Theoretical Foundations In Nursing Nursing Theory (under 3 major headings):

1) History
Concepts- term that abstractly describes and names  Florence Nightingale – established a School of
an object or phenomenon, thus providing it with a Nursing at St. Thomas Hospital in London.
separate identity or meaning; the building block of  Mid-1930- standardized curriculum had been
theories, classify the phenomena of interest. published.
Types of Concepts:  Mid-1800- Nightingale wrote that nursing
1. Abstract Concepts -are constructed mentally knowledge is distinct from medical knowledge.
independent of a specific time or place; it is not  From 1850s to 1950s, it was 100 years later. The
directly observed or intangible. nursing profession began to engage in serious
2. Concrete Concepts- are experience directly discussion about the needs to develop, articulate,
observed and relate to a particular time or place. and test nursing theory.
Abstract Concrete  1950s- nursing practice was based on principles
 Social system  South surgery floor and traditions that had been passed on through an
 Debate  Memorial hospital apprenticeship model of education and hospital
 Loss of  Nurse-patient family  Mid-1970s an evaluation of journal nursing
relationship caregiver research revealed that nursing studies lacked
 Nurse  Obama - Mc Cain conceptual connections and theoretical
competency Debate framework.
 Divorce widowhood  1980s, was a period of major developments in
 Culture, nasogastric nursing theory characterized as a transition from
tube placement, pre paradigm to the paradigm period.
medication  The Nursing paradigms model- provided
administration perspectives for nursing practice,
Variable Concepts- such as ratio of professional and administration, education, research, and further
non-professional staff, communication flow, the ratio theory development.
of nurse to patients. 2) Analysis of the theory- the process that is
Classification of Concepts: carried out to acquire knowledge of the
1. Discrete Concepts- identifies as belonging to, a theoretical work.
given class or category. 3) Significance
E.g. patient nurse health and environment, typology Criteria for profession:
of married status, widowed, and single a. Utilize body of knowledge in intellectual level.
2. Continuous Concepts- permit classification of b. Improve techniques of education through
dimensions. scientific method.
E.g. degree of marital conflict, extent of c. Entrusts the education of its practitioner to
communication, no. of children, degree of institutions.
temperature, level of anxiety, pain scale. d. Applies body of knowledge in practical service.
e. Functions autonomously in the formulation of
Basic Nursing Concepts: professional policy.
1. Person f. Attracts individuals with intellectual and
2. Environment personal qualities.
3. Health g. Strive to compensate its practitioners by
4. Nursing providing freedom of action.
Theory- organized system of accepted knowledge
that is composed of concepts, propositions,
definitions and assumptions intended to
explain a set of fact, event or phenomena.
Purpose of Theory- the patterns that guide
thinking about being and doing of nursing .
Levels of Abstraction:
1. Paradigm- framework of assumptions
related to aspects of discipline.
2. Grand theories/conceptual models-
composed of concepts and relationship
statements; less abstract than paradigm, but
more abstract than middle range.
3. Middle range theories- next level in structure of
discipline; broad enough to be useful in complex
situations; appropriate for empirical testing
4. Practice theories- More limited scope and level of
abstraction
Characteristics of a Theory:
1. Theories can correlate concepts to generate a
different way of looking at a certain fact or
phenomenon.
2. Theories must be logical in nature.
3. Theories should be simple but generally broad
in nature.
4. Theories can be the source of hypotheses that
can be tested for it to be elaborated.
5. Theories contribute in enriching the general
body of knowledge through the studies
implemented to validate them.
6. Theories can be used used by practitioners to
direct and enhance their practice.
7. Theories must be consistent with other validated
theories, laws, and principles but will leave open
unanswered issues that need to be tested.
Components of theory according to Barnum
(1994):
1. Context- nursing act take place
2. Content- subject of theory
3. Process- method
Scope of theories:
Nursing
-Is an accountable profession guided by science,
theory, a code of ethics, and the art of care and
comfort to treat human responses to health and
illnesses.
- “Autonomous and collaborative care”.
Nursing theory is a group of interrelated concepts
that are developed from various studies of disciplines
and related experiences.
Purposes of Nursing Theory:
1) Aims to predict the phenomenon of nursing
2) Provide the foundations of nursing practice
3) Helps us to decide what we know and what we
need to know.
4) Distinguish the basis of practice by explicitly
describing nursing.
Benefits of Nursing theory.
1. Better patient care, enhanced professional status
for nurses, improved communication between
nurses, and guidance for research and education.
2. More multidisciplinary approach to health care.
3. Attempt by the nursing profession to maintain its
professional boundaries.
Criteria for Analysis and Evaluation of Nursing
Theory:
1) Clarity
2) Simplicity
3) Generality
4) Empirical Precision
5) Derivable Consequences
Philosophy - It sets forth the meaning of phenomena
through analysis, reasoning, and logical argument.
Phenomenon - Sets of empirical data or
experiences that can be physically observed or
tangible such as crying or grimacing when in pain.
Propositions - Explains the relationships of
different concepts.
Process - it is a series of actions
Assumption - is a statement that specifies the
relationship or connection of factual concepts or
phenomena.
Definitions - is composed of various descriptions
which convey a general meaning and reduces the
vagueness in understanding a set of concepts.
Framework- the abstract, logical structure of
meaning that guides the development of the study
and enables the researcher to link the findings to
nursing’s body of knowledge.
Theoretical framework- used in a study based on a
theory
Conceptual Framework- used in a study that has its
roots in a specified conceptual model.
Steps in Constructing a Study Framework:
1. Selecting and defining concepts.- relevance to
the phenomenon of concern
a) Sources of conceptual definitions are the
following:
i. Published concept analysis.
ii. Literature associated with instrument
development
(Conceptual models- derived from a persons
own point of view.)
2. Developing relational statements.- relationship
of some kind exists between two or more
concepts.
Sample of Conceptual definitions:
1. Family support
2. Internal family system resources
3. Family demands
4. Family strains
5. Family well-being
3. Developing hierarchical statement sets.
Composed of a specific proposition and a
hypothesis or research question
4. Constructing a conceptual map. Diagrams the
interrelationships of the concepts and statements.
Conceptual Model
A set of highly abstract, related construct that broadly
explains phenomena of interest, expresses
assumptions, and reflects a philosophical stance.
Conceptual Derivation
Conceptual definition derived from theories in other
disciplines.
Types of Nursing Theoretical Works:
1. Nursing Philosophies- nursing phenomena
through analysis, reasoning, and logical presentation.
(e.g. Nightingale, Watson, Roy, Benner)
2. Nursing Conceptual Models- provides a distinct
frame of reference for its adherents; metaparadigm
concepts.
 Imogene King (1981)- Open System Models
 Madeline Leininger(1991)- Theory of Culture
Care Diversity and Universality
 Myra Levine (1973)- Conservation Model
 Betty Neuman (1989)- Health Care Systems
Model
 Margaret Newman (1994)- Health as
Expanding Consciousness
 Dorothea Orem (1985)- Self-Care Model
 Rosemarie Rizzo (1992, 1995)- Theory of
Human Becoming
 Martha Rogers (1970, 1986)- Science of
Unitary Human Beings
 Sr. Callista Roy (1984, 1991)- Adaptation
Model
 Jean Watson (1999)- Theory of Caring
3. Nursing Theories- derived from nursing
philosophies, conceptual models, or more abstract
nursing theories
- a specific to aspect of patient’s life process of health
and illness.
4. Middle Range Nursing Theories- more precise;
Focus on specific nursing practice.
Nurse Researcher- worked to develop and clarify a
substantive body of nursing knowledge with goals of
improving the quality of patient care, providing
professional practice and being recognized as a
profession.
Relationship Between Theory and Research
- Reciprocal and mutual
- Research plays a dual and continuing role in theory
building and testing.
- Theory guides and generates ideas for research.
- Research assesses the worth of the theory and
provides a foundation for new theories.
Sources of Knowledge:
1. Traditional knowledge – practice w/c is passed
down from generation to generation.
2. Authoritative knowledge- an idea by a person
of authority w/c is perceived as true of his/her
expertise.
3. Scientific knowledge – came from a scientific
method through research, ideas are tested and
measured systematically using objective criteria.
Four ways of knowing ( EEEP):
1. Empirical knowing – the principal form relating
factual and descriptive knowing aimed at the
expansion of abstract and theoretical explanations
 any scientific, researched based, theoretical
and factual information that the nurse makes use of.
2. Ethical knowing- requires knowledge of different
philosophical positions regarding what is good and
right in making moral actions and decisions,
particularly in the theoretical and clinical
components of nursing.
3. Esthetics or aesthetics knowing – related to
understanding what is of significance to particular
patients such as feelings, attitudes,points of view
4. Personal knowing – encompasses knowledge of
the self in relation to others and to self. It involves
entirety of the nurse-patient relationship.
Patterns or models- show a clear relationship
among the existing theoretical works in nursing.
Metaparadigm- most global philosophical or
conceptual framework of a profession.
- Greek words ‘meta’ meaning ‘with’ and
‘paradigm’ meaning ‘pattern’.
Four major abstract concepts referred to as
metaparadigm of nursing:
1. Person or client- the recipient of nursing care;
individuals, families, and communities.
2. Environment- internal and external surroundings
that affect the client.
3. Health- degree of wellness or wellbeing that the
client experiences.
4. Nursing- the attributes, characteristics and actions
of the nurse providing care
DEVELOPMENT PROCESS OF THEORY IN
NURSING:
 In ancient civilizations, care revolves around the
use of magical thinking, superstitious, &
religious beliefs
 Female slaves provide physical maintenance &
comfort for the sick as ordered by a master,
healer or priest
 In Egypt, people worshiped the Goddess as they
believed to manipulate the dreams of sick
 Code of Hammurabi in Babylonia(1900 BC) -
The practice medicine but nursing was not
clearly defined
 Old Testament – mentioned nursing roles of
women as the one who provide and assist in the
care of children & infants in delivery
 Greece & Rome – care of the sick revolves
around mythology ( Greek god & chief healer)
 Africans – saw nurses as midwives, herbalists,
wet nurses and care givers for children and
elderly.
 Religion greatly influenced the practice of caring
for the sick individual
 Christians based this from the use of Christ’s
parable of the “ GOOD SAMARITAN”.

Nursing Science and Theory (early 20th century)
 use of experimentation to gain new knowledge
 Nurses strive to base their actions on evidence &
scientific data
 Use of logical and empiricism in the discovery
of truth for the development of science
( Positivism)
 Empirical and objective data co exist as the
focus of interest of study – tested to determine as
what is true or what is not.
 Growth of new scientific knowledge
 Evident with the emergence of radical thinking -
rationalism and empiricism
Rationalism
- Use of reason gained thru expert study
- Deductive type of reasoning- gen to spec
- emphasizes the use of reasoning for the main
purpose of knowing the harm or benefits of an act to
an individual
Empiricism
- use of objective and tangible data or those that are
perceived by the senses to observe and collect data.
- Inductive type of reasoning- spec to gen
- assessment of patients all throughout the entire
process
Hierarchy of Needs (Abraham Maslow);
1. Biological: Hunger, warmth, rest
2. Safety: Protection from danger
3. Socialization/ Love: affection, affiliation
4. Self-esteem: Autonomy, dignity, respect
5. Self-actualization: Realize one's potential through
competence, creativity, and achievement
Conclusion:
As the need is met & satisfied, it decrease in priority
and becomes less a motivator.
Nursing Theorists and Their Views:
1. Florence Nightangle- “The Lady w/ the Lamp”
 Environmental Theory
 Born in Florence, Italy on May 12, 1820.
 Mother of Modern Nursing
 First Nursing Theorist
 Was a linguist with reputable education
 Has vast knowledge
 Well informed about the workings of government
and political science.
 Had a religious calling (Unitarian Christian)
 Began her nursing training in 1851 in Germany
 Pioneered the concept of formal nursing
education
 Her experience in treating sick/injured soldiers in
the Crimean War strongly influenced her
philosophy of nursing
 Nurse statistician
 First to use statistics to guide care delivery
 Was the first nurse researcher
 Her strongest influence was education,
observation, and hands-on experience
Awards:
 First woman granted the Order of Merit and the
Royal Red Cross in Great Britain & many other
countries.
 The 2nd most famous British person
 Able to work at the age of 80.
 Her birthday marks the International Nurses Day
Celebration. (May 12, 1820)
Theoretical sources of Nightingale’s theory:
 Education
 Literature
 Intellectuals
 Religious beliefs
 Use of empirical evidence
Environmental Theory:
 The first published nursing theory (1860)
 Persons are in relation with the environment
 Stresses the healing properties of the physical
environment (fresh air, light, warmth, and
cleanliness)
 Nursing puts patients in the “best conditions” for
nature to act upon them
 Health is “the positive of which the pathology is
the negative”
 “Nature alone cures”
 When aspects of the environment are out of
 balance, the client must use energy to counter
these environmental stresses
Three Types of Environment:
1. Physical
- Consists of physical elements where the patient is
being treated
- Affects all other aspects of the environment
- Cleanliness of environment relates directly to
disease prevention and patient mortality
2. Psychological
- Can be affected by a negative physical
environment which then causes stress
3. Social
- Involves collecting data about illness and disease
prevention
- Consists of a person’s home or hospital room, as
well as the total community that affects the patient’s
specific environment
5 Major Components of a Healthful
Environment:
1. Proper ventilation
2. Adequate light
3. Sufficient warmth
4. Control of noise
5. Control of effluvia (noxious odors)
- Nightingale emphasized that a nurse should have
control over the patient’s environment.
Health -“being well & using every power that the
person has to the fullest extent”
Disease – “ a reparative process that nature instituted
from a want of attention”
3 major relationship of Environmental theory:
· Environment to patient
· Nurse to environment
· Nurse to patient
Nursing is very essential for everybody’s well being.
Notes on Nursing - provided essential principles for
rendering & implementing an efficient & effective
nursing care.
2. Ernestine Wiedenbach
 The Prescriptive Theory of Nursing
3. Faye Glenn Abdellah
 Twenty – one Nursing Problems
 Born on March 13, 1919
 Magna cum laude – basic nursing education
 She is a pioneer in nursing research who has
been recognized with 77 professional and
academic honors.
 She was the first nurse officer to receive the
rank of a two star rear admiral.
 She helped transform nursing theory, nursing
care and nursing education and as a result was
inducted into The National Women’s Hall of
fame in 2000.
 She is the first nurse and the first woman to serve
as Deputy Surgeon General.
 She is a former Chief Nurse Officer for the
U.S. Public Health Service, Department of
 Health and Human Services, Washington D.C.
 She developed educational materials in many
key areas of public health, including AIDS, the
mentally handicap, violence, hospice care,
smoking cessation, alcoholism, and drug
addiction.
 She has been a leader in nursing research and has
150 publications related to nursing education for
advanced practice in nursing and nursing
research.
 In 1960, influenced by the desire to promote
client-centered comprehensive nursing care,
Abdellah described nursing as a service to
individuals, to families, and therefore to society.
 According to her, nursing is based on an art and
science that mold the attitudes, intellectual
competencies, and technical skills of the
individual nurse into the desire and ability to
help people, sick or well, cope with their health
needs. Nursing maybe implemented out under
general or specific medical direction.
Three chief concepts of theory:
1. Health
2. Nursing problems
3. Problem solving
Typology of 21 Nursing Problems:
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity
3. To promote safety through the prevention of
accidents
4. To maintain good body mechanics
5. To facilitate the maintenance of a supply of
oxygen
6. To facilitate the maintenance of nutrition
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and
electrolyte balance.
9. To recognize the physiological responses of the
body to disease conditions.
10. To facilitate the maintenance of regulatory
mechanisms and functions.
11. To facilitate the maintenance of sensory function
12. To identify and accept positive and negative
expressions, feelings, and reactions.
13. To identify and accept the interrelatedness of
emotions and organic illness.
14. To facilitate the maintenance of effective verbal
and non verbal communication.
15. To promote the development of productive
interpersonal relationships.
16. To facilitate progress toward achievement of
personal spiritual goals.
17. To create and or maintain a therapeutic
environment.
18. To facilitate awareness of self as an individual
with varying physical , emotional, and developmental
needs.
19. To accept the optimum possible goals in the light
of limitations, physical and emotional.
20. To use community resources as an aid in
resolving problems arising from illness.
21. To understand the role of social problems as
influencing factors in the case of illness.
4. Virginia Henderson
 The 14 Basic Human Needs
 5th of 8 children
 Born in 1897
 A native of Kansas City, Missouri
 WWI, when she developed the interest in nursing
 1918, she entered the Army School of Nursing in
Washington, DC
 1927 – she finished her BS and MA degrees in
nursing education at Teachers College at
Columbia University
 “The Nightingale of Modern Nursing”
 “Modern-Day Mother of Nursing.”
 "The 20th century Florence Nightingale."
 “ First Lady of Nursing” &“ First Truly
International Nurse”
 Was an early advocate for the introduction of
psychiatric nursing in the curriculum
 Was a well known nursing educator and a
prolific author.
 She has received honorary doctoral degrees from
the Catholic University of America, Pace
University, University of Rochester,,
University of Western Ontario, Yale
 University
 Her stature as a nurse, teacher, author,
researcher, and consumer health advocate
warranted an obituary in the New York
Times, March 22, 1996.
 She argued that nurses needed to be prepared
for their role by receiving the broadest
understanding of humanity and the world in
which they lived.
 concept of nursing was derived form her
practice and education
 called her definition of nursing as “concept”
(Henderson1991) Although her major clinical
experiences were in medical-surgical hospitals,
she worked as a visiting nurse in New York City.
 experience enlarges Henderson’s view to
recognize the importance of increasing the
patient’s independence so that progress after
hospitalization would not be delayed
 defined nursing as "assisting individuals to gain
independence in relation to the performance of
activities contributing to health or its
recovery" (Henderson, 1966).
Define Nursing as:
- The unique function of the nurse is to assist the
individual, sick or well
Nursing Process:
1. Nursing assessment – assess need of human being
based on the 14 components of nursing care.
2. Nursing diagnosis – identify individual’s ability
to meet own needs with or without assistance
3. Planning – establish desired outcomes. Document
how the nurse can assist the individual, sick or well.
4. Implementation – assist the sick or well individual
and the family in the performance of activities. Carry
out treatment prescribed by the physician.
5. Evaluation – outcomes of nursing care rendered.
5. Hildegard Peplau
 Theory of Interpersonal Relations
 born in Reading, Pennsylvania on September 1,
1909.
 After graduating from the Pottstown,
Pennsylvania Hospital School of Nursing in
1931 she worked as an operating room
supervisor at Pottstown Hospital.
 During World War II, Hildegard Peplau was a
member of the Army Nurse Corps and worked in
a neuropsychiatric hospital in London, England.
She also did work at Bellevue and Chestnut
Lodge Psychiatric Facilities and was in contact
with renowned psychiatrists Freida Fromm-
Riechman and Harry Stack Sullivan. Hildegard
Peplau holds numerous awards and positions.
She retired in 1974. On March 17th, 1999,
Hildegard Peplau died peacefully at her home in
Sherman Oaks California after a brief illness.
She was 89 years old.
 mother of psychiatric nursing.
Theory of Interpersonal Relations
- emphasizes that the therapeutic nurse–patient
relationship is an integral part of nursing practice and
that the nurse's role evolves as a result of it.
Psychodynamic nursing facilitates understanding of
one's own behavior.
Peplau’s Nursing Roles:
1. Stranger role: Receives the client the same way
one meets a stranger in other life situations;
provides an accepting climate that builds trust.
2. Teaching role: Gives instructions and provides
training; involves analysis and synthesis of the
learner's experience.
3. Resource Person role: Answers questions,
interprets clinical treatment data, gives
information.
4. Counseling role: Helps client understand and
integrate the meaning of current life
circumstances; provides guidance and
encouragement to make changes.
5. Surrogate role: Helps client clarify domains of
dependence, interdependence, and independence
and acts on clients behalf as advocate.
6. Leadership role: Helps client assume maximum
responsibility for meeting treatment goals in a
mutually satisfying way.
7. Technical expert role: Provides physical care by
displaying clinical skills; Operates equipments.
Major Concepts Defines in Peplau’s Model:
1. Person
- a developing organism that tries to reduce anxiety
caused by needs.
- an individual is made of physiological,
psychological and social spheres striving towards
equilibrium in life.
2. Health- Peplau viewed health as "a word symbol
that implied forward movement of personality”
3. Environment - Being and occurring in the context
of the nurse client relationship; existing forces
outside of the individual.
4. Nursing - an educative and therapeutic
relationship
5. Illness - Symptoms from anxiety-bound energy.