THEORETICAL FO
WEEK 1-2
THEORETICAL FOUNDATION
NURSING
EVOLUTION OF NURSES
NURSING DURING THE EARLY
YEARS
FABIOLA
From the wealthy matrons of the
Roman Empire who converted to
Christianity and used their wealth
to provide houses for the poor,
homeless and sick.
KNIGHTS OF SAINT LAZARUS
Dedicated themselves to the care
of people with leprosy, syphilis
and chronic skin conditions.
ALEXIAN BROTHERS
Organized care for victims of the
Black Plague in the 14th Century
in Germany.
NURSING DURING WAR
FLORENCE NIGHTINGALE
Recruited a contingent of
female nurses to provide
sick and injured in the
Crimea and transformed
military hospitals by setting
up sanitation process.
HARRIET TUBMAN AND
SOJOURNER TRUTH
Provided care and safety to
slaves fleeing to the North
on the Underground
Railroad.
CLARA BARTON
Searched the battlefields
and gave care to injured and
dying soldiers.
DOROTHEA DIX
Became the Unions Superintendent of
female nurses responsible for
recruiting nurses and supervising the
nursing care of all women nurses
working in the army hospitals.
SOCIETAL ATTITUDES
- Before the mid-100s, nursing
was without organization,
education or social status.
- The prevailing attitude was that
a woman’s place was in the
home and that no respectable
woman should have a career.
- Society’s attitudes about
nursing during this period are
reflected in the writings of
Charles Dickens in his book
Martin Chuzzlewit (1896),
through the character of Sairy
Gamp.
NURSING THEORIES
- Organized bodies of knowledge
to define what nursing is, what
nurses do, and why they do it.
- Provide a way to define nursing
as a unique discipline that is
separate from other disciplines
(e.g., medicine).
- Framework of concepts and
purposes intended to guide
nursing practice at a more
concrete and specific level.
HISTORY OF NURSING
THEORIES
1860
Florence Nightingale defined
nursing in her “Environmental
Theory” as the “act of utilizing the
patient’s environment to assist
him in his recovery.”
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.
1952
Hildegard Peplau introduced her
Theory of Interpersonal Relations
that emphasizes the nurse-client
relationship as the foundation of
nursing practice.
1955
Virginia Henderson
conceptualized the nurse’s role as
assisting sick or healthy
individuals to gain independence
in meeting 14 fundamental needs.
1960
Faye Abdallah published her work
“Typology of 21 Nursing
Problems” which shifted the focus
of nursing from a disease-
centered approach to a patient-
centered approach.
1962
Ida Jean Orlando emphasized the
reciprocal relationship between
patient and nurse and viewed
nursing’s professional function as
finding out and meeting the
patient’s immediate need for help
1968
Dorothy Johnson pioneered the
Behavioral System Model and upheld
the fostering of efficient and effective
behavioral functioning in the patient to
prevent illness.
1970
Martha Rogers viewed nursing as both
a science and an art as it provides a
way to view the unitary human being,
who is integral with the universe.
1971
Dorothea Orem stated in her theory
that nursing care is required if the
client is unable to fulfill biological,
psychological, developmental, or
social needs.
Imogene King’s 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.
Building blocks of theories which are
primarily the vehicles\ of thought that
involve images.
MODELS
Representations of the interaction
among and between concepts showing
patterns. Present an overview of the
theory’s thinking and may demonstrate
how theory can be introduced into
practice.
COMPONENTS OF THEORY

1972
Betty Neuman states that many needs PURPOSE
exist, and each may disrupt client “Why is the theory formulated?”
balance or stability.
Specifies the context and situation
within which the theory is formulated.
1979 CONCEPTS
Sr. Callista Roy viewed the individual Ideas, mental images of a
as a set of interrelated systems that phenomenon, an event or object that is
maintain the balance between these derived from an individual’s\
various stimuli. experience and perception.
Jean Watson developed the philosophy DEFINITIONS
of caring, highlighting humanistic
aspects of nursing. Give meaning to concepts, making
them clearer and more understandable.
PROPOSITIONS
DEFINITION OF TERMS
Expressions of relational statements
between and among concepts.
PHILOSOPHY ASSUMPTIONS
Beliefs and values that define a way of Accepted “truths” that are basic and
thinking and are generally known and fundamental to the theory.
understood by a group or discipline.
THEORY
PURPOSES OF NURSING
A belief, policy, or procedure proposed THEORIES
or followed as the basis of action.
Refers to logical group of general
propositions used as principles of
explanation. Also used to describe,
predict or control a phenomenon.
PRIMARY PURPOSE
CONCEPT
 - To improve practice by
positively influencing the health
and quality of life of patients.
- Developed to define and
describe nursing care, guide
nursing practice and provide a
basis for clinical decision-
making.
ACADEMIC DISCIPLINE
- To explain the fundamental
implications of the profession
and enhance the profession’s
status.
PROFESION
- Clinical practice generates
research questions and
knowledge for theory.
- To reflect, question and think
about what nurses do.
RESEARCH
- The development of theory is
fundamental to the research
process.
- To guide the research process by
creating and testing phenomena
of interest.
HISTORY AND PHILOSOPHY OF
SCIENCE
- Modern science was established
over 400 years ago as an
intellectual activity to formalize
given phenomena of interest in
an attempt to describe, explain,
predict, or control states of
affairs in nature.
- Scientific activity has persisted
because it has improved quality
of life and has satisfied human
needs for creative work, a sense
of order, and the desire to
understand the unknown.
- The development of nursing
science has evolved since the
1960s as a pursuit to be
understood as a scientific
discipline.
- Being a scientific discipline
means identifying nursing’s
unique contribution to the care
of patients, families, and
communities.
RATIONALISM
The scope of knowledge in rationalism
epistemology emphasizes the
importance of a priori reasoning as the
appropriate method for advancing
knowledge.
• Priori Reasoning
- Utilizes deductive logic by
reasoning from the cause to an
effect or from a generalization to
a particular instance
- An example in nursing is to
reason that a lack of social
support (cause) will result in
hospital readmission (effect).
This conceptual system is analyzed by
addressing the logical structure of the
theory and the logical reasoning
involved in its development.
EMPIRICISM
The empiricist view is based on the
central idea that scientific knowledge
can be derived only from sensory
experience (i.e., seeing, feeling,
hearing facts).
Francis Bacon received credit for
popularizing the basis for the
empiricist approach to inquiry.
- Believed that scientific truth
was discovered through
generalizing observed facts in
the natural world.
- Inductive method – is based on
the idea that the collection of
facts precedes attempts to
formulate generalizations.
One of the best examples to
demonstrate this form of logic in
nursing has to do with formulating
differential diagnoses. Formulating a
differential diagnosis requires
collecting the facts and then devising a
list of possible theories to explain the
facts.
EARLY 20th CENTURY VIEWS
There was minimal interest in the
history of science, the nature of
scientific discovery, or the similarities
between the philosophical view of
science and the scientific methods.
Positivism, a term first used by Comte,
emerged as the dominant view of
modern science.
Modern logical positivists believed
that empirical research and logical
analysis (deductive and inductive)
were two approaches that would
produce scientific knowledge.
The logical empiricists offered a more
lenient view of logical positivism and
argued that theoretical propositions
(proposition affirms or denies
something) must be tested through
observation and experimentation.
This perspective is rooted in the idea
that empirical facts exist
independently of theories and offer the
only basis for objectivity in science.
In this view, objective truth exists
independently of the researcher, and
the task of science is to discover it,
which is an inductive method.
This view of science is often presented
in research method courses as: “The
scientist first sets
up an experiment, observes what
occurs, reaches a preliminary
hypothesis to describe the occurrence:
runs further experiments to test the
hypothesis and finally corrects or
modifies the hypothesis considering
the results.”
Empirical knowledge was arranged in
different patterns at a given time and in
a given culture and that human were
emerging as objects of study.
Phenomenology, set forth by Edmund
Husserl (1859 to 1938)
proposed that the objectivism of
science could not provide an adequate
apprehension of the world.
A phenomenological approach reduces
observations or text to the meanings of
phenomena independent of their
particular context, an approach that
focuses on the lived meaning of
experiences.
One of the major perspectives in the
new philosophy emphasized science as
a process of continuing research rather
than a product focused on findings.
• Scenario:
- “An elderly patient has been in a
trauma and appears to be crying.
The nurse on admission
observes that the patient has
marks on her body and believes
that she has been abused; the
orthopedist has viewed an x-ray
and believes that the crying
patient is in pain due to a
fractured femur that will not
require surgery only a closed
reduction; the chaplain observes
the patient crying and believes
the patient needs spiritual
support. Each observation is
concept laden
WEEK 3
 THEORETICAL FOUNDATIONS
OF NURSING STRUCTURE OF
NURSING THEORIES
THEORY DEVELOPMENT
- Implies that theory development
in nursing is based on theories
developed by other disciplines
and used in nursing situations.
THEORY-PRACTICE-THEORY
- Based upon and evolved from
clinical practice.
- The theorist develops his/her
ideas through actual
observations or experiences in
the clinical area, either as a
caregiver herself or as an
observer of other caregivers.
PRACTICE-THEORY
- Used by those who believe that
theories must evolve from
research findings (also known as
inductive method).
RESEARCH-THEORY
- Theories developed by other
disciplines are utilized but given
a unique nursing perspective.
- Conceptual or theoretical
frameworks in nursing research
studies are adapted from these
theories.
THEORY-RESEARCH-THEORY
- Theories developed by other
disciplines are utilized but given
a unique nursing perspective.
• Conceptual or theoretical
frameworks in nursing research
studies are adapted from these
theories.
CHARACTERISTICS OF A
THEORY
Systematic, logical and coherent
- There must be orderly reasoning
and no contradictions between
and among the concepts.
- Proper sequencing of ideas and
propositions or theoretical
assertions.
Creative structuring of ideas
- Creation of different ways of
looking at a particular
phenomenon, event or object.
Tentative in nature
- A theory can change over time,
implying that it is evolving and
dynamic.
COMPONENTS OF NURSING
THEORIES
- 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.
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.
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.
• Abstract Concepts
- Defined as mentally constructed
independently of a specific time
or place.
• Concrete Concepts
- Directly experienced and related
to a particular time or place.
DEFINITIONS
- 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
purpose, relationships, and
structure of a theory.
IMPORTANCE OF NURSING
THEORIES
1. Nursing theories are the basis of
nursing practice today.
2. Nursing theories guide
knowledge development and
directs education, research, and
practice.
3. Historically, nursing was not
recognized as an academic
discipline or as a profession we
view today.
4. Before nursing theories were
developed, nursing was a task-
oriented occupation.
STRUCTURE OF NURSING
The requirement for a body of
specialized knowledge for recognition
of nursing as a profession was a
driving force in the 20th century.

- States how concepts are

measured.

RELATIONAL STATEMENTS

- Relational statements define the

relationships between two or
more concepts.
- They are the chains that link
concepts to one another.

ASSUMPTIONS

- Assumptions are accepted as

truths and are based on values
and beliefs.
- These statements explain the
nature of concepts, definitions,

TYPES OF THEORIES
ACCORDING TO RANGE
GRAND THEORIES
- Consist of broad conceptual
frameworks that reflect wide
and expansive perspectives for
practice and ways of describing,
explaining, predicting, and
looking at nursing phenomena.
- Most complex and broadest in
scope.
- Examples: Henderson’s The
Nature of Nursing, Levine’s
Four Conservation Principles,
Roy’s Adaptation Model,
Orem’s Self-Care
MIDDLE-RANGE THEORIES
- Less complex and narrower in
scope than grand theories.
- Fill the gap between the grand
theory and micro theory.
- Has less variables, more limited
in scope and is testable.
- Examples: Peplau’s
Psychodynamic Nursing,
Orlando’s Nursing Process
Theory.
MICRO THEORIES
- Least complex and contains the
narrowest in scope.
- Deal with a small aspect of
reality.
- Set of theoretical statements that
deal with specific and narrowly
defined phenomena.
ACCORDING TO ORIENTATION
OR FOCUS OF THE THEORY
CLIENT-CENTERED
- Those focused on the needs and
problems of clients which are
met, resolved or alleviated by
nursing interventions.
-
NURSE-CLIENT-DYNAMICS
- Focus on interaction between
the nurse and client.
NURSE-CLIENT- ENVIRONMENT
DYNAMICS
- Focus on the interaction
between nurse and client in an
environment that includes
broader dimensions of time and
space, as well as culture, cultural
diversity, and universality.
METAPARADIGM OF NURSING
THEORIES
Metaparadigm is a set of theories or
ideas that provide structure for how a
discipline should function.
Originated from two Greek words:
meta (with) and paradigm (pattern).
Four (4) concepts to be central to
nursing:
- The person, individuals or
clients are the recipients of
nursing care (includes
individuals, families, groups
and communities).
- The environment is the internal
and external surroundings that
affect the client (includes people
in the physical environment
such as families, friends and
significant others).
- Health is the degree of wellness
or well-being that the client
experiences.
- Nursing is the attributes,
characteristics and actions of the
nurse providing care on behalf
of, or in conjunction with the
client.
WEEK 4
NURSING THEORIES:
NIGHTINGALE AND WATSON
FLORENCE NIGHTINGALE
Born: May 12, 1820, Nightingale,
Italy; Died: August 13, 1910.
A nurse who contributed to
developing and shaping the modern
nursing practice and has set examples
for nurses who are standards for
today’s profession.
First nurse-theorist well-known for
developing the Environmental Theory
that revolutionized nursing practices
to create sanitary conditions for
patients to get care.
Recognized as the founder of modern
nursing.
During the Crimean War, she tended
to wounded soldiers at night and was
known as “The Lady with the Lamp.”
EARLY LIFE:
She was the younger of two children,
belonging to a British family of elite
social circles.
• Father: William Shore Nightingale,
a wealthy landowner who had
inherited two estates (Lea Hurst ,
Derbyshire; and Embley Park,
Hampshire)
Mother: Frances Nightingale, hailed
from a family of merchants and took
pride in socializing with prominent
social standing people.
Sibling: Frances Parthenope Verney
EDUCATION:
Raised on the family estate at Lea
Hurst, where her father provided her
with classical education, including
German, French and Italian studies.
Homeschooled by her parents and
teachers, gaining excellence in
Mathematics.
Active in philanthropy from a very
young age, ministering to the ill and
poor people in the village neighboring
her family’s estate.
At the age of 17, she decided to
dedicate her life to medical care for
the sick resulting in a lifetime
commitment to speak out, educate,
overhaul and sanitize the appalling
health care conditions in England.
PERSONAL LIFE:
Decided to enter the field in 1844,
expressing her desire to be a nurse.
Suitor: Richard Monckton Milnes, 1
St. Baron Houghton.
She had little respect for women in
general and preferred friendships with
powerful men.
Correspondence with an Irish nun,
Sister Mary Clare Moore.
WORKS AND CONTRIBUTIONS:
Notes on Matters Affecting the Health,
Efficiency and Hospital
Administration of the British Army
(1857)
- 830-page report analyzing her
experience and proposing
reforms for other military
hospitals operating under poor
conditions.
Notes on Nursing (1860)
- Outline nursing principles,
which is still in print today with
translation in many foreign
languages.
In all, she had published some 200
books, reports and pamphlets.
She used the money she got from the
British government to fund St.
Thomas’ Hospital’s establishment and
within it, the Nightingale Training
School for Nurses.
In the 1870s, Nightingale mentored
Linda Richards, who was latter on
referred to as “America’s first trained
nurse” and became a great nursing
pioneer in the USA and Japan.
Strict Precautions (early 1880s)
- Wrote an article regarding strict
precautions, designed to kill
germs.
APPOINTMENTS:
Accepted the superintendent’s position
at the Institute for the Care of Sick
Gentlewomen in Upper Harley Street,
London (1853-1854).
Sidney Herbert (Ministry at War)
appointed Nightingale to oversee the
care for the wounded soldiers.
Supervised a team of nurses in
Turkey’s
military hospitals, leading an
expedition of 38 women to take over
the management of the barrack
hospital at Scutari, observing
disastrous sanitary condition (Crimean
War).
AWARDS AND HONORS:
“The Lady with the Lamp”
- During the Crimean War, she
initially made her rounds on
horseback and at night used an
oil lamp to light her way.
“Nightingale Jewel”
- An engraved brooch rewarded
by the Queen, along with a prize
of $250,000 from the British
government.
“Royal Red Cross”
 - Rewarded by Queen Victoria
(1883)
Lady of Grace of St. John’s Order
First woman to be awarded by the
Order of Merit (1907)
Honorary Freedom of the City of
London (1908)
little education and training, and were
frequently incompetent and unreliable
in attending to the patient’s needs.
Deficiencies in these five factors
produce illness or lack of health, but
the body could repair itself with a
nurturing environment.

DEATH:
Fell ill in August 1910, seeming to
recover and was reportedly in good
spirits.
Developed an array of troubling
symptoms a week later.
Died unexpectedly at 2pm on August
13, 1910, at her home on London.

ENVIRONMENTAL THEORY
The act of utilizing the environment of
the patient to
assist him in his recovery.
Involves the nurse’s initiative to
configure environmental settings
appropriate for the gradual restoration
of the patient’s health and that external
factor associated with the patient’s
surroundings affect the life of biologic
and physiologic processes and his
development.
Posed great significance during the
time when health institutions had poor
sanitation, and health workers had
ENVIRONMENTAL THEORY

The Environmental Theory of Nursing
is a patient-care theory, focusing on
altering the patient’s environment to
affect change in his or her health.
The environmental factors affect
different patients unique to their
situations and illnesses.
The nurse must address these factors
on a case-by-case basis to make sure
the factors are altered to best care for
an individual patient and his or her
needs.
JEAN WATSON
Born: June 10, 1940, USA. An
American nurse theorist and nursing
professor known for her “Philosophy
and Theory of Transpersonal Caring.”
Also written numerous texts,
including Nursing: The Philosophy
and Science of Caring.
Her study on caring has been
integrated into education and patient
care to various nursing schools and
healthcare facilities worldwide.
EARLY LIFE:
Margaret Jean Harmon grew up in
Welch, West Virginia, in the
Appalachian Mountains.
Youngest of eight (8) children and
was surrounded by an extended
family-community environment.
Attended high school in West
Virginia and then the Lewis Gale
School of Nursing in Roanoke,
Virginia, where she graduated in
1961.
PERSONAL LIFE:
After her graduation in 1961, Watson
married her husband, Douglas
Watson, and moved west to his native
state of Colorado.
In 1997, Watson experienced an
accidental injury that resulted in the
loss of her left eye, and soon after, in
1998, her husband, whom she
considers as her physical and spiritual
partner, and her best friend passed
away and left her and their two grown
daughters, Jennifer and Julie, and five
grandchildren.
EDUCATION:
• Jean Watson ardently and quickly
progressed through her nursing
education, earning her bachelor’s
degree in nursing in 1964, a Master of
Science in psychiatric and mental
health nursing in 1966, and a Ph.D. in
educational psychology and
counseling in 1973, all from the
University of Colorado at Boulder.
CAREER AND APPOINTMENTS:
After Jean Watson concluded her
doctoral degree, she has served in
both faculty and administrative
positions in the School of Nursing
faculty, University of Colorado
Health Sciences Center in Denver.
In the 1980s, Watson and her
colleagues established the Center for
Human Caring at the University of
Colorado, the nation’s first
interdisciplinary center committed to
using human caring knowledge for
clinical practice, scholarship,
administration, and leadership.
Watson served as chairperson and
assistant dean of the undergraduate
program at the University of Colorado
School of Nursing. She was involved
in the planning and implementing of
the nursing Ph.D. program and served
as coordinator and director of the
Ph.D. program between 1978 and
1981.
From 1983 to 1990, she was Dean of
University of Colorado School of
Nursing and Associate Director of
Nursing Practice at University
Hospital.
During her deanship, she was
instrumental in developing a post
baccalaureate nursing curriculum in
human caring, health, and healing that
led to a Nursing Doctorate (ND), a
professional clinical doctoral degree
that in 2005 became the Doctor of
Nursing Practice (DNP) degree.
WORKS
Watson has authored 11 books, shared
in the authorship of six books, and has
written countless nursing journal
articles.
THEORY OF TRANSPERSONAL
CARING
Mainly concerns how nurses care for
their patients and how that caring
progresses into better plans to
promote health and wellness, prevent
illness and restore health.
In Watson’s view, the disease might
be cured, but illness would remain
because, without caring, health is not
attained.
Caring is the essence of nursing and
connotes responsiveness between the
nurse and the person; the nurse co-
participates with the person.
Watson contends that caring can help
the person gain control, become
knowledgeable, and promote healthy
changes.
According to Watson’s theory,
“Nursing is concerned with promoting
health, preventing illness, caring for
the sick, and restoring health.”
It 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.
The nursing model also states that
caring can be demonstrated and
practiced by nurses; and caring for
patients promotes growth; a caring
environment accepts a person as they
are and looks to what they may
become.
The Philosophy and Science of Caring
addresses how nurses express care to
their patients.
Caring is central to nursing practice
and promotes health better than a
simple medical cure.
Watson believes that a holistic
approach to health care is central to
the practice of caring in nursing.
SEVEN (7) ASSUMPTIONS:
1. Caring can be effectively
demonstrated and practiced
only interpersonally.
2. Caring consists of carative
factors that result in the
satisfaction of certain human
needs.
3. Effective caring promotes
health and individual or family
growth.
4. Caring responses accept the
patient as he or she is now, as
well as what he or she may
become.
5. A caring environment offers the
development of potential while
 allowing the patient to choose
the best action for themselves at
a given point in time.
6. The science of caring is
complementary to the science
of curing.
7. The practice of caring is central
to nursing.

Describing her theory as descriptive,

Watson acknowledges the theory’s
evolving nature and welcomes input
from others.
Watson’s theory continues to provide
a useful and important
metaphysical orientation for the
delivery of nursing care.
Watson’s theoretical concepts, such as
the use of self, patient-identified
needs, the caring process, and the
spiritual sense of being human, may
help nurses and their patients to find
meaning and harmony during a period
of increasing complexity.