INTRODUCTION

TO NURSING
THEORY
Learning
Objectives
A. Introduction to Nursing Theory
1. History of Nursing theory
2. Significance for the:
• Discipline
• Profession
A. Structure of Nursing Knowledge
1. Structure Level
2. Metaparadigm
❑ Person
❑ Health
❑ Environment
❑ Nursing
3. Philosophy
4. Conceptual Models
5. Theory
6. Middle-range theory
• Many nurses of early
times delivered
excellent care to
patients.
• However, much of
what is known about
nursing was passed on
through vocational
education that was
focused on skillful
completion of
functional tasks.
Though many of the practices
seemed effective, they are not
tested nor used uniformly.
Sustained efforts were put forth
by the nursing leaders for
nursing to be recognized as a
profession.
For nursing to be recognized as
a profession it should be
founded on a well-developed
body of knowledge or
substantive nursing knowledge
Comparison of Vocation and Profession

Vocation Profession

Driven by passion and intrinsic motivation Chosen for practical benefits and career advancement

May not require formal education or certification Requires specialized knowledge and training

Often associated with higher levels of income and

Often associated with lower levels of income and status
status
“Why should nurses be
interested in the history and The history and philosophy of science
philosophy of science? is important as a foundation for
exploring whether scientific results are
actually truth.
As nurses, our practice should be
based upon truth and we need the
ability to interpret the results of
science.
The legitimacy of any profession is
built on its ability to generate and
apply theory.”
(McCrae, 2011, p. 222)
Modern science was established over
400 years ago as an intellectual
activity to formalize given phenomena
of interest in an attempt to describe,
explain, predict, or control states of
affairs in nature.
Scientific activity has persisted
because it has improved quality of life
and has satisfied human needs for
creative work, a sense of order, and
the desire to under- stand the
unknown
(Bronowski, 1979; Gale, 1979;
Piaget, 1970).
History of
Nursing Theory
Development
• Started with the writings
of Florence Nightingale
• Notes on Nursing What
is it and what is Not?
• This book theoretically
describes the nature of
nursing
Nursing
Theories tree
 Historical Eras of Nursing’s Search for Specialized Knowledge
Historical Eras Major Question Emphasis Outcomes Emerging Goal

Curriculum What curriculum content Courses included in Standardized curricula Develop specialized
Era: should student nurses nursing programs for diploma programs knowledge and higher
1900 to 1940s study t be nurses? education

Research Era: What is the focus for Role of nurses and what Problem studies and Isolated studies do not
1950 to 1970s nursing research? to research studies of nurses yield unified knowledge

Graduate Edu- What knowledge is Carving out an advanced Nurses have an impor- Focus graduate educa-
cation Era: needed for the role and basis for tant role in health tion on knowledge
practice of nursing? nursing practice care
1950 to 1970s development

Theory Era: How do these frame- There are many ways to Nursing theoretical Theories guide nursing
1980 to 1990s works guide research think about nursing works shift the focus research and practice
and practice? to the patient

Theory What new theories Nursing theory guides Middle-range theory Nursing frameworks
Utilization Era: are needed to produce research, practice, may be from quanti- produce knowledge
Twenty-first evidence of quality education, and tative or qualitative (evidence) for quality
Century care? administration approaches care
• Nursing theoretical works
represent the most
comprehensive presentation of
systematic nursing knowledge;
therefore, nursing theoretical
works are vital to the future of
both the discipline and the
profession of nursing.
The Meaning of a Discipline and a
Profession
Discipline

……is specific to academia and refers

to a branch of education, a department
of learning, or a domain of knowledge.

Alligood (2018),
Profession

…..refers to a specialized field of prac-

tice, founded upon the theoretical
structure of the science or knowledge
of that discipline and accompanying
practice abilities.
Alligood (2018),
Nursing is both a discipline and a profession.
Significance of theories
in Nursing Discipline
• Provide for general focus for curriculum design.

• Guide curricular decision making.

• Offer a framework for generating knowledge and

new ideas.

• Assist in discovering knowledge gaps in the specific

field of study.

• Offer a systematic approach to identify questions

for study, select variables, interpret finding and
validate nursing interventions.
 Criteria for Development of the Professional
Status of Nursing
1. Utilizes in its practice a well-defined and well-
organized body of specialized knowledge [that] is on the
intellectual level of the higher learning.

2. Constantly enlarges the body of knowledge it

uses and improves its techniques of education and service
through use of the scientific method.

3. Entrusts the education of its practitioners to

institutions of higher education.

4. Applies its body of knowledge in practical

services vital to human and social welfare
Criteria for Development of the Professional
Status of Nursing
5. Functions autonomously in the formulation of
professional policy and thereby in the control
of professional activity.

6. Attracts individuals with intellectual and

personal qualities of exalting service above
personal gain who recognize they’re chosen
occupation as a life work.

7. Strives to compensate its practitioners by

providing freedom of action, the opportunity for
continuous professional growth, and economic
Security.
 Significance of theories for the
Nursing Profession
• Help to establish criteria to measure the quality of
nursing care.

• Help build a common nursing terminology to use in

communicating with other health professionals. Ideas
are developed & words defined.

• Enhance the autonomy( independence & self-

governance) of nursing by defining its own
independent functions.
 Significance of theories for the
Nursing Profession
• Assist nurses to describe, explain and predict everyday
experiences.

• Serve to guide assessment, intervention, & evaluation

of nursing care.

• Provide a rationale for collecting reliable & valid data

about the health status of clients, which is essential
for effective decision-making & implementation.
History of Nursing Theory Development
• 1950s- gov’t recognize the need
to prepare nurses at the
graduate level for administrative
position
• Columbia University Teacher’s
College- developed an education
program to meet the need.
History of Nursing Theory Development
• 1960s- theoretical thinking
shifted on the relationship
between the nurse and the
patient
• Nursing is a PROCESS
• “ What & How the nurses do
and How patient perceives his or
situation
TO BE CONTINUED
4 Major Concepts of Nursing Theory/ Nursing
Paradigm
Person

▪ the recipient of nursing care.

▪ Includes physical, spiritual,
psychological and socio-
cultural components.
▪ Individual, family , community.
 Environment

▪ A ll internal and external conditions,

circumstances, and influences
affecting the person.

▪ All possible conditions affecting the

client and the setting in which
health care needs occur.

▪ In can be influenced by factors

at home, school or workplace
Health……
• is dynamic and
continuously changing
Nursing
• Nursing is the
attributes,
characteristics and the
action of the
nurse providing care
on behalf of, or on
conjunction with the
client.
• Philosophies- (from Greek, by
way of Latin, philosophia, “love of
wisdom”) the rational, abstract,
and methodical consideration of
reality as a whole or of fundamental
dimensions of human existence and
experience.

• Philosophical inquiry is a central

element in the intellectual history of
many civilizations.
Famous Philosophers
• Philosophies of nursing,
conceptual models of nursing,
nursing theories, and middle-range
theories provide the nurse
with a view of the patient
and a guide for data
processing, evaluation of
evidence, and decisions
regarding action to take in
practice
 Two competing philosophical foundations of science,
Rationalism And Empiricism, have evolved in the era of
modern science with several variations.
Rationalist epistemology
❑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).
❑. The traditional approach proceeds by explaining hospitalization with a systematic explanation
(theory) of a given phenomenon (Gale, 1979).

❑Theoretical assertions derived by deductive reasoning are then subjected to experimental testing
to corroborate the theory. Reynolds (1971) labeled this approach the theory-then-research
strategy.
The empiricist view
❑Based on the central idea that scientific knowledge can be derived only from
sensory experience (i.e., seeing, feeling, hearing facts). Francis Bacon (Gale,
1979) received credit for popularizing the basis for the empiricist approach to
inquiry.
❑Bacon believed that scientific truth was discovered through generalizing
observed facts in the natural world.
❑This approach, called the inductive method, is based on the idea that the
collection of facts precedes attempts to formulate generalizations, or as Reynolds
(1971) called it, the research-then-theory strategy.
Common Terms
Conceptual Models
• Are sets of concepts that
address phenomena central to
nursing in propositions that
explains the relationship among
them.

• Example in the environmental

model of Florence Nightingale
Nursing Theory
• …..Testable propositions from
philosophies, conceptual
models, grand theories, abstract
nursing theories, or theories
from other disciplines.

• ……it provides framework to

develop new & validate current
knowledge.
Nursing Theory

• Nursing theories provide a

framework for nurses to
systematize their nursing
actions: What to ask, what to
observe, what to focus on, and
what to think about.
Theory….systematic, organized perspectives serve as a guides for
nursing action in administration, education, research and practice.

…. A set of statements that tentatively describe, explain, or predict

relationships among concepts that have been systematically selected
and organized as an abstract representation of some phenomenon.
CONCEPT

Concept Kinds of Concept

mental formulation of an object or • Concrete concept- example:
event or phenomena that comes Ipod, body temperature, height,
from individual perceptual age
experience, an idea, a mental image,
words that describe objects,
properties or events.
• Abstract concept- example:
Formulated in words to enable hope, love, desire
people to communicate and give
meaning to event or phenomena.
Construct Definition
• a group of words forming a • General meaning of the concept.
phrase That fits the theory.
• Complex type of concept,
comprised of more than one • Necessary to measure construct,
concept. relationships or variables within
the theory.
• a phenomena that cannot be
observed and must be inferred
 • representations of the interaction among
Model and between the concepts showing
patterns.

• as an abstraction of reality, provides a way

to visualize reality to simplify thinking.
Phenomena
• designation of an aspect of reality
that can be consciously sensed or
experienced; event; happening;
occurrence, incidence,

Ex. Divorce/ break up

Hospital confinement
Death
loss of job
Marriage
 Analysis of Theory
• Clarity: How clear is this theory?
• Simplicity: How simple is this theory?
• Generality: How general is this theory?
• Accessibility: How accessible is this theory?

• Importance: How important is this theory

▪ Concepts most specific to practice
that propose precise testable
nursing practice questions and
include details such as patient age,
group, family situation, health
condition, location of the patient
and action of the nurse.

▪ can be tested.
▪ limited number of concepts

Ex. (Pender,Benner)
 2 Primary Reasons why the theorist Created
theories?
1. To further
nursing as a
scholarly
profession.

2. To organize
and improve
the delivery of
nursing care.
THE END