Theoretical Foundations of Nursing

Vinz Merril G. Reyes, RN, MAN, MSN, ECHA

Assistant Professor IV (Adjunct Faculty)
UPHS Isabela Campus – College of Allied Health Sciences
INTRODUCTION TO NURSING THEORY
 Although nurses of early eras often delivered
excellent care to patients, much of what was known
about nursing was not tested or used uniformly in
practice or education.
 FLORENCE
NIGHTINGALE
envisioned nurses as
a body of educated
women at the time
when women are not
educated nor
employed in public
service.
 Pioneering activities in nursing practice and education and her
subsequent writings became a guide for establishing nursing schools
and hospitals in the US at the beginning of the 20th century
Nursing
Medicine
 Nursing as a vocation
to a profession is based
on the search for
substantive nursing
knowledge on which to
base nursing practice.
Theory development
in nursing has
evolved rapidly over
the past 6 decades,
leading to the
recognition of
nursing as an
academic discipline
with a specialized
body of knowledge.
 A major goal was put forth by nursing leaders in the 20th
century for the development of nursing knowledge on which to
base nursing practice, improve quality of care, and gain
recognition of nursing as a profession.
 Nurse scholars led the search for specialized
theoretical nursing knowledge to guide education,
professional practice, research, and administration.
Nursing followed a developmental path from concepts
to conceptual frameworks to models to theories to
practice-level middle-range theories in the theory
utilization era.
Historical Eras of Nursing’s Search for Specialized Knowledge
Historical Era Period Major Question Emphasis Outcomes Emerging Goal

What curriculum Courses included Standardized Develop

Curriculum Era 1900-1940s content should in nursing curricula for specialized
student nurses programs diploma programs knowledge and
study to be nurses? higher education

What is the focus Role of nurses and Problem studies Isolated studies do
Research Era 1950-1970s for nursing what to search and studies of not yield unified
research? nurses knowledge
What knowledge is Carving out an Nurses have an Focus graduate
Graduate 1950-1970s needed for the advanced role and important role in education on
Education Era practice of basis for nursing health care. knowledge
nursing? practice development
How do these There are many Nursing theoretical Theories guide
Theory Era 1980-1990’s frameworks guide ways to think works shift the nursing research
research and about nursing. focus to the and practice.
practice? patient.
Nursing
What new theories Nursing theory Middle-range frameworks
are needed to guides research, theory may be produce
Theory Utilization 21st Century produce evidence practice, from quantitative knowledge
for quality care? education, and or qualitative (evidence) for
administration. approaches. quality care.
 Nursing history and significant
developments demonstrate the incredible
influence theory has had on nursing as a
specialized field of practice (profession) and
a division of education (discipline).
DISCIPLINE PROFESSION

Refers to a
specialized field of
Specific to academia
practice, founded on
and refers to a branch
the theoretical
of education, a
department of structure of the
science or knowledge
learning, or a domain
of that discipline and
of knowledge
accompanying
practice abilities
 Basis for university
baccalaureate programs,
Doctoral programs were
development of master’s opened to generate nursing
programs, and knowledge
standardization of
curriculum

Provides nurses a
Discipline is dependent on perspective of the patient
theory for its existence
for professional practice
Characteristics of a Profession
Significance of Theory to
Nursing Profession

Recognition of nursing as a profession

Constant growth of the body of nursing

knowledge

Evidence-based nursing practice

Tool for reasoning, critical thinking, and

decision-making for safe and quality
nursing practice
NURSING THEORISTS OF HISTORICAL SIGNIFICANCE
HILDEGARD
E. PEPLAU

Theory of
Interpersonal
Relations
 HILDEGARD E. PEPLAU
Theory of Interpersonal Relations
• Peplau is described as the mother of psychiatric
nursing because her theoretical and clinical work
led to the development of the distinct specialty
field of psychiatric nursing.
• She stressed the importance of nurses’ ability to
understand their own behavior to help others
identify perceived difficulties.
• She described the importance of the nurses-
patient relationship as a significant therapeutic
interpersonal process.
 HILDEGARD E. PEPLAU
Theory of Interpersonal Relations
• Nurses should apply the principles of human
relations to the problems that arise at all levels.
• Her book entitled “Interpersonal Relations in
Nursing” published in 1952 is recognized as
the first nursing theory textbook since
Nightingale’s work in the 1850’s.
 HILDEGARD E. PEPLAU
Theory of Interpersonal Relations
 VIRGINIA
HENDERSON

Definition of
Nursing
 VIRGINIA HENDERSON
Definition of Nursing
• Henderson viewed the patient as an individual
who requires help toward achieving
independence and completeness or wholeness
of mind and body.
• She clarified the practice of nursing as
independent form the practice of the
physicians and acknowledged her
interpretation of the nurse’s role as a synthesis
of many influences.
 VIRGINIA HENDERSON
Definition of Nursing
• Henderson identified three (3) levels of nurse-
patient relationship in which the nurse acts as:

A substitute for A helper to the A partner with

the patient patient the patient
 VIRGINIA HENDERSON
Definition of Nursing
• The 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 (or to peaceful death) that he would
perform unaided if he had the necessary
strength, will, or knowledge; and to do this in
such a way as to help him gain independence
as rapidly as possible.
FAYE GLENN
ABDELLAH

Twenty-One
Nursing
Problems
 FAYE GLENN ABDELLAH
Twenty One Nursing Problems
• Abdellah is recognized as a leader in the
development of nursing research and nursing
as a profession within the US Public Health
Service and as an international expert on
health problems.
• Her work, which is based on problem-solving
method, serves as a vehicle for delineating
nursing problems as the patient moves toward
a healthy outcome.
 FAYE GLENN ABDELLAH
Twenty One Nursing Problems
• Abdellah views nursing as an art and a science
that mold attitude, intellectual competencies, and
technical skills of the individual nurse into the
desire and ability to help individuals cope with
their health needs, whether they are ill or well.
• Abdellah’s work is a set of problems formulated
in terms of nursing-centered services, which are
used to determine the patient’s needs.
 FAYE GLENN ABDELLAH
Twenty One Nursing Problems
 ERNESTINE
WEIDENBACH

The Helping Art

of Clinical
Nursing
 ERNESTINE WEIDENBACH
The Helping Art of Clinical Nursing
• She is known for her work in theory development
and maternal infant nursing developed while
teaching maternity nursing at the Yale University
School of Nursing.
• She described nursing as: People may differ in
their concept of nursing, but few would disagree
that nursing is nurturing or caring for someone in
a motherly fashion.
• Wiedenbach postulated that clinical nursing is
directed toward meeting the patient’s perceived
need for help in a vision of nursing that reflects
considerable emphasis on the art of nursing.
 ERNESTINE WEIDENBACH
The Helping Art of Clinical Nursing
The nurse identifies patient’s
need for help.

The nurse administers the

help needed.

The nurse validates that the

need for help was met.
LYDIA HALL

Core, Care, and

Cure Model
 LYDIA HALL
Core, Care, and Cure Model
• Hall believed that professional nursing care
hastened recovery, and as less medical care
was needed, more professional nursing care
and teaching were necessary.
• Hall used three interlocking circles to represent
aspects of the patient and nursing functions.
• The three circles change in size and overlap in
relation to the patient’s phase in the disease
process.
 LYDIA HALL
Core, Care, and Cure Model
 JOYCE
TRAVELBEE

Human-to-
Human
Relationship
 JOYCE TRAVELBEE
Human-to-Human Relationship
• Travelbee proposed that the goal of nursing was
to assist an individual, family, or community to
prevent or cope with the experience of illness and
suffering and, if necessary, to find meaning in
these experiences, with the ultimate goal of being
the presence of hope.
• She proposed that nursing was accomplished
through human-to-human relationships that began
with the original encounter and progressed
through stages of emerging identities, developing
feelings of empathy and, later, sympathy, until the
nurse and the patient attained rapport in the final
stage.
KATHRYN E.
BARNARD

Child Health
Assessment
 KATHRYN E. BARNARD
Child Health Assessment
• Kathryn E. Barnard was an internationally recognized
pioneer in the field of infant mental health, which
studies the social and emotional development of
children during their first 5 years of life.
• She was the founder of the Nursing Child Assessment
Satellite Training Project (NCAST), providing health
care workers around the globe with guidelines for
assessing infant development and parent-child
interactions.
• Barnard proposed that individual characteristics of
members influence the parent-infant system, and
adaptive behavior modifies those characteristics to meet
the needs of the system.
EVELYN
ADAM

Conceptual
Model for
Nursing
 EVELYN ADAM
Conceptual Model for Nursing
• Her work focuses on the development of
models and theories on the concept of nursing.
• Adam included the goal of the profession, the
beneficiary of the professional service, the role
of the professional, the source of the
beneficiary’s difficulty, the intervention of the
professional, and the consequences.
 IDA JEAN
ORLANDO-
PELLETIER

Nursing Process
Theory
 IDA JEAN ORLANDO-PELLETIER
Nursing Process Theory
• Orlando’s nursing theory stresses the
reciprocal relationship between the patient and
nurse.
• Orlando was one of the early thinkers in
nursing who proposed that patients have their
own meanings and interpretations of situations
and therefore nurses must validate their
inferences and analyses with patients before
drawing conclusions (Meleis, 2012).
 IDA JEAN ORLANDO-PELLETIER
Nursing Process Theory
• According to Orlando, persons become patients
who require nursing care when they have needs
for help that cannot be met independently because
they have physical limitations, have negative
reactions to an environment, or have an
experience that prevents them from
communicating their needs.
• Patients experience distress or feelings of
helplessness as the result of unmet needs for help.
 IDA JEAN ORLANDO-PELLETIER
Nursing Process Theory
• There is a positive correlation between the
length of time the patient experiences unmet
needs and the degree of distress.
• Orlando views the professional function of
nursing as finding out and meeting the
patient’s immediate need for help.
IDA JEAN ORLANDO-PELLETIER
Nursing Process Theory
NANCY ROPER,
WINIFRED W.
LOGAN, ALISON
J. TIERNEY

A Model for
Nursing based on
a Model of
Living
 NANCY ROPER, WINIFRED W. LOGAN,
ALISON J. TIERNEY
A Model for Nursing based on a Model of Living
 NANCY ROPER, WINIFRED W. LOGAN,
ALISON J. TIERNEY
A Model for Nursing based on a Model of Living
• The five components can be used to describe the
individual in relation to maintaining health, preventing
disease, coping during periods of chronic ill health, and
coping when dying.
• Individualizing nursing is accomplished by using the
process of nursing – assessing, planning, implementing,
and evaluating.
• The nursing process is a method of logical thinking that
should be used with an explicit nursing model, and the
patient’s individuality in living must be borne in mind
during all four phases of the process.
HISTORY AND PHILOSOPHY OF NURSING SCIENCE
 Science is a method for
describing, explaining,
and predicting causes or
outcomes of
interventions.
 We desire to understand the
unknown and identify the cause,
the effect, and the significant
difference that an intervention can
make to increase the longevity of
life.
 RATIONALISM

Rationalist epistemology emphasizes the

importance of a priori reasoning as the
appropriate method for advancing knowledge.
 A priori reasoning uses
deductive logic by
reasoning from the cause
to an effect or from
generalization to a
particular instance.
 However, this
causal reasoning is
a theoretical
assertion until
tested and
disproven.
 As the continuous
interplay between
theory construction
and testing with
empirical research
progresses, the
theory becomes
more precise and
complete as a
description of
nature, and
therefore, more
useful for the goals
of science.
EMPIRICISM

Scientific
knowledge
can be
derived only
from sensory
experience
.
Scientific truth was
discovered through
generalizing
observed facts in the
natural world.
RATIONALISM EMPIRICISM

Theory-then-
Research-then-
research
theory strategy
strategy

Deductive and Inductive and

quantitative qualitative
 POSITIVISM

Rationalism Empiricism
 Empirical research and
logical analysis were two
approaches that would
produce scientific knowledge
Theoretical propositions
must be tested through
observation and
experimentation
 Foucault (1973) stated that empirical knowledge was
arranged in different patterns at a given time and in a given
culture and that humans were emerging as objects of study.
Brown (1977)
argued that
observations
are concept-
laden.
ASSUMPTIONS OF EMERGENT
VIEWS OF SCIENCE
Scientists are merely passive observers of
occurrences in the empirical world. Observable
data are objective truth waiting to be discovered.

Theories structure what the scientist perceives in

the empirical world.

Presupposed theories and observable data interact

in the process of scientific investigation.
 Science is viewed as an ongoing process.
Tentative consensus of scientists in any given
historical era regard as scientific knowledge.
What we understand today as the best approach to
patient care based upon the current science may
change with time.
STRUCTURE OF NURSING KNOWLEDGE
 CONCEPTS & DEFINITIONS
• Concepts are the building blocks of theories.
• It is crucial that concepts are considered within
the theoretical system in which they are
embedded and from which they derive their
meaning, because concepts may have different
meanings in various conceptual frameworks or
theoretical systems.
• Abstract concepts are mentally constructed
independent of a specific time or place, whereas
concrete concepts are directly experienced and
relate to a particular time or place.
 CONCEPTS & DEFINITIONS
• Typologies are systematic arrangements of
concepts within a category. There are no degrees.
• Continuous concept permits classification of
dimensions or gradations of a phenomenon.
• The development of concepts permits the
description and classification of phenomena
(Hage, 1972).
• Concept analysis is an important beginning step
in the process of theory development to create a
conceptual definition.
 CONCEPTS & DEFINITIONS
• It is crucial that concepts are clearly defined
within the conceptual model or framework to
reduce the ambiguity in the given concept or set
of concepts.
• To eliminate perceived differences in meaning,
explicit definitions are necessary.
• As the theory develops, theoretical and
operational definitions provide the theorist’s
meaning of the concept and the basis for the
empirical indicators.
 RELATIONAL STATEMENTS
• Relational statements propose relationships
between and among two or more concepts.
• In the connections between variables, one
variable (independent) may be proposed to
influence a second (dependent).
• A sufficient condition (if) means that one
variable results in another variable occurring. A
necessary condition (only if / if… then) asserts
that one variable is required for the occurrence of
another variable.
 LINKAGES & ORDERING
• Development of theoretical linkages provides
an explanation of why the variables are
connected in a certain manner; that is, the
theoretical reason for particular relationships.
• Operational linkages contribute a perspective
for understanding the nature of the relationship
between concepts, to know whether the
relationship between the concepts is positive or
negative, linear or curvilinear.
PHILOSOPHY
• Sets forth the meaning of nursing phenomena through analysis, reasoning,
and logical presentation of concepts and ideas
CONCEPTUAL MODELS
• Sets of concepts that addresses phenomena central to nursing in propositions
that explain the relationship among them
GRAND THEORY
• Derives from conceptual model and proposes an abstract testable theory

NURSING THEORY
• Comprises works derived from nursing philosophies, conceptual models,
grand theories, abstract nursing theories, or works in other disciplines
MIDDLE-RANGE THEORY
• Proposes precise testable nursing practice questions; they address the
specifics of nursing situations within the perspective of the model, grand
theory, or theory from which they originate
 THANK YOU!

Vinz Merril Reyes @vinzeeelog

@vinzeeelog Vinz Merril Reyes