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MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Alimannao Hills, Peñablanca Cagayan

NCM 100

Theoretical Foundation of Nursing

First Semester F.Y.2022-2023 Prelims

Glaiza P. Salvador, RN, MSN

Clinical Instructor
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Table of contents
I. Preliminaries
Chapter 1: introduction of nursing theory

Definition of:
1. Theory
2. Nursing Theory
3. Nursing Paradigms
a. Person
b. Health
c. Environment
d. Nursing
4. Philosophy
5. Conceptual Models
6. Science
7. Knowledge
8. Phenomenon
9. Concepts

Chapter 2: importance of nursing theory

1. Education
2. Research
3. Clinical Practice

Chapter 3: four ways of knowing

1. Empirical
2. Ethical
3. Esthetics
4. Personal

Chapter 4: development process of theory in nursing

1. Rationalism
2. Empiricism
3. Science & Theory in the early 20th Century
4. Science & Theory in the late 20th Century

Chapter 5: categories of theories

1. Micro-range (Practice Theories)
2. Middle range theories
3. Grand theories
4. Non-Nursing Theories
a. Human Need theory
b. Systems Theory
c. Change Theory
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References:

--------------------Alligood, (2018). Nursing Theories and their Works 9th edition.

Other References:
1. Bastable, Susan B., (2019). Nurse as educator: principles of teaching and
learning for nursing practice (R)
2. Mcewen, (2019). Theoretical basis for nursing 5th ed. (R)
3. Potter, (2017). Fundamentals of nursing 9th ed. (T)
4. Bermam, (2016). Kozier and Erb's Fundamentals of Nursing: Concepts,
Process, and Practice volume 1+ vol 2 (T)
5. Nettina, S. (2014). Lippincott Manual of Nursing Practice10th ed

Journals:
1. American Journal of Nursing
2. Philippine Journal of Nursing Education
3. The Journal for Nurse Practitioners

Website:
1. www.nurseslabs.com
2. medicinenet.com
3. nursing-theory.org
4. www.nursingguide.html
5. www.nursingscribd.com

Course Description:
This course deals with the meta concepts of a person, health, environment, and
nursing as viewed by the different theorists. Likewise, it includes non-nursing
theories such as systems, developmental and change theories. It presents how
these concepts and theories serve as guide to nursing practice. Its further deals
with health as a multifactorial phenomenon and the necessary core competencies
that the nurse need to develop.

Course Outcomes:
At the end of the course and given relevant actual or simulated
situations/conditions, the student will be able to:
1. Differentiate views given by various nursing theorists on person, health,
environment, and nursing
2. Describe the various non-nursing theories as applied to nursing
3. Utilize selected nursing theory and non-nursing theories in the care of clients
4. Demonstrate selected competencies under the eleven key area s of
responsibilities pertinent to nursing
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Chapter 1: introduction of nursing theory

Intended Learning Outcomes:

1. Define nursing theory and its implication to nursing practice
2. Provide examples and scenario where the nursing paradigm is applicable
3. Identify and discuss the nursing paradigms
4. Differentiate between philosophy, science, knowledge, phenomenon, and
concepts in nursing profession

Key Terms:
Theory
Paradigms
Person
Health
Environment
Nursing
Philosophy
Concepts
Science
Knowledge
Phenomenon

Let’s Begin!
*memorize/analyze all the terms

1. Theory
 This term came from ancient Greek word “THEORIA”, meaning looking at,
viewing, beholding
 It is a creative and rigorous structuring of ideas that project a tentative,
purposeful, and systematic view of phenomena in which proposed
explanation of a phenomena made in a way consistent with the scientific
method

Characteristics of Theory:
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1. Creative- underscores the role of human imagination and vision in theory

development
2. Tentative-open to revision as new evidence emerge
3. Purposeful-suggests a direction in how to view facts and events
4. Systematic- step by step process

2. Phenomena
 A phenomenon is something that which strikes one as strange, unusual, or
unaccountable, an extraordinary or very remarkable person, thing, or
occurrence
 It is an aspect of reality that people consciously sense or experience

3. Nursing theory- implication to Nursing Practice-Pls do own research

 It is a body of knowledge that is used to support nursing practice.
 This is derived from experiential learning, from formal sources such as
research or from non-nursing sources meaning from other theories
 Derived from nursing philosophies, conceptual models or more abstract
nursing theories or from works of other disciplines
 Conceptualization of some aspects of nursing for the purpose of describing,
explaining, predicting, nursing care

4. Nursing metaparadigms-
 “meta” Greek Word àwith & “paradigm” à pattern= (with pattern)
 These are patterns used to show relationship among existing theoretical
works in nursing
 It is the core content of nursing discipline
 It places a boundary on the subject matter of the discipline (focus of nursing
theory)
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The Four Nursing Metaparadigm

Nursing metaparadigm is essential to understand for
every nursing professional. The four basic concepts which
includes person, health, environment, and nursing are
very vital because understanding these concepts will
enable the professional nurse to address the patient as a whole in
terms of health and well-being, the patient’s current environment
and the nursing responsibilities. The nursing metaparadigm point to a
holistic view of care for the patient.

1. Person
- It is the term used for HUMAN BEING
- Considered the recipient/s of nursing care in the form of: individual, family or
community
- The focus of nursing practice

2. Health
- Health is a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity (WHO)
- Has different meanings for each client, the clinical setting, and the health care
profession
- It is dynamic and continuously changing. Your challenge is to provide the best
possible care based on the client's level of health and health care needs at the time
of care delivery

3. Environment
- It represents the persons immediate physical surroundings, the community, or the
universe and all that it contains
- The internal and external surroundings of the client
- It refers to the surroundings of an object

4. Nursing
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- The profession concerned with the provision of services essential to the

maintenance and restoration of health
- This may include diagnosing and treatment of human responses to actual or
potential health problems

5. Philosophy
- It is from the Greek word philosophia, which literally means love of wisdom
- It is an academic discipline that exercises reason and logic in an attempt to
understand reality and answer fundamental questions about knowledge, life,
morality and human nature
- It specifies the definition of paradigm concepts in each conceptual models of
nursing
- It provides a broad understanding and direction

6. Conceptual model/framework
- It is the representations of an idea (a model is anything used in any way to
represent anything else) based on the own understanding of the person
- The representations of the interaction among and between the concepts showing
patterns
- It allows the concepts in nursing theory to be successfully applied to nursing
practice
- Concepts that specify their interrelationship to form an organized perspective for
viewing the phenomena
Ex. King’s Goal Attainment

7. Science
- It came from Latin word: Scientia, meaning "knowledge"
- System of acquiring knowledge based on scientific method
- Organized knowledge based on research
• Basic Types of Science:
1. Natural Sciences- geology, meteorology
2. Basic or Pure Sciences- mathematics, English
3. Human or Social Sciences- political science, economics, sociology,
psychology
4. Practice or Applied Sciences- nursing, engineering, architecture

8. Knowledge
- It is an expertise, and skills acquired by a person through experience or education

9. Concepts
- These are considered to be the building blocks of theory
- It can include words that describe objects, properties, or events and are basic
components of theory
- …or an idea, thought or notion conceived in the mind
- These bring forth mental pictures & give meanings of things

-Concepts can be categorized in terms of:

1. Types:
a. Empirical/Concrete
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b. Abstract
2. Defining:
a. Theoretical Definition
b. Operational Definition
3. Typologies:
a. Discrete
b. Continuous Concepts

-Categorization Of Concepts:

1.Empirical/ Concrete
-they can be observed or experienced through the senses
ex. Stethoscope (can be seen and touch)
2.Abstract
-those that are not observable, such as caring, hope, and infinity
-all concepts become abstractions in the absence of the object
ex. social system, nurse competency
3.Theoretical Definitions
-are the meaning of a word based on how a certain theory or relevant
literature perceives it to be.
4.Operational Definitions
-are meaning of a word based on the method of how it was measured
or how the person come up with the perception
5.Discrete
-identifies categories or classes of phenomena
ex. Typologies of marital status: single, married, widowed, or divorced
6.Continuous
-permits classifications of dimensions or gradations of a phenomena
ex. indicating degree of marital conflict. (High or low)
-it uses continuum
ex. degree of temperature, level of anxiety, degree of pain
-can be simple or complex and relate to an object or event that comes from
individual perceptual experiences
ex. Height of children, Weight of cars, Time to wake up in the morning, Speed
of the train

Concepts clarifies the subject matter of the theories of a discipline.

They can be compared to as bricks of wall and lend structure. For an
instance, concepts from psychology include personality, intelligence,
and cognition. For nursing discipline concepts have been borrowed or
derived from other disciplines and as well as directly from nursing
practice and research. As a professional nurse one must be able to
fully comprehend the concepts of nursing discipline so as to be able to
apply it appropriately in nursing practice.

END of Chapter 1
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Chapter 2- Importance of nursing theory

This chapter include importance of nursing theory in nursing clinical practice,
nursing education and nursing research. It will help students better understand
the application of nursing theory in the three major areas of expertise of nursing
discipline.

Importance of Nursing Theory in:

1. Clinical Practice
2. Nursing Education
3. Nursing Research

Intended Learning Outcomes:

1.Create a conceptual model based on current needs in nursing practice,
administration and education

Key Terms:
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Clinical Practice
Health Care Providers
Nursing Education
Nursing Curriculum

Let’s Begin!
A. Clinical practice
-Assists nurse to describe, explain, & predict everyday experiences
-Serves to guide assessment, intervention, and evaluation of nursing care
-Provides a rationale for collecting reliable data about the health status of clients
essential for decision-making & implementation
-Helps to establish criteria to measure the quality of nursing care
-Helps build a common nursing terminology to use in communicating with other
HCPs
-Enhances autonomy of nursing through defining its own independent functions

B. Education
-Provides a general focus for curriculum design
-Guides curricular decision making

C. Research
-Offers a framework for generating knowledge & new ideas
-Assists in discovering knowledge gaps in the specific field of study
-Offers a systematic approach to identify questions for study, select variables,
interpret findings & validate nursing interventions

D. Nursing Curriculum
-The nursing curriculum has traditionally been skills-based and test-driven, relying
heavily on behavioral objectives to assess techniques and processes. Over time,
curricular goals have changed, and nurses are now trained and prepared to engage
in critical decision-making and innovative practice. As a result, nursing as a
professional practice needs curricula that can articulate learning experiences with
goals, theory, and evidence-based content, as well as ethical and philosophical
underpinnings, in order to address contextualized and current public-health
priorities and community needs.
-consists of general education, major and professional nursing courses which
emphasizes nursing concepts and related learning experiences (RLEs), along with
intensive practicum to refine the necessary competencies in the field.

Theory in nursing is very vital in these three aspects of nursing

because it continues to advance nursing discipline through theory testing
research. It is widely believed that use of theory offers structure and
organization to nursing knowledge and provides a systematic means of
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collecting data to describe, explain and predict nursing practice. At the same
time, it distinguishes nursing from other caring professions by setting
professional boundaries.

End of Chapter 2

Chapter 3- four ways of knowing

This chapter will discuss the different ways of knowing applied in nursing
science. In application of these different ways of knowing in nursing discipline they
will have a better grasp on how to handle situations in their day-to-day experience
as a future nurse.

The four ways of knowing:

1. Empirics Knowing
2. Ethical Knowing
3. Esthetics Knowing
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4. Personal Knowledge

Intended Learning Outcomes:

1. Identify and discuss the four ways of knowing
2. Apply the four ways of knowing in their student nurse’s career

Key Terms:
Esthetics
Ethics
Empirics
Personal Knowledge

Let’s Begin!
"Nursing depends on the scientific knowledge of human behavior in health and in
illness, the esthetic perception of significant human experiences, a personal
understanding of the unique individuality of the self, and the capacity to make
choices within concrete situations involving particular moral judgments. “Barbara A.
Carper, 1978”.

Four ways of knowing

1. Empirical
-denotes information gained by means of observation, experience, or
experiment thus it is objective, abstract, generally quantifiable, exemplary,
and verifiable

-when verified through repeated testing overtime, it is formulated into

scientific generalizations, laws, theories, and principles that explain and
predict.

-Most emphasized way of knowing in nursing because there is a need to know

how knowledge can be organized into laws and theories for the purpose of
describing, explaining, and predicting phenomena of concern to nurses

2. Ethics
-Being in accordance with the accepted principles of right and wrong that
govern the conduct of a profession
-In nursing, it refers to the moral code in nursing and is based on obligation to
service and respect to human life.
-Ethical knowledge occurs as moral dilemmas arise in situations of ambiguity
and uncertainty and when consequences are difficult to predict.
-Requires rational and deliberate examination and evaluation of what is good,
valuable, desirable as goals motives or characteristics.
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3. Aesthetics/ Esthetics
-Is a branch of philosophy dealing with the nature of beauty, art, and taste,
and with the creation and appreciation of beauty.
-Relies on perception
-It is expressive, subjective, unique, and experiential rather than formal or
descriptive.
-It involves sensing the meaning of the moment
-It is evident through actions, attitudes, and interactions of the nurse in
response to another. It is not usually expressed in language.

4. Personal
-Knowledge of the self, individual’s, private, owned
-Incorporates experience, knowing, encountering, and actualizing the self
within the practice.
-Personal maturity and freedom are components of personal knowledge.
-Expressed in personality

Integration of all patterns of knowing are essential for professional

nursing practice. They are interrelated and independent because there are
multiple points of contact between and among the four concepts. There are
instances that two or more of the patterns of knowing in nursing is utilized in
one circumstance or situation.
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To supplement your readings, here is a link of actual video

lecture/presentation regarding the topic.

https://www.youtube.com/watch?v=1gWyPF0TZ4w
https://www.youtube.com/watch?v=RwF0ugfAAQk Empirical Knowing
https://www.youtube.com/watch?v=V69P7zb8z9Q Aesthetic Knowing
https://www.youtube.com/watch?v=LzDnSc_mmXU Personal
Knowledge
https://www.youtube.com/watch?v=bO7q9c92ipQ Ethical Knowing

End of Chapter 3
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Chapter 4- development process of theory in nursing

This chapter will outline the different views of scientists and philosophers in
terms of nursing theory development. Furthermore, it will discuss the relationship of
theory development based on rationalism and empiricism. Understanding the
nature of these different philosophical stances will facilitate appreciation of what it
contributed to nursing knowledge.

Development Process of Theory in Nursing:

A. Rationalism
B. Empiricism
C. Science in Theory in the 20th Century
c.1 Early 20th century views of science and theory
c.2 Emergent views of science and theory in the late 20th century

Intended Learning Outcomes:

1.Trace the evolution and development of nursing science
2.Differentiate rationalism from empiricism
3.Identify the major developments in nursing science during the early and
late 20th century

Key Terms:
Scientist
Philosopher
Empiricism
Rationalist
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Let’s Begin!
I. Empiricism
-Knowledge can be derived only from sensory experience (seeing, feeling,
and hearing facts)
-Empiricist view believes that scientific truth was discovered through
generalizing observed facts in natural world
-Also called the inductive method- to formulate generalizations
-Research- then- theory method
-perceived by the senses to observe & collect data

II. Rationalism
-Making use of reason as the appropriate method for advancing knowledge
-Uses from the cause to an effect or from a generalization to a particular
instance
-Uses deductive logic
-Theory –then –research method

III. Early 20th century views of science and theory

-Philosophers focused on the analysis of theory structure
-Scientists focused on empirical research knowledge should not only be
based on existing understanding but what is still to be observed

Major developments:
-Experimentation
-Positivism believes that empirical research and logical analysis (deductive
and inductive were two approaches that would produce scientific knowledge
-EMPIRICAL & OBJECTIVE DATA co-exist

IV. Emergent views of science and theory in the late 20th century
-Emphasized that science was a process of continuously building research
rather than a product of findings emphasis shifted to understanding scientific
discovery and process as theories change over time
-A new epistemology challenging the empiricist view proposing that theories
play an important role in determining what the scientists observe and how it
is interpreted an observation is influenced by the values and ideas in the
mind of the observer

Three different views of the relationship between theories and

observation:
1. Scientists are merely passive observers of occurrences in the empirical
world. Observable data are objective truth waiting to be discovered.
2. Theories structure what the scientist perceives in the empirical world
3. Presupposed theories and observable data interact in the process of
scientific investigation.
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-Science is ongoing process as the best approach to patient care based upon
current science may change with time. (When hew problems or a new way to
interpret observation emerges, a change in the way we think and do things
occurs.)

End of Chapter 4

CHAPTER 5- categories of theories

Micro-range (Practice Theories)

Middle range theories
Grand theories
Non-Nursing Theories
-Human Need theory
-Systems Theory
-Change Theory

Intended Learning Outcomes:

1. Discuss the three categories that relate to scope of a theory (grand,
middle-range and micro-range theories)
2. Get to know the theorist behind each non-nursing theory.
3. Discuss the 3 major non-nursing theories (Human Need, Systems and
Change theory)
4. Compare and contrast the different concepts on the three major non-
nursing theories.

Key Terms:
Micro Range Theories
Middle Range Theories
Grand Theories
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Let’s Begin!
1. Micro range theory
-Also known as practice theory
-is a linking of concrete concepts into a statement that can be examined in
practice and research
-Concepts used are narrowly defined, list specific goal and action
-Least complex in nature and more specific than middle range
-Provide specific directions and limited to specific populations
-Examples: Social Learning theory, Stress and Coping

2. Middle range theory

-Deals with portion of nursing’s total concern but not with the totality of the
discipline
-They are moderately abstract and inclusive but are composed of concepts
and propositions that are measurable
-Middle Range Theories are more helpful to nursing practice
-They have narrower focus than grand theory, more precise than grand
theories & focus on developing theoretical statements to answer questions
about nursing
-Middle range theories cover such concepts as pain, symptoms management,
cultural issues, and health promotion
-Examples: Theory of adaptation to chronic pain (Dunn, 2004), Theory of
caregiver stress (Tsai,2003)

3. Grand theory
-Any theory which attempts an overall explanation of human experiences
-Abstract and do not easily lend themselves to application or testing
-Tend to include views on person, health, and environment to create a
perspective of nursing
-Several well-known nursing theorists whose grand theories have served as a
basis for practice and research
-Grand Theories does not prescribe actions but rather provide structural
framework
-Examples: Madeleine Leininger’s CULTURAL CARE, DIVERSITY &
UNIVERSALITY; Betty Neuman’s HEALTH CARE SYSTEMS MODEL; Imogene
King’s GOAL ATTAINMENT THEORY; Florence Nightingale’s ENVIRONMENTAL
THEORY
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4. Non nursing theories

1. Human needs theory

-The physiological needs. oxygen, water, protein, salt, sugar, calcium, and
other minerals & vitamins. the need to maintain a pH balance (getting too
acidic or base will kill you) and temperature. these are the needs to be
active, to rest, to sleep, to get rid of wastes (CO2, sweat, urine, and feces), to
avoid pain, and to have sex.

-The safety and security needs. When physiological needs are largely taken
care of. You will become increasingly interested in finding safe
circumstances, stability, protection.

-The love and belonging needs. When physiological needs and safety needs
are, a third layer starts to show up. You begin to feel the need for friends, a
sweetheart, children, affectionate relationships in general, even a sense of
community.

-The esteem needs. Next, we begin to look for a little self-esteem. (FAME,
GLORY SELF-RESPECT)

-Self-actualization - continuous desire to fulfill potentials, to “be all that you

can be.” They are a matter of becoming the most complete, the fullest,
“you” -- hence the term, self-actualization.

2. Systems theory
-Considers a system as a set of independent and interacting parts.
-The main goal is to study general principles of system functioning to be
applied to all types of system in all fields of research

3. Change theory
-Provides the ability to identify strategic communication needs and allows
identification of the obstacles to the accomplishment of change
-Teaches patience in the achievement of change as well as the importance of
flexibility on the part of management in achieving change objectives.
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-Concept that change is constant but resistance to change is normal

End of Chapter 5

This is the end of the prelim

coverage