Structure of

Nursing
Knowledge
Structure of Nursing Knowledge
Overview
• Development of the body of
specialized knowledge required for
nursing to be recognized as a
profession was a driving force in the
20th century.
• Because of the importance of nurses
to the nation’s health, studies of
nursing were legislated early in the
century and conducted by
sociologists who recommended that
nursing be developed as a
profession.
• Nursing knowledge is the
cumulative, ever-evolving result of
prior learning, experience, theory
and research.
Structure Level
• Metaparadigm
• Philosophy
• Conceptual Models
• Grand Theory
• Theory
• Middle-range theory
Metaparadigm
• A metaparadigm is defined as the global concepts that
identify the phenomena of central interest to a
discipline, the global propositions that describe the
concepts, and the global propositions that state the
relations between the concepts.
• The concepts and propositions of a metaparadigm are
admittedly extremely abstract and provide no
definitive direction for such activities as research and
practice. Rather, the function of a metaparadigm is to
identify the basic subject matter of the discipline. 
Philosophy
• Is an abstract type that sets forth the meaning of nursing
phenomena through analysis, reasoning, and logical
presentation.
• Contribute to nursing knowledge with direction for the
discipline, forming a basis for professional scholarship that
leads to new theoretical understanding.
• Represents early works predating the theory era and
contemporary works of a philosophical nature.
• Are works that provide broad understandings that advance
the discipline of nursing and its professional applications.
• Example: Nightingale’s philosophy
 Conceptual Models
• Comprises nursing works by theorists referred to by
some as pioneers in nursing.
• Are a set of concepts that address phenomena
central to nursing in propositions that explain
relationships among them.
• Are comprehensive , and each addresses the
metaparadigm concepts of person, environment,
health and nursing.
• Theoristswho developed nursing conceptual
models often proposed a grand theory from their
model.
Grand Theory
• Derives from the conceptual model and proposes an
abstract testable theory.
• These theories have the capacity to threaten the
solvency of the conceptual model from which they are
derived, because they test the major premise of the
conceptual model.
• Example: Roy’s theory of the person as an adaptive
system, King’s theory of goal attainment, and
Neuman’s theory of optimal client stability.
Theory
• Comprises works derived from nursing philosophies,
conceptual models, grand theories, abstract nursing
theories, or works in other discipline.
• A work classified as nursing theory is developed from
some conceptual framework or grand theory and is
generally not as specific as a middle-range theory.
• Maybe specific to a particular aspect or setting of
nursing practice.
• Example: Meleis’ transition theory which is specific to changes
in a person’s life process in health and illness.
Middle-range theory
• Has the most specific focus and is concrete in its level of
abstraction.
• Propose precise testable nursing practice questions.

• They address the specifics of nursing situations within the

perspective of the model, grand theory, or theory from which
they originate.
• The specifics in this theories are:
• Age group of the patient
• Family situation
• Patient’s health condition
• Location of the patient
• Action of the nurse
 “The art of nursing is the
creative use of the science of
nursing for human
betterment.”
-Rogers, 1990, p.5