1

ADVANCED NURSING PRACTICE

CLASS PRESENTATION
ON
OVERVIEW OF NURSING THEORIES, METAPARADIGM -CONCEPTUAL
FRAMEWORK, PURPOSE AND IMPORTANCE

SUBMITTED TO ;-
MADAM M. SAMANTA SUBMITTED TO :-
SR, LECTURER CHANDRALEKHA ROY
CON, NBMCH, DARJEELING M.SC NURSING 1st year
CON, NBMCH, DARJEELING

INTRODUCTION :
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A nursing theory is a set of concepts, definitions , relationships and assumptions or propositions

derived from nursing models or from other disciplines and project a purposive ,systematic view of
phenomena by designing specific interrelationships among concepts for the purposes of
describing ,explaining predicting and/or prescribing.

Definition of theory and nursing theory :

A theory is a group of related concepts that propose action that guide practice .

A theory is a set of statements that is developed through a process of continued abstraction. It is a

generalized statement aimed at explaining a phenomenon.

Nursing theory is a way of identifying the professions unique knowledge base .

 Nursing theories to describe to explain the human conditions in terms of the environment
and illness but are limited in their ability to predict or control a nursing situation.
 Nursing theories is a framework designed to organize knowledge and explain
phenomenon in nursing at a more concrete and specific level than a conceptual model
and met a paradigm.

From the definition, it suggests three things …..

-first theory is logically composed of concepts, definitions, assumptions and

generalizations .

- second the major function of theory is to describe and explain – in fact , theory is a
general explanation , which often leads to basic principles .

-A theory is a group of related concepts that propose action ,that guide practice.

Components of theory:
For a theory to be a theory, it has to contain concepts, definitions, relational statements, and
assumptions that explain a phenomenon. It should also explain how these components relate to
each other.

Components of theory

Phenomena
Concepts definitions

assumptions

Phenomenon : A term given to describe an idea or response about an event, a situation, a process, a
group of events, or a group of situations. Phenomena may be temporary or permanent. Nursing
theories focus on the phenomena of nursing.
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Concepts

Interrelated concepts define a theory. Concepts are used to help describe or label a phenomenon.
They are words or phrases that identify, define, and establish structure and boundaries for ideas
generated about a particular phenomenon. Concepts may be abstract or concrete.

 Abstract Concepts. Defined as mentally constructed independently of a specific time

or place.
 Concrete Concepts. Are directly experienced and related to a particular time or
place.

Definitions

Definitions are used to convey the general meaning of the concepts of the theory. Definitions can be
theoretical or operational.

 Theoretical Definitions. Define a particular concept based on the theorist’s

perspective.
 Operational Definitions. States how concepts are measured.
Assumptions

Assumptions are accepted as truths and are based on values and beliefs. These statements explain
the nature of concepts, definitions, purpose, relationships, and structure of a theory.

Concepts of theory :
Concept. Concepts are often called the building blocks of theories. They are primarily the vehicles of
thought that involve images.
The common concepts of theory are -

a) The person (patient)

b) The environment
c) Health
d) Nursing ( goals ,roles ,functions )

Each of these concepts is usually defined and described by the nursing theorists .

Conceptual framework. A conceptual framework is a group of related ideas, statements, or

concepts. It is often used interchangeably with the conceptual model and with grand theories.
Purposes of nursing theories :
In practice :

 Assists nurses to describe ,explain and predict everyday experiences

 Serve to guide assessment, intervention and evaluation of nursing care
 Provide a rational for collecting reliable and valid data about patients health status
 Help to establish criteria to measure quality of nursing care
 Help to build a common nursing terminology to use in communicating with other
health professionals
 Enhence autonomy of nursing
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In education :

 Provide general focus on curriculum design

 Guide curricular decision making

In research :

a) Offer framework for generating knowledge and new ideas

b) Assist in discovering knowledge gaps in specific field of study
c) Offer a system=mic approach to identify questions for study ,,select variables
interpret findings and validate nursing interventions.

Characteristics of a theory :
1. Theories can interrelate concepts in such a way as to create a different way of looking at a
particular phenomenon.
2. Theories must be logical in nature.
3. Theories should be relatively simple yet generalizable.
4. Theories can be the bases for hypothesis that can be tested.
5. Theories contribute to and assists in increasing the general body of knowledge within the
discipline through the research, implemented to validate them.
6. Theories can be utilized by the practitioners to guide and improve their practice.
7. Theories must be consistent with other validated theories, law and principle but will leave
open unanswered questions that need to be investigated.

Importance of nursing theory :

Nursing theories are the basis of nursing practice today. In many cases, nursing theory guides
knowledge development and directs education, research, and practice. Historically, nursing was not
recognized as an academic discipline or as a profession we view today. Before nursing theories were
developed, nursing was considered to be a task-oriented occupation. The training and function of
nurses were under the direction and control of the medical profession. Let’s take a look at the
importance of nursing theory and its significance to nursing practice :

1. Nursing theory aims to describe, predict and explain the phenomenon of nursing. (Chinn and
Jakobs,1987) .
2. It should provide the foundations of nursing practice, help to generate further knowledge
and indicate in which direction nursing should develop in the future. (Brown,1964).
3. Theory is important because it helps us to decide what we know and what we need to know.
(Parsons 2002).
4. It helps to distinguish what should form the basis of practice by explicitly describing the
nursing.
5. The benefits of having a defined body of theory in nursing include better patient care,
enhanced professional status of nurses ,improved communication between nurses, and
guidance for research and education.
6. The main exponent of nursing “caring” cannot be measured, it is vital to have the theory to
analyze and explain what nurses do.
7. As medicine tries to make a move towards adopting amore multidisciplinary approach to
health care, nursing continues to strive to establish a unique body of knowledge.
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8. This can be seen as an attempt by the nursing profession to maintain its professional
boundaries.

9. Nursing theories help recognize what should set the foundation of practice by explicitly
describing nursing.
10. By defining nursing, a nursing theory also helps nurses understand their purpose and role in
the healthcare setting.
11. Theories serve as a rationale or scientific reasons for nursing interventions and give nurses
the knowledge base necessary for acting and responding appropriately in nursing care
situations.
12. By providing nurses a sense of identity, nursing theory can help patients, managers, and
other healthcare professionals to acknowledge and understand the unique contribution that
nurses make to the healthcare service (Draper, 1990).
13. Nursing theories prepare the nurses to reflect on the assumptions and question the nursing
values, thus further defining nursing and increasing the knowledge base.
14. It can be regarded as an attempt by the nursing profession to maintain and preserve its
professional limits and boundaries.
15. In many cases, nursing theories guide knowledge development and directs education,
research, and practice, although each influences the others. (Fitzpatrick and Whall, 2005).

Classification of nursing theory : Theory is classified based on the following …

1.Function :

a) Descriptive - To identify the properties and workings of discipline

b) Explanatory - To examine how properties relate and thus affect the discipline

c) Predictive - To calculate relationships between properties and how they occur

d) Prescriptive - to identify under which conditions relationships occur

2.Generalisability :

Meta theory : The theory of theory. Identifies specific phenomena through abstract concepts.

Grand theory : Provides a conceptual framework under which the key concepts and Principles of the
discipline can be identified.

 These theories have the broadest scope and present general concepts and propositions.
 Theories at this level may both reflect and provide insights useful for practice but are not
designed for empirical testing.
 Grand theories consist of conceptual frameworks defining broad perspectives for
practice and ways of looking at nursing phenomena based on the perspectives.

Middle range theory : Is more precise and only analyze sa particular situation with a limited
number of variables .

 These theories are narrower in scope than grand nursing theories and offer an effective
bridge between grand nursing theories and nursing practice.
 They present concepts and propositions at a lower level of abstraction and hold great
promise for increasing theory-based research and nursing practice strategies.
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Nursing Practice theory : explores one particular situation in nursing . It identifies explicit goals and
details how these goals will be achieved.

 Nursing practice theories have the most limited scope and level of abstraction and are
developed for use within a specific range of nursing situations.
 Nursing practice theories provide frameworks for nursing interventions, and predict
outcomes and the impact of nursing practic

Based on the philosophical Underpinning :

 Needs theories
 Interaction theories
 Outcome theories
 Humanistic theories

“Needs” theories

 These theories are based around helping individuals to fulfill their physical and mental
needs.The basis of these theories are well-illustrated in Roper, Logan and Tierney’s model
of nursing (1980).
 Needs theories have been criticized for relying too much on the medical model of health
and placing the patient in an overtly dependent position.

“interaction” theories

 As described by Peplau (1988), these theories revolve around the relationships nurses
form with patients.
 Such theories have been criticized for largely ignoring the medical model of health and
not attending to basic physical needs.

“Outcome” theories

 These portray the nurse as the changing force, who enables individuals to adapt or to
cope with ill health.
 Outcome theories have been criticized as too abstract and difficult to implement in
practice.

“Humanistic” theories

 Humanistic theories developed in response to the psychoanalytic thought that a

person’s destiny was determined early in life.
 Humanistic theories emphasize a person’s capacity for self-actualization.
 Humanists believe that the person contains within himself the potential for healthy and
creative growth.
 Carl Rogers developed a person centered model of psychoanalytic that emphasizes the
uniqueness of the individual.
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Nursing metaparadigm
Conceptual models and theories in nursing are based on the nursing metaparadigm . metaparadigm
is the most global conceptual or philosophical framework of a discipline or profession .

I. It defines and describes relationships among major ideas and values .

II. It guides the organization of theories and models for a profession .

Definition of nursing metaparadigm

 A metaparadigm is the most general statement of discipline and functions as a
framework in which the more restricted structures of conceptual models develop .
Most of theoretical work in nursing focused on articulating relationship among four
major concepts :
 Person
 Environment
 Health
 Nursing
 A metaparadigm is a set of theories or ideas that provide structure for how a discipline
should function . For a nursing discipline ,these theories consists of four basic concepts
that address the patient as a whole , the patient’s health and wellbeing ,patient’s
environment and the nursing responsibilities .
While there are several different nursing theories ,these four
basic nursing metaparadigms point to a holistic view of care where a
person’s well-being and medical health is connected to four interactive
components .

Conceptual view of nursing metaparadigm:

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Components of nursing metaparadigm :

1. Person component :
The person component of the metaparadigm focuses on the receiver of care.
However, the person connection also includes family members and other groups
important to patient .
The care structure considers the persons spiritual and social needs as
well as health care needs . the resulting health outcome is attributed to how the
person interacts with these physical and social connections .
The premise is that the person empowered to manage his health and
well-being with dignity and self-preservation with positive personal connection .

2. Environment component :
The environment aspect of the nursing metaparadigm focuses on the
surroundings that affect the patient .The environment consists of internal and
external influences ,and contends that how a person continuously interacts with her
surroundings .
Surroundings has a bearing on health and well-ness. interactions with family
friends, and other people are part of the environment, as are physical and social
factors such as economic condition, geographic location, culture, social connection
and technology .
This meta paradigm component theorizes that a person can modify her
environmental factors to improve her health status .
3. Health component :
The health component of four metaparadigm s refers to the extent of well-ness
and health care access that a patient has . The health component is characterized as
one with multiple dimensions in a constant state of motion .
Health and well-ness covers a persons life span and genetic make up. And, how
the physical ,social ,emotional , intellectual and spiritual well-being is integrated in
health care for maximum benefits .
The theory is that these factors influence the patient’s state of well-being.
4. Nursing component :
The Nursing component of the metaparadigm involves the delivery of optimal
health outcomes for the patient through a mutual relationship in a safe and caring
environment .
The nursing component applies principles of knowledge ,skills ,technology
collaborations ,professional judgement and communication to carry out duties and
responsibilities for achieving the best possible scenario inpatient outcome .
This nursing component values a high degree of service and integrates with other
metaparadigm components for patient well-being .

Historical Development of nursing theory

The history of professional nursing began with Florence nightingale. nursing began with strong a
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emphasis on practice, but throughout the century nurses worked towards development of nursing

as a profession. It was not until the 1950s the nurse scholars started to develop nursing theories.

The first nursing theories appeared in the late 1800s when a strong emphasis was placed on nursing
education.

 In the early part of nursing’s history, knowledge was extremely limited and almost entirely
task oriented.
 Role of nurses where questioned; what they do, for whom where and when were
determined.
 The professionalization of nursing has been and is being brought about through the
development and use of nursing theory.
 Brought leading scholars and theorists to discuss and debate on issues regarding nursing
science and theory development.
1.Florence nightingale (1860). Environmental theory of nursing -to facilitate the bodies
reparative process by manipulating clients environment . Environment affects the human
condition ,with nursing having the role of affecting that environment ,so that health or disease
become a reparative process .
“the act of utilizing the environment of the patient assist him in his recovery”.

Environmental theory

• Pure fresh air

• Pure water
• Effective drainage
• Cleanliness
• Light(especially direct sunlight)
Any deficiency in one or more of these factors could lead to impaired functioning of life processes or
diminished health status.
Application:
"Patients are to be put in the best condition for nature to act on them, it is the responsibility of nurses to
reduce noise, to relieve patients’ anxieties, and to help them to sleep." • As per most of the nursing
theories, environmental adaptation remains the basis of holistic nursing care.
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In the 1950s, there is a consensus among nursing scholars that nursing needed to validate itself
through the production of its own scientifically tested body of knowledge.

2.Virginia Henderson (1955)

Nursing need theory Modern Nursing Nightingale /The 20th century Nightingale “ 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" (Henderson, 1966).
Henderson proposed 14 components or needs of basic nursing care .Needs theory emphasizes the
importance of increasing the patients independence and focus on the basic human needs. The 14
components of the needs theory shows a holistic nursing approach covering the physiological
,psychological ,spiritual and social needs .
The 14 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 within normal range by adjusting clothing and modifying
environment
8. Keep the body clean and well groomed and protect the integument
9. Avoid dangers in the environment and avoid injuring others.
10. Communicate with others in expressing emotions, needs, fears, or opinions.
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 the
available health facilities.
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3.Hildegard Peplau (1952) : Interpersonal theory

Peplau developed Interpersonal Relationship theory that emphasizes the nurse-client relationship
as the foundation of nursing practice. nursing is therapeutic interpersonal process. In her theory
,Nursing defined as an inter personal therapeutic process takes place when professionals especially
educated to be nurses, engage in therapeutic relationship with people who are in need of health
services.

• Focuses on the interpersonal processes and therapeutic relationship that develops between the
nurse and client. 4 phases of Nurse- patient relationship ..

• Orientation • Identification • Exploitation • Resolution

4. Abdellah ‘s theory (1960 ) : 21 nursing problem theory:

Abdellah;s theory emphasizes delivering nursing care for the whole person to meet the physical
,emotional ; intellectual , social , spiritual bees of the client and family .

 Developed the 21 Nursing Problems Theory.

 According to her “Nursing is based on an art and science that molds 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.”
 Changed the focus of nursing from disease-centered to patient-centered and began to
include families and the elderly in nursing care.
 The nursing model is intended to guide care in hospital institutions but can also be applied
to community health nursing, as well.
Nursing Problems
1. To maintain good hygiene and physical comfort
2. To promote optimal activity: exercise, rest, sleep
3. To promote safety through prevention of accident, injury, or other trauma and through
prevention of the spread of infection
4. To maintain good body mechanics and prevent and correct deformity
5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition for all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
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9. To recognize the physiologic responses of the body to disease conditions—pathologic, physiologic,

and compensatory
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 interrelatedness of emotions and organic illness
14. To facilitate the maintenance of effective verbal and nonverbal communication
15. To promote the development of productive interpersonal relationships
16. To facilitate progress toward achievement and personal spiritual goals
17. To create 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 that arise from illness
21. To understand the role of social problems as influencing factors in the cause of illness.

5. Imogene King‘s Theory of Goal attainment:

In 1971, Imogene King‘s  Theory of Goal Attainment has interrelated the concepts of interaction,
perception, communication, transaction, self, role, stress, growth and development, time, and space into
a theory of goal attainment. Nursing is a process of action, reaction, and interaction whereby nurse and
client share information about their perceptions in the nursing situation. The nurse and client share
specific goals, problems, and concerns and explore means to achieve a goal.
Theory of Goal attainment stated that the nurse is considered part of the patient’s environment and
the nurse-patient relationship is for meeting goals towards good health.

Concepts for Personal System

• Perception
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• Self
• Growth & development
Body image
• Space
• Time
Concepts for Interpersonal System
• Interaction
• Communication
• Transaction
• Role
• Stress
Concepts for Social System
• Organization
• Authority
• Power
• Status
• Decision making
• Control

6. In 1971, Dorothea Orem  Self care theory :stated in her theory that nursing care is
required if the client is unable to fulfill biological, psychological, developmental, or social needs.
Dorothea E. Orem’s Self-Care Framework focuses on the actions taken by people who are considered
legitimate patients to meet their own and their dependent others’ therapeutic self-care demands, as
well as on actions taken by nurses to effectively use nursing systems that will assist people who have
limitations in their abilities to provide continuing and therapeutic self-care or care of dependent
others.
The goal of nursing guided by Orem’s Self-Care Framework is “to compensate for or overcome
patients’ health-associated limitations in self-care or dependent care”. 

Self care deficit theory People should be self-reliant and responsible for their own care and others in
their family needing care. Composed of three interrelated theories:
(1) The theory of self-care
(2) The self-care deficit theory, and
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(3) The theory of nursing system

• Nursing is as art through which the practitioner of nursing gives specialized assistance to persons
with disabilities which makes more than ordinary assistance necessary to meet needs for self-care.
The nurse also intelligently participates in the medical care the individual receives from the
physician.

7..Jean Watson (1979): Theory of Human Caring

In 1979, Jean Watson developed the philosophy of caring, highlighted humanistic aspects of nursing

as they intertwine with scientific knowledge and nursing practice.

 She pioneered the Philosophy and Theory of Transpersonal Caring.

 “Nursing is concerned with promoting health, preventing illness, caring for the sick, and
restoring health.”
 Mainly concerns with how nurses care for their patients and how that caring progresses into
better plans to promote health and wellness, prevent illness and restore health.
 Focuses on health promotion, as well as the treatment of diseases.
 Caring is central to nursing practice and promotes health better than a simple medical cure.

• Caring can be effectively demonstrated and practiced only interpersonally.

• Caring consists of carative factors that result in the satisfaction of certain human needs.
• Effective caring promotes health and individual or family growth.
Ten primary carative factors:
1. The formation of a humanistic- altruistic system of values.
2. The installation of faith-hope.
3. The cultivation of sensitivity to one’s self and to others.
4. The development of a helping-trust relationship
5. The promotion and acceptance of the expression of positive and negative feelings.
6. The systematic use of the scientific problem-solving method for decision making
7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective and /or corrective mental, physical, socio-cultural and
spiritual environment.
9. Assistance with the gratification of human needs.
10. The allowance for existential-phenomenological forces.

Nursing metaparadigm of different Nurse theorists :

Person health nursing Environment

Nightingal human beings are not Did not defined “what nursing has to do Her writings reflect a
e defined by health specifically … is to put the patient in community health model
Nightingale . best condition for nature in which all that
recipient of nursing to act upon him” surrounds human beings
care is considered in relation
to their state of health
Orem Human beings are Health is” being Nursing is an art through The environment has
defined as ”man, structurally and which the practitioner of physical chemical and
woman ,children care functionally whole nursing gives specialized biological features. It
for either singly or as or sound “. assistance to person with includes the family
social units “ and are disabilities which makes culture and community .
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the material and more than ordinary

object of nurses and assistance necessary to
others who provide meet needs for self care
direct care.
Henderson Individuals have basic health was taken to The unique function of No explicit definition of
needs that are mean balance in all the nurse is to assist the the environment though
component of health realms of human individual ,sick or well ,in she stated that :
and require assistance life. the performance of “maintaining a
to achieve health and those activities supportive environment
independence or a contributing to health or conducive for health is
peaceful death its recovery that he one of the elements of
would perform unaided her 14 activities for
if he had the necessary client assistance .”
strength ,will or
knowledge .and to do
this in such a way as to
help him gain
independence as rapidly
as possible .
Peplau An organism that Health is defined as Peplau considers nursing Although Peplau does
“strives in its own way “ a word symbol to be a” significant , not directly address
to reduce tension that implies forward therapeutic , society /environment
generated by needs .” movement of interpersonal process .” ,she does not encourage
personality of other the nurse to consider the
ongoing human patient’s culture and
processes in the mores when the patient
direction of adjust to hospital routine
creative , .
constructive
,productive
,personal and
community living .”
Rogers A person is defined as Rogers define health Nursing aims to assist It is the study of unitary,
an individual, pan- as expression of the people in achieving their irreducible, individual
dimensional energy life process maximum health human and
field identified by a potential. environmental fields:
pattern and people and their world.
manifesting
characteristics specific
to the hole and that
cannot be predicted
from knowledge of
the parts.”
Kings Individuals are social Health is a dynamic Environment is the Nursing is a process of
beings who are life experience of a background for human action, reaction and
rational and sentient. human being which interactions. It is both interaction whereby
humans communicate implies continuous external and internal to nurse and client share
their thought, actions, adjustment to the individual. information about their
customs, and beliefs stressors in the perceptions in the
through language. internal and nursing situation.
external
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environment
through optimum
use of one’s
resources to achieve
maximum potential
for daily living.
Watson Human being is a Health is the unity Society provides the Nursing is a human
valued person to be and harmony within values that determine science of persons and
cared of, respected, the mind, body, and how one should behave human health – illness
nurture, understood, soul; health is and what goals one experiences that are
and assisted, in associated with the should strive toward. mediated by
general a degree of professional, personal,
philosophical view of congruence scientific, esthetic and
a person as a fully between the self as ethical human care
functional integrated. perceived and the transactions
self as experienced.

Conclusion:
A move towards theory based practice has made contemporary nursing more meaningful and
significant by shifting nursing’s focus from vocation to an organized profession.
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