipline.
 HISTORICAL PERSPECTIVE
1860 to 1959
1. In 1860, Florence Nightingale developed her Environmental Theory.

2. In 1952, the journal Nursing Research was established, encouraging

nurses to become involved in scientific inquiry.

3. In the same year, Hildegard Peplau published Interpersonal Relations in

Nursing; her ideas have influenced later nursing theorists.

4. In 1955, Virgina Henderson published Definition of Nursing.

5. In the mid-1950s, Teachers College, Columbia University, New York City,

began offering master’s and doctoral programs in nursing education
and administration, resulting in student participation in theory
development and testing.
1960 to 1969
 
1. During the 1960s, Yale University School of Nursing, New
Haven, Conn., defined nursing as a process, interaction, and
relationship.
2. Also during the 1960s, the U.S. government began funding
master’s doctoral education in nursing.  
3. In 1960, Faye Abdellah published Twenty-One Nursing
Problems.  
4. In 1961, Ida Orlando published her theory in The Dynamic
Nurse-Patient  
5. Relationship: Function, Process, and Principles of
Professional Nursing.
6. In 1962, Lydia Hall published Core, Care, and Cure model.  
7. In 1964, Ernestine Wiedenbach published her theory in
Clinical Nursing:  A Helping Art
 
8. In 1965, the American Nurses Association published a position paper
stating that theory development was an important goal for nursing.
9. In 1966, Myra Levine published Four Conservation Principles.

10. In 1969, Dorothy Johnson published Behavioral Systems Model.

 
1970 to 1979
 
11.During the 1970s, Case Western Reserve University,
Cleveland, sponsored symposia to stimulate theory
development.
12.During the mid 1970s, the National League for Nursing
established an accreditation requirement that nursing
schools base their curricula on a nursing conceptual
framework.
3. In 1970, Martha Rogers published her model in An
Introduction to the Theoretical Basis of Nursing.
4. In 1971, Dorothea Orem published Self-Care Deficit
Therory of Nursing, Imogene King published Theory of
Goal Attainment, and Joyce Travelbee published
Interpersonal Aspects of Nursing.
5. In 1972, Betty Neuman published Health Care Systems
Model.  
6. In 1976, Sister Callista Roy published Adaptation Model.
 
7. In 1976, J.G.Paterson and L.T.Zderad published
Humanistic Nursing.
1980 to the present
 
1. In 1980, Evelyn Adam published To be a Nurse and Joan Riehl-
Sisca published Symbolic Interactionism
2. In 1982, Joyce Fitzpatrick published Life Perspective Model.
3. In 1983, Kathryn Barnard published Parent-Child Interaction Model
and Helen Erickson, Evelyn Tomlin, and Mary Ann Swain
published Modeling and Role Modeling.
 
3. In 1984, Patricia Benner published from Novice to Expert:
Excellence and Power in Clinical Nursing Practice.
 
4. In 1985, Ramona Mercer published Maternal Role Attainment.
6. In 1986, Margaret Newman published Model of Health.

7. In 1994, Parish Nursing Model:proposed by Bergquist and King

8. In 1994,Rogers proposed “Occupational Health Nursing Model”

9. In 1997, Barbara Artinian and Margarnet Conger published “The

intersystem Model: Integrating Theory and Practice”
KEY CONCEPTS
Nightingale • To facilitate “the body’s
reparative processes”
1860: by manipulating client’s
environment

• Nursing is; therapeutic

Peplau 1952: interpersonal process.

Henderson • The needs often called

Henderson’s 14 basic
1955: needs
 • delivering nursing care for
Abdellah the whole person to meet
the physical, emotional,
1960: intellectual, social, and
spiritual needs of the client
and family.

• the client is an individual;

with a need; that, when met,
diminishes distress, increases
Orlando 1962: adequacy, or enhances well-
being.

• focuses on how the client

adapts to illness and how

Johnson’s actual or potential stress can

affect the ability to adapt. The
goal of nursing to reduce
Theory 1968: stress so that; the client can
move more easily through
recovery.
 • maintain and promote health,
Rogers 1970: prevent illness, and care for and
rehabilitate ill and disabled client
through “humanistic science of
nursing”

• self-care deficit theory. Nursing

Orem1971: care becomes necessary when

client is unable to fulfill
biological, psychological,
developmental, or social needs.

King 1971: • use communication to help client

reestablish positive adaptation to
environment.
Neuman 1972: • Stress reduction is goal of
system model of nursing
practice

• This adaptation model is based

on the physiological,
Roy 1979: psychological, sociological and
dependence-independence
adaptive modes.

Watson’s • defines the outcome of nursing

activity in regard to the;
Theory 1979: humanistic aspects of life.
FRAMEWORK OF
ANALYSIS

Criteria for Evaluating

Theoretical Works
  Major Concepts and sub-
CLARITY concepts and their
definitions are identified.
 “The danger of lost
“HOW CLEAR IS YOUR
THEORY?” meaning when terms
are borrowed from
other disciplines and
used in a different
context.” (Ellis)

 Diagrams and examples

may facilitate clarity and
should be consistent.
SIMPLICITY Nurse in practice need simple

theory, such as middle-range
“How simple is this theory?” theory to guide practice.
(Chinn and Kramer)

 “The most useful theory

provides the greatest sense of
understanding.” (Reynolds)

 “Elegant in its simplicity,

even though it may be broad
in content.” (Walker and
Avant)
GENERALITY  Scopes of concepts and goals
within the theory are
“How general is this theory?” examined.

 The situations the theory

applies to should not be
limited.
 “The broader the scope, the
greater the significance of
the theory.” (Chinn and
Kramer)
EMPIRICAL  “ How well the
evidence supports the
PRECISION theory is indicative of
“How accessible is this empirical adequacy.”
theory?” (Hardy)

 Other scientists
should be able to
evaluate and verify
results by themselves.
  “It is essential for a theory to
DERIVABLE develop and guide
CONSEQUENCE practice...Theories should
reveal what knowledge nurses
must and should, spend time
“How important is this
theory?” pursuing.”
SIGNIFICANCE OF THEORY
FOR NURSING
As a Discipline and Profession
DISCIPLINE
 Specific to the academia
and refers to a branch of
education, a department of
learning or a domain of
knowledge.
PROFESSION
 A specialized field of
practice, which is
founded upon the
theoretical structure of
the science or
knowledge of the
discipline and the
accompanying
practice abilities.
 NURSING AS A DISCIPLINE
 Theories provided frameworks to structure curriculum content
or to guide the teaching of nursing practice in nursing
programs.

 Discipline is dependent upon theory.

 Focus on knowledge about how nurses function which
concentrated on the nursing process to a focus on what nurses
know and how they use knowledge to guide their thinking and
decision making while concentrating on the patient.

 New nursing science is developed through theory based research

studies.
 NURSING AS A PROFESSION

 Criteria of a profession by Bixler and Bixler published in the

American Journal of Nursing 1959

1. Utilizes in its practice a well defined and well- organized

body of specialized knowledge that is on the intellectual
level of higher learning.
2. Constantly enlarges the body of knowledge it uses and
improves its techniques of education and service by the
use of the scientific method.
3. Entrusts the education of its practioners to institutions of
higher education.

4. Applies its body of knowledge in practical services that are

vital to human and social welfare.

5. Functions autonomously in the formulation of professional

policy and in the control of professional activity thereby.
6. Attracts individuals of intellectual and personal qualities who
exalt service above personal gain and who recognize their
chosen occupation as a life work.

7. Strives to compensate its practitioners by providing freedom

of action, opportunity for continuous professional growth, and
economic security.
8. Presented specific goals and achievements of the
profession.
9. Nurses are recognized for the contribution they make in
healthcare and the society.
10. Professional practice requires a systematic approach that is
focused on the patient. Nursing theoretical works provide a
perspective of the patient.
11. Nursing theory is a useful tool for reasoning, critical
thinking, and decision making in the nursing practice.
NURSING THEORY AND THE PRACTICE OF NURSING

Theory assists the practicing nurse to:

•Organize patient data

•Understand patient data
•Analyze patient data
•Make decisions about nursing interventions
•Plan patient care
•Predict outcomes of care
•Evaluate patient outcomes
 APPLICATION OF THEORY IN NURSING
PROCESS
 Nursing theory is an organised and systematic articulation of a set
of statements related to questions in the discipline of nursing.
IMPORTANCE OF NURSING THEORIES IN PRACTICE
 Assist the nurse to describe, explain and predict everyday
experiences
 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 nursing care
 Helps in building a common nursing terminology to use in
communication with other health professionals. Ideas are
developed and words are defined
 Enhances autonomy (independence and self governance) of
nursing by defining its own independent functions
RELATION BETWEEN THEORIES AND
NURSING RESEARCH
 RESEARCH --- Process of inquiry
 THEORY---- Product of knowledge

 SCIENCE---- Result of the relation between research and

theory
 To effectively build knowledge---- research process should be
developed within some theoretical structure that facilitates
analysis and interpretation of findings
 Research without theory result in discreet information or data
which does not add to the accumulated knowledge of the
discipline.
 Theory guides the research process , forms the research
questions, aids in design, analysis and interpretation
 It enables the scientist to weave the facts together.

PURPOSE OF THEORY IN RESEARCH

 To identify the meaningful and relevant areas of study.

 To propose possible approaches to health problems

 To develop or refine theories

 Define concepts and proposed relationships between concepts.

 To interpret research findings

 To develop clinical practice protocols

 Generate nursing diagnosis.

USE OF THEORY IN RESEARCH
 Theory generation via inductive research

Theory testing via deductive research

Formal practice
APPLICATION OF NURSING THEORIES IN
NURSING PRACTICE
EXAMPLES