THEORETICAL

FOUNDATION OF
NURSING
INTRODUCTION TO NURSING THEORY
Presented by Liana Cervantes
CHARACTERISTICS OF THEORY

1. ABSTRACTNESS (independence of time and space);

2. INTERSUBJECTIVITY (agreement about meaning among

relevant scientists);

3. EMPIRICAL RELEVANCE (can be compared to empirical

findings).
CHARACTERISTICS OF THEORY

1. ABSTRACTNESS
A concept is independent of a specific time or place. In other words, a
concept is not related to any unique temporal (historical time) or
spatial(location) setting.
CHARACTERISTICS OF THEORY

2. INTERSUBJECTIVITY
A. (MEANING)
“Intersubjectivity” means shared agreement among relevant individuals with
respect to :
(1) The events or phenomena encompassed by a concept, and
(2) The relationship between concepts specified by one or more statements

a. Explicitness—description in necessary detail and with terms selected to insure

that the audience agrees on the meaning of the concepts;
CHARACTERISTICS OF THEORY

INTERSUBJECTIVITY
B. (LOGICAL RIGOR)
The concept of intersubjectivity with respect to relationships between concepts
is more complex. Any statement, at a minimum,describes a relationship between
two concepts.
Rigorousness (logical rigor)—use of logical systems that are shared and
accepted by the relevant scientists to insure agreement on the predictions
and explanations of the Theory;
CHARACTERISTICS OF THEORY

EMPIRICAL RELEVANCE
The possibility of comparing some aspect of a scientific statement, a prediction
or an explanation, with objective empirical research.
The possibility should always exist that other scientists can evaluate the
correspondence between the theory and the results of empirical research.
WHAT IS A NURSING THEORY?

Meleis (2007) defines nursing theory as

“ a conceptualization of some aspect of nursing reality

communicated for the purpose of describing phenomena,
explaining relationships between phenomena, predicting
consequences, or prescribing nursing care”
CLASSIFICATION OF THEORIES IN NURSING
I. SCOPE OF THEORY
A. METATHEORY
B. GRAND THEORIES
C. MIDDLE RANGE THEORIES
D. PRACTICE THEORIES

II. TYPE OR PURPOSE OF THEORY

A. DESCRIPTIVE THEORIES(Factor-isolating theories)
B. EXPLANATORY THEORIES (Factor-relating theories)
C. PREDICTIVE THEORIES/PROMOTING OR INHIBITING THEORIES (Situation-relating
theories)
D. PRESCRIPTIVE THEORIES (Situation-producing theories)
III. CATEGORIZATION BASED ON SOURCE OR DISCIPLINE
CLASSIFICATION OF THEORIES
I. SCOPE OF THEORY
A. METATHEORY
 Theory about theory.
 Is a term used to label theory about the theoretical process and theory development

 To describe the philosophical basis of the discipline

 In nursing, metatheory focuses on broad issues such as the processes of generating knowledge and theory
development, and it is a forum for debate within the discipline.
 CLASSIFICATION OF THEORIES
I. SCOPE OF THEORY
A. METATHEORY
Example Theories
1. FOUR-C MODEL OF CREATIVITY
Dr. James C. Kaufman and Dr. Ronald Beghetto
 Consist of four developmental levels of creativity.(mini-c, little-c, Pro-c, and Big-C. Mini-c creativity)
 Offers a useful conception of humble, everyday forms of creativity.
2. BLIND VARIATION AND SELECTIVE RETENTION CREATIVITY THEORY (BVSR):
Donald T. Campbell
 Argues that creativity is a process involving an essentially random generation of ideas followed by evaluation of
those ideas, is clearly intended as a domain-general model of creativity, but the degree to which it
actually describes creative thinking is likely to vary greatly by domains.
3. THE DIVERGENT THINKING MODEL
Dr. James C. Kaufman
 The ability to think of as many different possible solutions as possible to an open question or problem.
CLASSIFICATION OF THEORIES

I. SCOPE OF THEORY
B. GRAND THEORIES
 The most complex and broadest in scope.
 Attempt to explain broad areas within a discipline and may incorporate numerous other theories.
 The term macrotheory is used by some authors to describe a theory that is broadly conceptualized
and is usually applied to a general area of a specific discipline (Higgins & Moore, 2000; Peterson,
2017).
 Grand theories are nonspecific and are composed of relatively abstract concepts that lack
operational definitions. Their propositions are also abstract and are not generally amenable to
testing.
 Grand theories are developed through thoughtful and insightful appraisal of existing ideas as
opposed to empirical research
 CLASSIFICATION OF THEORIES
I. SCOPE OF THEORY
B. GRAND THEORIES
Example Theories
1. Myra Levine’s Conservation Model
 Levine developed the Four Conservation Principles. In this model, the goal of nursing is to promote adaptation and maintain wholeness
using the principles of conservation. The model guides nurses to focus on the influences and responses at the level of the organism.
Nurses accomplish the theory’s goal through the conservation of energy, structure, and personal and social integrity.

2. Dorothy Johnson’s Behavioral System Model

 Proposed that the nursing client is a behavioral system with behaviors of interest to nursing and is organized into seven subsystems of
behavior: achievement, affiliative, aggressive, dependence, eliminative, ingestive, and sexual. Nurses using the model believed that an
additional area of behavior needed to be addressed (Auger, 1976; Derdiarian, 1990; Grubbs, 1974; Holaday, 1980).

3. Dorothea Orem’s Self-Care Deficit Theory

 It focuses on each individual’s ability to perform self-care, defined as “the practice of activities that individuals initiate and perform on
their own behalf in maintaining life, health, and well-being.”

4. Imogene King’s Theory of Goal Attainment

 It describes a dynamic, interpersonal relationship in which a patient grows and develops to attain certain life goals. The theory explains
that factors which can affect the attainment of goals are roles, stress, space, and time.

5. Sister Callista Roy’s Adaptation Model

 Sister Callista Roy's Adaptation Model focuses on changes experienced by human beings as they respond to environmental stimuli to
maintain their integrity. The major concepts include people as adaptive systems (both individuals and groups), the environment, health,
and the goal of nursing
CLASSIFICATION OF THEORIES
I. SCOPE OF THEORY
C. MIDDLE RANGE THEORIES
 Merton (1968) describes middle range theories as those “that lie between the minor
but necessary working hypotheses that evolve in abundance during day-to-day research
and the all-inclusive systematic efforts to develop unified theory that will explain all the
observed uniformities of social behavior, social organization and social change” (p. 39).
 Descriptions of middle range theory in the nursing literature reflect congruency with
Merton. Nurse authors have described middle range theory as follows:
• Narrower in scope than grand theories (Fawcett, 2005a; Suppe, 1996)
• Composed of a limited number of concepts and propositions that are written at
a level that is concrete and specific (Fawcett, 2005a; McKenna, 1997)
• Concerned with less abstract, more specific phenomena (Fawcett, 2005a;
Meleis, 2007)
• More applicable to practice. (Fawcett, 2005a; Liehr & Smith, 1999)
 CLASSIFICATION OF THEORIES
I. SCOPE OF THEORY
C. MIDDLE RANGE THEORIES
Example Theories
1. COMFORT THEORY KATHARINE KOLCABA
 Patient comfort exists in three forms: relief, ease, and transcendence. These comforts can occur in four contexts: physical, psychospiritual, environmental, and
sociocultural.

2. QUALITY CARING MODEL JOANNE R. DUFFY

 Provides the clinician with a way of practicing nursing that is primarily relationship-centered.
 It provides a “way of being with” patients and families through the caring factors that can be used to guide nursing interventions and ongoing learning about the
self.

3. THEORY OF SELF-TRANSCENDENCE PAMELA G. REED

 Proposes that when people face life-threatening illness or undergo health-related changes that intensify one’s awareness of vulnerability, there may be a readiness
or need to expand (or transcend) the self-boundary to

4. THEORY OF CARING KRISTEN M. SWANSON

 integrate those changes in order to achieve a sense of well-being. Individuals often do this themselves, but in times of difficulty nurses and other health
professionals can help in this process.

5. THEORY OF UNITARY CARING MARLAINE C. SMITH

 The primary assumption of this theory is that every patient, regardless of sex, age, prejudices, and other factors, has the right to rely on help from junior medical
personnel (Smith & Parker, 2015)
CLASSIFICATION OF THEORIES
I. SCOPE OF THEORY
D. PRACTICE THEORIES
 Practice theories are also called situation-specific theories, prescriptive theories, or
microtheories and are the least complex.
 Practice theories are nursing theories used in the actual delivery of nursing care to
clients.
CLASSIFICATION OF THEORIES
I. SCOPE OF THEORY
D. PRACTICE THEORIES
Example Theories
1. THEORIES OF HEALING, AIRWAY PATENCY, FATIGUE, AND SPEECH. (Theories providing explanations about client
problems)

2. THEORIES OF SUCTIONING, WOUND CARE, REST, AND LEARNING (Theories describing therapeutics for client
problems)

3. THEORIES OF CARING, EMPOWERMENT, AND COMMUNICATION (Theories providing the nurse with ideas about how
to approach clients)

4. THEORIES OF CLINICAL INFERENCE AND CLINICAL DECISION MAKING (Theories providing explanations or ideas about how
the nurse makes or should make decision)

5. THEORIES DESCRIBING OUTCOMES OF CLIENT CARE (Theories providing explanations about what happens )
CLASSIFICATION OF THEORIES

II. TYPE OR PURPOSE

A. DESCRIPTIVE (FACTOR-ISOLATING) THEORIES
 Descriptive theories are those that describe, observe, and name concepts, properties, and
dimensions.
 Descriptive theory identifies and describes the major concepts of phenomena but does not explain
how or why the concepts are related.
 The purpose of descriptive theory is to provide observation and meaning regarding
the phenomena.
 It is generated and tested by descriptive research techniques including concept analysis, case
studies, literature review phenomenology, ethnography, and grounded theory.
 CLASSIFICATION OF THEORIES

II. TYPE OR PURPOSE

A. DESCRIPTIVE (FACTOR-ISOLATING) THEORIES
EXAMPLE THEORIES
1. CLINICAL GROWTH: An Evolutionary Concept Analysis
Jessica Barkimer
 A concept analysis of clinical growth in nursing education produced defining attributes, antecedents, and consequences..
Identification of critical attributes allows educators to adapt to student-centered learning in the clinical environment.
2. THEORETICAL MODEL OF HOSPICE NURSES’ RESPONSES TO PATIENT SUFFERING
Jodi L. Sacks, PhD, APRN, ANP-C, ACHPN ƒ Deborah L. Volker, PhD, RN, AOCN, FAAN
 The purpose of this study was to develop an inductive theory describing the process that hospice nurses use to identify
and respond to their patients’ suffering. In addition, the study sought to describe the coping strategies that hospice
nurses used when working with patients they considered to be suffering.
CLASSIFICATION OF THEORIES

II. TYPE OR PURPOSE

B. EXPLANATORY THEORIES
 Factor-relating theories, or explanatory theories, are those that relate concepts to one
another, describe the interrelationships among concepts or propositions, and specify the
associations or relationships among some concepts.
 They attempt to tell how or why the concepts are related and may deal with cause and
effect and correlations or rules that regulate interactions.
 They are developed by correlational research and increasingly through comprehensive
literature review and synthesis.
 CLASSIFICATION OF THEORIES
II. TYPE OR PURPOSE
B. EXPLANATORY (FACTOR-RELATING) THEORIES
EXAMPLE THEORIES

1. A THEORETICAL MODEL OF HEALTH-RELATED OUTCOMES OF RESILIENCE IN MIDDLE ADOLESCENTS

Robert Scoloveno
 This theory was developed from a correlational research study that surveyed the effects of resilience on hope, well-being, and health
promoting lifestyle in middle adolescents.

2. MEANING IN LIFE: A CONCEPTUAL MODEL FOR DISASTER NURSING PRACTICE

Uki Noviana, Misako Miyazaki, Mina Ishimaru
 Aimed to develop a conceptual model for understanding meaning in life (MIL) using respondents' quotations in the primary qualitative
studies.

3. A MODEL OF PERSON, FAMILY, AND CULTURE-CENTERED NURSING CARE

Maichou Lor, Natasha Crooks , Audrey Tluczek
 To explicate and compare four conceptual care models: person-, patient-, family-centered, and culturally competent care
CLASSIFICATION OF THEORIES

II. TYPE OR PURPOSE

D. Predictive (Situation-Relating) Theories
 Situation-relating theories are achieved when the conditions under which concepts are related are
stated and
the relational statements are able to describe future outcomes consistently.
 Situation-relating theories move to prediction of precise relationships between concepts.
Experimental research is used to generate and test them in most cases.
 Predictive theories are relatively difficult to find in the nursing literature.
CLASSIFICATION OF THEORIES

II. TYPE OR PURPOSE

C. PREDICTIVE THEORIES
1. Cobb (2012) used a quasi-experimental, model-building approach to predict the RELATIONSHIP BETWEEN
SPIRITUALITY AND HEALTHSTATUS AMONG ADULTS LIVING WITH HIV.
2. In another example, Fearon-Lynch and Stover (2015) merged two research-based, extant theories to
develop a middle range THEORY EXPLAINING MASTERY OF DIABETES SELF MANAGEMENT.
3. CAREGIVING EFFECTIVENESS MODEL. by Smith and colleagues (2002)
 In the model, caregiving effectiveness is dependent on the interface of a number of factors including the
characteristics of the caregiver, interpersonal interactions between the patient and caregiver, and the educational
preparedness Of the caregiver, combined with adaptive factors, such as economic stability, and the caregiver’s own
health status and family adaptation and coping mechanisms.
 CLASSIFICATION OF THEORIES

II. TYPE OR PURPOSE

D. Prescriptive Theories

 Situation-producing theories are those that prescribe activities necessary to reach defined goals.
 Prescriptive theories address nursing therapeutics and consequences of interventions. They include
propositions that call for change and predict consequences of nursing interventions. They should describe
the prescription, the consequence(s), the type of client, and the conditions (Meleis, 2012).
CLASSIFICATION OF THEORIES

II. TYPE OR PURPOSE

A. PRESCRIPTIVE THEORIES THEORIES
EXAMPLE THEORIES

1. “PRESCRIPTIVE THEORY EXPLAINING MEDICAL ACUPUNCTURE” FOR NURSE

PRACTITIONERS Walling (2006).
 The model describes how acupuncture can be used to reduce stress and enhance well-being.

2. Auvil-Novak (1997) THEORY OF CHRONOTHERAPEUTIC INTERVENTION FOR POSTSURGICAL

PAIN
 based on three experimental studies of pain relief among postsurgical clients.
 The theory uses a time-dependent approach to pain assessment and provides directed nursing
interventions to address postoperative pain
THANK YOU!