NURSING GRAND THEORIES
Concepts:
Levels of Theory
 Meta – Theory
 Grand Theory
 Middle Range Theory
 Practice Theory
GRAND THEORY
Characteristics:
 Derived from conceptual models
 Most complex and widest in scope
Concepts – abstract and lack operational definitions.
Propositions – abstract and not directly amenable to testify.
 Provide a background of philosophical reasoning
that allows nurse scientists to develop middle range
theory.
Review Criteria of Grand Nursing Theories
1. Background of the Theorist
2. Philosophical Underpinnings
3. Major assumptions, concepts and relationships
4. Usefulness
5. Testability
6. Parsimony
7. Value in expending nursing science
VIRGINIA HENDERSON (20th Century Theorist)
 Received diploma in nursing from the Army
School of Nursing at Walter Reed Hospital in 1921
 A well – known nursing educator and author
 Wrote Harmer’s classic book of nursing and added
her personal definition of nursing
 Created with other nursing scholars a curriculum in
which education was “patient centered and
organized around nursing problems rather than
medical diagnoses”
“The nurse is temporarily the consciousness of the
unconscious, the love of life of the suicidal, the leg of the
amputee, the eyes of the newly blind, a means of locomotion
for the newborn, knowledge and confidence for the young
mother, a voice for those too weak to speak, and so on.
- Virginia Henderson
Nursing Need Theory
Philosophical Underpinnings
 Presents the patient as a sum of parts with
biophysical needs and the patient is neither client
nor consumer.
 Recognized the importance of increasing patient’s
independence so that progress post-hospital would
be delayed.
Assumptions :
1. Nurses care for patients until patients can care for
themselves once again.
2. Patients desire to return to health.
3. Nurses are willing to serve.
4. “Nurses will devote themselves to be patient day
and night.”
5. Nurses should be educated at the university level in
both arts and sciences.
Nurse – unique function of the nurse is to assist the
individual, sick or well, in the performance of those
activities contributing to health or its recovery that he would
perform unaided if he had the necessary strength, will or
knowledge.
Patient – someone who needs nursing care, but did not limit
nursing to illness care.
Environment – maintaining a supportive environment as
part of the 14 activities.
Health – means balance in all human life.
Need for Help Concept
 Anything that the individual may require “to
maintain or sustain himself comfortably or capably
in his situation.
 If the individual do not see that they need help,
they may not take any action to resolve the
situation that affect health and wellness.
3 Levels of Nurse – Patient Relationship
1. Substitute for the patient
2. Helper to the patient
3. Partner with the patient
14 need components
1. Breath normally
2. Eat and drink adequately
3. Eliminate Body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes – dress and undress
7. Maintain body temperature by adjusting clothing
and modifying environment
8. Keep body clean and well-groomed and protect the
integument.
9. Avoid dangers in the environment and avoid
injuring others.
10. Communicate with other
11. Worship according to one’s faith.
12. Work in such a way that there is a sense of
accomplishment
13. Play or participate in various forms of recreation
14. Learn, discover or satisfy the curiosity that leads to
normal development and health and use available
health facilities.
LYDIA HALL
 Born on Sept. 21, 1906
 Worked as the first director of the Loeb Center for
Nursing in the elderly.
 A rehabilitation nurse who argued that follow-up or
evaluative care is where professional care nursing
is important.
CARE, CORE, & CURE
 Nursing – required when persons are not able to
provide intimate bodily care for themselves. The
nursing intent of this care is to comfort. Visualized
3 aspects of nursing process related to the patient,
to supporting sciences and underlying
philosophical dynamics.
  Patient – Has 3 aspects: the person, the body, and
the disease which overlaps and influence each The Helping Art of Clinical Nursing (Theory)
other Prescriptive Theory

“Now when the patient reaches the point where we know he WEIDENBACH’S PERSPECTIVE
is going to live, he might be interested in learning how to  Theory – abstract phenomenon that lies dormant in
live better before he leaves the hospital. But the one nurse the mind until it is given expression through action
who could teach him, the one nurse who has the background and/or through words
to make this a truly learning situation, is now busy with the  Practice – concrete phenomenon characterized
new patients in a state of biological crisis.” primarily by action
 When action is goal-directed, then practice
Hall’s Three Aspects of Nursing becomes theory-based
 Consider the motivating factors that influence the
nurse not only in doing what she does but also in
The Person doing it the way she does.
Core
3 ingredients:
1. Central Purpose – what you look into in the
future.
The Body The Disease - Reverence for the gift of life
Care Cure - Respect for the dignity,
autonomy, worth and
individuality of each human
being
Care – aspect of nursing that is concerned with infinite care - Resolution to act dynamically in
(e.g., bathing, feeding, toileting, positioning, moving, relation to one’s beliefs
dressing, undressing, and maintaining a healthful
environment) belongs to exclusively to nursing 2. Prescription – things that you will do to do
the Central Purpose.
Trade Profession - nature of action
3 Kinds of Deliberate Action
Cure – an aspect of nursing that is shared with medicine.  Mutually Understood and agreed upon
The nurse may assume medical functions, or help the patient  Patient-directed
with these through conformity and nurturing.  Nurse-directed

Second class doctors 3. Realities – things in immediate environment.

First class nurses Concepts of Realities
 Agent
Core – aspect that emphasizes social, emotional, spiritual  Recipient
and intellectual needs of the patient in relation to family,  Framework
institution, community and the world.  Goal
 Mean
 The nurse hero knows self by the same token can
love and trust the patient enough to work with him 3 Types of Goal
professionally, rather than for him technically, or at Goal – the tend to be attained
him vocationally. Goal – in – intent – goal/patient
Goal – in – applicant – goal/environment
Goal – in – execution – goal/realities
Vocational
Practice of Dynamic Nursing Model
 Professional Nursing Practice Focus and
Professional Technical Components

ERNESTINE WIEDENBACK
 Born in 1900 from an affluent family
 Pursuing nursing in this era was atypical for
someone who came from a family or gentility.
 Known for her maternal and child curriculum for
undergraduate and graduate courses

What’s your purpose in nursing?

 “The purpose”
“The agent”
“The recipient”
HELPING ART OF CLINICAL NURSING
Revised Health Promotion Model
How to identify needs
 Observing consistency of behaviors
 Exploring the meaning of their behavior
 Determining cause of their discomfort
 Determining whether they can resolve their
problems / need for help.

NOLA J. PENDER

 “The experience of watching the nurses caring for

my aunt in her illness created in me a fascination
with the work of nursing”

 Born in 1941

Assumptions
 Person seek to create conditions of living through
which they can express their unique human health
potential
 Person have the capacity for reflective self-
awareness, including assessment of their won
competences
 Person value growth in directions viewed as
positive and attempt to achieve a personally
acceptable balance between change and stability I. Individual Characteristics and Experiences
 Individuals seek to actively regulate their own Prior Related Behavior
behavior  Frequency of the same or similar behavior in the
past
Major Assumptions
 Individuals in all their biophycho-social complexity Personal Factors
interact with the environment, progressively  Biological – age, gender, BMI, pubertal status,
transforming the environment and being aerobic capacity
transformed over time  Psychological – self-esteem, motivation, personal
 Health professionals constitute a part of the competence
interpersonal environment which exerts influence  Socio-cultural – race, ethnicity, acculturation,
on person throughout their lifespan education
 Self-initiated reconfiguration of person
environment interactive patterns is essential to II. Behavioral – Specific Cognitions and Affects
behavioral change Perceived Benefits of Actions
 Anticipated positive outcomes resulting from
Health Promotion Model health behavior

Perceived Barriers to Action

 Anticipated, imagines, real blocks and personal
costs of undertaking a given behavior

Perceived Self-Efficacy
 Judgement of personal capability to organize and
execute a health-promoting behavior

Activity Related Affect

 Subjective positive or negative feelings that occur
before, during and after behavior

III. Influences
Interpersonal
 Cognitions concerning behaviors, beliefs or
attitudes [norms, social-support, modeling]

Situational
  Personal perceptions and cognitions of any given
situation or context that can facilitate or impede
behavior
IV. Behavioral Outcomes
Commitment to a plan of action
 Concept of intention and identification of planned
strategy
Immediate competing demands and preferences
 Alternative behaviors over which individuals have
low control, due to environmental contingencies
Health Promoting Behavior
 End point or action outcome that is directed toward
attaining positive outcomes
MODELEINE LEININGER
 Instrumental in demonstrating to nurses the
importance of the impact of culture on health.
 Conceptualize transcultural nursing in 1950s while
working in anthropology
 Authored the first qualitative research book in
nursing and developed the research method,
“ethnonursing”
What led you to develop your theory?
“From my focused observations and daily nursing
experience, I became aware that the children in the guidance
home were from many different cultures. These children
were different in their nursing care needs, responses, and
expectations.
I experienced cultural shock and felt helpless to care for
both children and adults of diverse cultures.”
TRANSCULTURAL NURSING THEORY
 Uses researched – based knowledge to provide
safe, responsible, meaningful care to people of
different cultures supporting their health needs and
dealing with illness, disabilities and death.
 Forms, expressions, patterns and processes of
human care vary among all cultures of the world.
Major Tenets
 Commonalities. Cultural care diversities and
similarities exist within and between cultures.
 Worldview and Social Structure factors.
Includes religion, political, and economic
considerations are essential to understand and
powerful influences on care outcomes.
 Professional and Generic Care. Care differences
and similarities with professional and generic
knowledge and practice influence health.
Transcultural Nursing
 Refers to a humanistic and scientific knowledge
and practices focused on holistic CULTURE
CARE phenomena and competencies
Three Modalities
1. Culture care preservation / maintenance
2. Culture care accommodation / negotiation
3. Culture care restricting or repatterning
Purpose:
 To discover, document, analyze, and interpret
cultural and caring factors influencing human
beings in health, sickness or dying.
Goal:
 Use research – based knowledge to provide
culturally congruent, safe and beneficial care to
people of diverse or similar cultures for their
health.
Assumptions:
1. Care is essential for human growth, development,
and survival and when facing death.
2. Care is essential for curing and healing.
3. Forms, expressions, patterns, and process of human
care vary among cultures.
4. Every culture has generic care and professional
practice.
5. Culture care values and beliefs are embedded in
various cultural aspects.
6. Therapeutic way to help people of diverse cultures.
CONCEPTS AND DEFINITIONS
Human Care and Caring
 Abstract and manifest phenomena with expressions
of assistive, supportive, enabling and facilitating
ways to help
Culture
 Patterned lifeways, values, beliefs, norms, symbols
and practices that are learned, shared, and
transmitted
Culture Care
 Synthesized and culturally assistive, supportive,
enabling or facilitative caring acts toward self or
others
Culture Care Diversity
 Cultural variability or differences in care beliefs,
meaning, patterns, values, symbols and lifeways
Culture care Universality
 Commonalities based on care meanings
Worldview
 Way an individual or group looks out on and
understands the world
Cultural and Social Structure Dimensions
 Environmental Context
 Ethnohistory
 Emic
 Etic
 Health
THE SUNRISE ENABLER (MODEL)
 Developed to provide holistic and comprehensive
conceptual picture of the major influences of
CULTURE CARE Diversity and University
 Can be used as valuable guide for doing
culturalogical health-care assessment of clients

ROSEMARIE RIZZO PARSE
- Founder of the institute of human becoming
- 21st Century Theorist
- Goal of Nursing as discipline is to expand
knowledge about human experiences through
creative conceptualization and research
Theory of Human Becoming
Dimensions of Parse’s Theory
Principles:
1. Meaning – finding meaning
2. Rhythmicity – creating patterns
3. Transcendence – creating relationships
Concepts:
1. Concepts in Squares: powering emerges with the
revealing-concealing of imaging.
2. Concept in the Ovals: originates emerges with the
enabling-limiting of valuing.
3. Concept in the triangles: transforming emerges
with the language.
ANNE BOYKIN & SAUNA SCHOENHOFER
Bookworm Musician
Nursing as Caring
Major Assumptions:
Person
- Persons are caring by virtue of their humanness.
- Persons are whole and complete in the moment.
- Persons live caring from moment to moment.
Health
- Personhood is a way of living grounded in caring.
Environment
- Personhood is enhanced through participation in
nurturing relationships with caring others.
Nursing
- Nursing is both a discipline and a profession.
Caring
- An altruistic, active expression of love and is the
intentional and embodied recognition of value and
connectedness.
- Nursing uniquely focuses on caring as its central
value, its primary interest and the direct intention
of practice.
Key Themes:
 Focus and Intention of Nursing
 Nursing Situation
 Personhood
 Call for Nursing
 Nursing response
 Caring Between
 Lived Meaning of Nursing as Caring
Focus – nurturing person’s living and growing in caring
Intention – know persons as caring and to support and
sustain them as they live caring
METAPARADIGM
Person – Fundamentally, potentially and actually each
person is caring even though every act might not be
understood as caring
Nursing situation – shared, lived experience in which
caring between nurse and nursed enhances personhood
Caring between – when the nurse enters the world of the
other person with the intention of knowing the other as a
caring person
Personhood – process of living that is grounded in caring
Call for nursing – call for nurturance perceived in the mind
of the nurse
Nursing Response – co-created in the immediacy of what
truly matters and is a specific expression of caring
nurturance to sustain and enhance the other
STORY AS A METHOD
 Method of knowing nursing and a medium for all
forms of nursing inquiry
 Embody the lived experience of nursing situations
involving the nurse and the nurse
 Situations are best communicated through aesthetic
media such as storytelling, poetry, graphic arts and
dance
Dance of Caring Persons – symbol
BARBARA DOSSEY
- Pioneer in the holistic nursing movement and the
integrative nurse coach movement
- Headed the global project, “Nightingale Initiative
for Global Health”
- Received the pioneer of Integrative Medicine
Award
Theory of Integral Nursing
- Incorporates physical, mental, social, spiritual,
cultural, and environmental dimensions and
expansive worldview.
- Philosophical Foundations include Florence
Nightingale and adapting Ken Wilber’s central
concept of healing
Integral Foundation and Model
 - Ken Wilber, philosopher [2000], synthesizes that Theory of Integral Nursing
the best known and most influential thinkers to
show that no individual or discipline can determine
or lay claim to all the answers

Components:
Healing
- Central core (aspects of oneself)
Metaparadigm
- Nurse, health, persons, environment (society)
 Integral Nurse
 Integral Health
 Integral Environment – interval/external
 Integral Person(s)

Patterns of Knowing

 Personal – process of being whole.

 Empirical – observation
 Aesthetic – explore experiences and meaning in
life.
 Ethical – novel knowledge
 Not knowing – physical presence
 Socio-Political – social, economic, geographic,
cultural, political, historical factors in theoretical,
evidence-based practice

Four Quadrants
“I” – subjective intentional (interpretive)
“It” – objective biological behavioral (measurable)
“ We” – intersubjective cultural shared values (Qualitative)
“It’s” – interobjective systems structures (Quantitative)