THEORETICAL FOUNDATION IN

NURSING
Highlights of Nursing Theory
1. Florence Nightingale
“Notes on Nursing” - environment
- directed nursing practice for over 140 years
2. Columbia School – 1950s
- functional roles of nurses, patient problems/focus
- administrative and faculty positions
3. Yale School – 1960s
- relationship between the nurse and the patient
4. 1970s – many nursing theories first presented
5. 1980s – many nursing theories were revised
6. 1990s – numerous research studies that tested and
expanded

* HISTORY OF NURSING THEORY

Eras of Nursing Knowledge:
1. Curriculum era (1900-1940s)
- Nursing education expanded beyond basic anatomy
and physiology courses to include courses in the social
sciences, pharmacology, and “nursing arts” that
addressed nursing actions, skills and procedures
2. Research era (1950s, 1960s, 1970s)
Nurses became increasingly involved in conducting
studies and sharing their findings; did not explore
clinical questions based on the medical model of
research

* HISTORY OF NURSING THEORY

Eras of Nursing Knowledge:
3. Graduate Education era (1950-1970s)
Early versions of nursing theories were developed that offered
more structure to nursing research
Renowned theorists includes Johnson. King, Levine, Neumann,
Orem, Rogers and Roy
- Master’s
4.Theory era (1980s-1990s)
Significantly contributed to knowledge development and the
nursing paradigm proposed by Fawcett
Resulted in the publication of several nursing journals, the
development of nursing conferences and the offering of doctoral
programs in nursing (Alligood, 2014)

* HISTORY OF NURSING THEORY

Eras of Nursing Knowledge:
5.Theory Utilization (21st Century)
Evidence-Based Practice (EBP)
- Focus of EBP is safe, comprehensive, individualized
and quality health care
- Stems from theory, research and experience
- Theory-based nursing practice

* HISTORY OF NURSING THEORY

Eras of Nursing Knowledge:
The Future

* HISTORY OF NURSING THEORY

Significance of Nursing Theory:
Nursing at the beginning of the 20th Century
was not recognized as an academic discipline or a
profession.
- The accomplishments of the past century
led to the recognition of nursing in both areas.
- The terms discipline and profession are interrelated,
and some may even use them interchangeably;
however they are not the same.

* HISTORY OF NURSING THEORY

A discipline is specific to academia and refers to a
branch of education, a department of learning, or a
domain of knowledge.
A profession refers to a specialized field of practice,
founded upon the theoretical structure of the science
or knowledge of that discipline and accompanying
practice abilities

I. Significance of Nursing Theory for the Discipline

II. Significance of Nursing Theory for the Profession
p. 13-18

* HISTORY OF NURSING THEORY

NURSING SCIENCE
Rationalism: Rationalist epistemology (scope of
knowledge) emphasizes the importance of a priori
reasoning as the
appropriate method for advancing knowledge.
- A priori reasoning utilizes deductive logic by reasoning
from the cause to an effect or from a generalization to a
particular instance.
- An example in nursing is to reason that a lack of social
support (cause) will result in hospital readmission (effect).
- Reynolds (1971) labeled this approach the theory-then-
research strategy

HISTORY AND PHILOSOPHY OF NURSING

SCIENCE
NURSING SCIENCE
Epistemology is concerned with the theory of knowledge in
philosophical inquiry

Two competing philosophical foundations of science,

Rationalism and Empiricism, have evolved in
the era of modern science with several variations
- Various terms are utilized to describe these two stances:
Empiricist and Interpretive
Mechanistic and Holistic
Quantitative and Qualitative
Deductive and Inductive

HISTORY AND PHILOSOPHY OF NURSING

SCIENCE
NURSING SCIENCE
Empiricism: scientific knowledge can be derived only
from sensory experience (i.e., seeing, feeling, hearing
facts)
- This approach, called the inductive method, is based
on the idea that the collection of facts precedes
attempts to formulate generalizations
- research-then-theory strategy

HISTORY AND PHILOSOPHY OF NURSING

SCIENCE
NURSING SCIENCE
Deductive inquiry uses the theory then research
approach and Inductive inquiry uses the research then
theory approach. Both approaches are used in the field
of nursing.
Rationalism holds that reason is the source of all
knowledge
Empiricism advocates that senses are the source of all
knowledge

HISTORY AND PHILOSOPHY OF NURSING

SCIENCE
 Analysis Questions to
Determine Theoretical Adequacy
Clarity: How clear is this theory?
Simplicity: How simple is this theory?
Generality: How general is this theory?
- The generality of a theory speaks to the scope of
application and the purpose within the theory
Accessibility: How accessible is this theory?
- is linked to the empirical indicators for testability and
ultimate use of a theory to describe aspects of practice
Importance: How important is this theory?

HISTORY AND PHILOSOPHY OF NURSING

SCIENCE
Theoretical works in nursing: philosophies, conceptual
models, theories or middle-range theories
Metaparadigm of the discipline is the highest level of
abstraction
- Metaparadigm of Nursing:
- Person (human being), Environment, Health and
Nursing
Concept – phenomenon/ group of phenomena
Empirical Concept – can be observed or experienced
through senses
Abstract Concept – not observable i.e hope, caring

STRUCTURE LEVEL OF NURSING KNOWLEDGE

Nursing Metaparadigm allows nurses to understand and
explain what nursing is, what nursing does, and why nurses do
what they do (Fawcett and DeSanto-Mayenda, 2013)
The nursing metaparadigm has 4 concepts of: person (or
human beings), health, environment and situation and nursing.
a. Person is the recipient of nursing care
b. Environment/Situation includes all possible conditions
affecting a continuous interaction between a patient and the
environment
Has positive and negative effects on a person’s health care
needs
Factors in the home, school, workplace or community
influence the level of these needs

STRUCTURE LEVEL OF NURSING KNOWLEDGE

c. Health

- the state of being free from illness or injury

- “Health is a state of complete physical, mental and

social well-being and not merely the absence of
disease or infirmity” WHO

STRUCTURE LEVEL OF NURSING KNOWLEDGE

d. Nursing is the … protection, promotion, and
optimization of health and abilities, prevention of
illness and injury, alleviation of suffering through the
diagnosis and treatment of human response and
advocacy in the care of individuals, families,
communities and population” (ANA, 2014)

“The art of nursing is the creative use of the science

of nursing for human betterment”
Rogers,1990

STRUCTURE LEVEL OF NURSING KNOWLEDGE

Philosophies of Nursing – general meaning of nursing and nursing
phenomena through reasoning and the logical presentation of
ideas
e.g. Florence Nightingale : Modern Nursing
Conceptual Models of Nursing
– paradigms or frameworks
- Set of concepts and statements that integrate the concepts
into a meaningful configuration
e.g. Roy’s Adaptation Model
Assumptions – values and beliefs of the theory or conceptual
framework
Proposition – statement between a concept or a statement of
the relation between two or more concepts

STRUCTURE LEVEL OF NURSING KNOWLEDGE

The Philosophy of Nursing has been developing
over a 150-year period:
Caring is the wholeness of the patient’s situation,
which implies that nursing care requires
interpretation,understanding, and hermeneutic
experience.
The philosophy of caring involves knowledge, skills,
patient trust, and the ability to manage all elements
simultaneously in the context of care; KSA

STRUCTURE LEVEL OF NURSING KNOWLEDGE

CONCEPTS
Something understood or retained in the mind, from
experience, reasoning, and/or imagination;
a generalization or abstraction of a particular set of
instances or occurrences
e.g. person, health, environment, nursing
Conceptual Framework/Model
A set of interrelated concepts that symbolically represents
and conveys a mental image of a phenomenon.
Conceptual models of nursing identify concepts and describe
their relationships to the phenomena of central concern to
the discipline: person, environment, health and nursing

STRUCTURE LEVEL OF NURSING KNOWLEDGE

The Philosophy of Nursing has been developing
over a 150-year period:
Wholistic nursing views the biophysical, psychological,
and sociological subsystems as related but separate,
thus the whole is equal to the sum of the parts.
Holistic nursing recognizes that multiple subsystems
are in continuous interaction and that mind-body
relationships do exist
Naturalism insists that knowledge and beliefs are
gained by one’s senses guided by reason, and by the
various methods of science

STRUCTURE LEVEL OF NURSING KNOWLEDGE

Concept analysis is an important beginning step in
the process of theory development to develop a conceptual definition.
Theories are tested in reality; therefore, the concepts must be linked
to operational definitions

Concept
Body temperature
Theoretical Definition
Homeothermic range of one’s internal environment maintained by the
thermoregulatory system of the human body
Operational Definition
Degree of temperature measured by oral thermometer taken for 1
minute under the tongue

STRUCTURE LEVEL OF NURSING KNOWLEDGE

THEORY
helps explain an event by defining ideas or concepts, explaining
relationships among the concepts and predicting outcomes
(McEwen and Wills, 2014)
In nursing, theories are designed to explain a phenomenon such as
self-care or caring
CHARACTERISTICS OF A THEORY
A theory is:
Logical in nature
Generalizable
Basis for hypotheses that can be tested
Interrelating concepts in such a way as to create a different way
of looking at a particular phenomenon

STRUCTURE LEVEL OF NURSING KNOWLEDGE

Theory is an organized, coherent, and systematic
articulation of a set of statements related to significant
questions in a discipline that are communicated in a
meaningful whole

Nursing Theory – pertains to nursing

- describing, explaining, predicting or prescribing
nursing care

STRUCTURE LEVEL OF NURSING KNOWLEDGE

Types of Theory
Grand theories are abstract, broad in scope and
complex; they require further clarification through
research
- Does not provide guidance for specific nursing
interventions; but provides the structural framework
for general; global ideas about nursing
Intend to answer, “What is nursing” and focus on the
whole of nursing rather than on a specific type of
nursing
e.g. Imogene King, Dorothea Orem

STRUCTURE LEVEL OF NURSING KNOWLEDGE

Types of Theory
Middle-range theories are more limited in scope and
less abstract (e.g. Jean Watson, Joyce Travelbee)
Address a specific phenomenon and reflect practice
(administration, clinical or teaching)
e.g. Kolcaba’s Theory of Comfort encourages nurses to
meet patient’s needs for comfort in physical, psycho-
spiritual, environmental and sociocultural realms.
Kolcaba’s theory was based on the works of a grand
theorist – Nightingale

STRUCTURE LEVEL OF NURSING KNOWLEDGE

Types of Theory
Practice theories – also known as situation-specific
theories, bring theory to the bedside
Guide the nursing care of a specific patient population at a
specific time (Meleis, 2012)
E.g. Pain management protocol for patients recovering
form cardiac surgery
Descriptive theories are the first level of theory
development
Describe phenomena and identify circumstances in which
the phenomena occur
ex. Theories of growth and development

STRUCTURE LEVEL OF NURSING KNOWLEDGE

Types of Theory
Prescriptive theories address nursing interventions for a
phenomenon, guide practice change and predict the
consequences
i.e. outcomes of nursing interventions
Theory-Based Nursing Practice
Nature of nursing as a profession that requires knowledge
distinct from medical knowledge (Nightingale, 1860)
EBP
Nursing Process (assessment, planning, implementation,
evaluation)

STRUCTURE LEVEL OF NURSING KNOWLEDGE

Types of Theory
Shared theories
From other disciplines (medical, sociological and
behavioral sciences)
e.g.
Piagets’ theory of cognitive development
Children think, reason, and perceive the world
Knowle’s adult learning theory
- Provide discharge teaching for a patient recovering
from surgery

STRUCTURE LEVEL OF NURSING KNOWLEDGE

 Structure Level Example
Metaparadigm Person, environment, health, and
nursing
Philosophy Nightingale
Conceptual models Neuman’s systems model
Theory Neuman’s theory of optimal client
stability

Maintaining optimal client stability

Middle-range theory
with structured activity (body recall)
in a community setting for healthy
aging

Knowledge Structure Levels

with Examples
Types of Nursing Theoretical Works
Nursing Philosophies
Nightingale
Watson
Ray
Benner
Martinsen
Eriksson
Nursing Conceptual Models
Levine
Rogers
Orem
King
Neuman
Roy
Theory Development in the Scientific Method:
Observation: Start with an observation that evokes a
question
Logical hypothesis: Using abductive, inductive, or
deductive logic, state a possible answer (hypothesis)
Testing: Perform an experiment or test
Dissemination: Publish your findings for the discipline.
Replication: Other scientists will read your published
work and try to duplicate it (verification).
Theory: If experiments from other researchers support
your hypothesis, it will become a theory

STRUCTURE LEVEL OF NURSING KNOWLEDGE

Types of Nursing Theoretical Works
Nursing Theories
Boykin and Schoenhofer
Meleis
Pender
Leininger
Newman
Parse
Erickson, Tomlin, and Swain
Husted and Husted
Types of Nursing Theoretical Works
Middle-Range Nursing Theories
Mercer
Mishel
Reed
Wiener and Dodd
Eakes, Burke, and Hainsworth
Barker
Kolcaba
Beck
Swanson
Ruland and Moore
Hildegard E. Peplau
Theory of Interpersonal Relations
Nurse-Patient relationship as a “significant , therapeutic
interpersonal process”
4 phases:
1. Orientation
2. Identification
3. Exploitation
4. Resolution

6 nursing roles:
stranger, resource person, teacher, leader, surrogate and
counselor

Nursing Theorists of Historical Significance

Virginia Henderson

- viewed the patient as an individual who requires help

toward achieving independence and completeness or
wholeness of mind and body

- nursing as independent from the practice of physicians

- 14 basic human needs

Nursing Theorists of Historical Significance

Faye Glenn Abdelah
- 21 Nursing Problems
- Nursing as an art and a science

Ernest Wiedenbach
-The Helping Art of Clinical Nursing
- theory of development and maternal infant nursing
- 4 elements of clinical nursing: philosophy, purpose,
practice and art

Nursing Theorists of Historical Significance

Lydia Hall
- Core, Care and Cure Model

Joyce Travelbee
- Human to Human Relationship
- Care (The Body), The Core (The Person), The Cure (The
Disease)

Joyce Travelbee
-Human to Human Relationship Theory
1) Original encounter
2) Emerging identities
3) Empathy
4) Sympathy
5) Rapport
Nursing Theorists of Historical Significance
Kathryn Barnard
- Child Health Assessment
- Infant mental health (first 5 years of life)

Evelyn Adam
- Conceptual Model of Nursing

Nancy Roper, Winifred Logan, Alison Tierney

- A Model for Nursing Based on a Model of Living
- ALs (activities of living): biological, psychological,
sociocultural, environmental and politicoeconomic

Nursing Theorists of Historical Significance