NCM 100: Theoretical Foundations of Nursing Handout

Prepared by: Genevieve M. Soriano, RN

I. Introduction to Nursing Theory

A. Define Theory, Concepts and Principles

Definition of Theory

Theory- system of ideas intended to explain something, especially one based on

general principles independent of the thing to be explained.
* general definition of theory based on Oxford dictionary*

- an idea used to account for a situation or justify a course of action.

- Basically means a system of ideas to explain something.

What makes up a theory?

To further understand what a theory is. Let’s break it down to it’s essential parts

-theories describe, explain or predict phenomena

1. phenomena are things we witness through our senses.

-E.g. a patient falling, infected wound, staff burnout, a patient experiences anxiety
before surgery

ACTIVITY 1. Consider your average day in class or at work. Identify five phenomena
that you have seen, heard, smelled, touched or tasted.

ACTIVITY 2. Consider the hospital setting, identify five phenomena you have seen,
heard, smelled, touched or tasted.

2. When we put a name to a phenomenon, it becomes a concept.If we can

define the concepts, they help clarify our view of the phenomena. So,
concepts are the building blocks of a theory.

E.g. Patient A fall, infected wound, staff burnout, surgery induced anxiety

3. Proposition-When two or more concepts are linked

E. g. Patient A fall- wet floor (proposition), Infected wound- poor hygiene,

staff burnout- lack of manpower, surgery induced anxiety- lack of explanation
about surgery and its effects. These are all examples of causal proposition.
There are different types of propositions, they can be seen as the cement or mortar
that binds the concepts
(bricks) together to form the structure (a theory).

ACTIVITY 3: Consider your every day life as a student, give some examples of
propositions.
My example: Working 10 hours a day- stiff shoulders and back pain

ACTIVITY 4: Consider your experience when you got sick, went to the clinic, or got
hospitalized. Give an example of a proposition.
My example: I noticed that bed-ridden patients who are not turned every four hours
tend to develop productive cough.
Lack of mobility- productive cough

An assumption is something that you accept as true even though it has not been
tested.
Example: people are composed of biological, psychological and social dimension
A disease/sickness can have physical and psychological origins.
Ethical challenges are embedded in everyday practice in all settings in which nurses
work.
RECAP
1. Phenomenon: something that you experience through your senses
2.Concept: a name given to a phenomenon
3.Proposition: a statement that links concepts together different types of
relationships
4.Assumption: something that you take for granted even though it has not been
proved or tested

B. Nursing Theory

Let’s now define Nursing Theory

Nursing theory is constructed out of specific nursing phenomena represented as

concepts, definitions, assumptions and propositions that help describe, explain or
predict how nursing may support and help patients, families or society.

WHY DO WE NEED TO STUDY NURSING THEORY?

-As described, theories are a set of ideas that explain a phenomena.

- Nursing theories serve as a guide or a road map that guides us on how we give care
to our patients
- a theory represents knowledge developed by a systematic process, with the
purpose of being useful and helping to improve practice. This is new knowledge,
which still has to be tested (Pajnkihar 2003).Theory is best tested by research and
once this has been undertaken the theory becomes part of nursing science.

E.g. 1. Virginia Henderson’s Theory on ADLs (Activities of Daily Living)

THEORY: Her theory outlined how nurses should be focused on encouraging
patients to be independent in certain activities of daily living (ADLs) such as sleeping,
eating, mobilising etc.

APPLICATION: Many clinical nurses used the ADL theory to assess patients. Using
this, we can asses which areas the patient is independent at and we focus our care
on areas they are dependent with.

E.g. 2 The physical set up in hospitals, communities and even clinics are based on
Nightingale’s theory that the environment plays a key role in the recovery of patients.
Most set ups are maintained to be clean, have good water source, well-ventilated
and well-lit by sunlight.

E.g. 3 Peplau’s (1952) Peplau’s theory is mainly centered on how to

establish and sustain interpersonal relations with patients. We use this theory to
build nurse-patient relationship and establish rapport.
Nursing theories are also important in academic discipline

Much of the earlier nursing programs identified the major concepts in one or two
nursing models, organized the concepts, and build an entire nursing curriculum
around the created framework.

These models’ unique language was typically introduced into program objectives,
course objectives, course descriptions, and clinical performance criteria. The purpose
was to explain the fundamental implications of the profession and enhance the
profession’s status. GIL WAYNE, 2021

Source: Fundamentals of Nursing Practice, Mckenna, et. Al.

Metaparadigms of Nursing Theories

The most abstract and general component of the structural hierarchy of nursing
knowledge is what Kuhn (1974) called the metaparadigm

A metaparadigm refers “globally to the subject matter of greatest interest to

member of a discipline” (Powers & Knapp, 2011, p. 107).

The metaparadigm includes major philosophical orientations or worldviews of a

discipline, the conceptual models and theories that guide research and other
scholarly activities, and the empirical indicators that operationalize theoretical
concepts (Fawcett, 1996).

*empirical based on, concerned with, or verifiable by observation or experience

rather than theory or pure logic.
*abstract- refers to ideas, thought, a body of knowledge
The purpose or function of the metaparadigm is to summarize the intellectual and
social missions of the discipline and place boundaries on the subject matter of that
discipline (Kim, 1989).

The simplest definition of a paradigm is that it is the way in which we view the
world.

A nursing paradigm is considered to offer a perspective on what nursing is, and it is

influenced not just by different scientific traditions but by the problems of the
nursing discipline that require different perspectives for understanding (Kim 1989:
169).

Fawcett and DeSanto-Madeya (2013) identified four requirements for a

metaparadigm.

1. A metaparadigm must identify a domain that is distinctive from the

domains of other disciplines . . . the concepts and propositions represent a
unique perspective for inquiry and practice. KEYWORD: UNIQUE

2. A metaparadigm must encompass all phenomena of interest to the

discipline in a parsimonious manner . . . the concepts and propositions are
global and there are no redundancies.
KEYWORD PARSIMONY- accuracy, simplicity and something that must not
be multiplied unnecessarily

3. A metaparadigm must be perspective-neutral . . . the concepts and

propositions do not represent a specific perspective (i.e., a specific paradigm
or conceptual model or combination of perspectives).
KEYWORD: SPECIFIC, NEUTRAL

4. A metaparadigm must be global in scope and substance . . . the concepts

and propositions do not reflect particular national, cultural, or ethnic beliefs
and values.
KEYWORD: GLOBAL in scope.

The Four Metaparadigms of Nursing

These are the work of Fawcett and DeSanto-Madeya (2013), in the 1970s and early
1980s. This was further examined by Janet Wagner in 1986.

1. Person refers to a being composed of physical, intellectual, biochemical,

and psychosocial needs; a human energy field; a holistic being in the world;
an open system; an integrated whole; an adaptive system; and a being who is
greater than the sum of his or her parts (Wagner, 1986).

*holistic- interconnection of parts as a whole

 *open system- a system that interacts with the environment
NOTE: Nursing theories can be differentiated by how they define this metaparadigm.
Some nursing theories focus on the person as an individual while some have
expanded this definition to include the family or community.

2. Health is the ability to function independently; successful adaptation to

life’s stressors; achievement of one’s full life potential; and unity of mind,
body, and soul (Wagner, 1986).
Plummer and Molzahn (2009) suggested replacing the term “health” with
“quality of life.” They posited that quality of life is a more inclusive notion, as
health is often understood in terms of physical status.

NOTE: This aspect has been a central interest to nursing since its inception.

3. Environment typically refers to the external elements that affect the

person; internal and external conditions that influence the organism;
significant others with whom the person interacts; and an open system with
boundaries that permit the exchange of matter, energy, and information with
human beings (Wagner, 1986).

NOTE: Once again nursing theories can be differentiated by how they view the
environment. Some focus only on the immediate surroundings or circumstances.
Some theories offer a multilayered view of the environment encourages
understanding of an individual’s perspective and immediate context and
incorporates the sociopolitical and economic structures and underlying ideologies
that influence reality (Thorne et al., 1998).

4. Nursing is a science, an art, and a practice discipline and involves caring.

Goals of nursing include care of the well, care of the sick, assisting with self-
care activities, helping individuals attain their human potential, and
discovering and using nature’s laws of health. Furthermore, nursing practice
facilitates, supports, and assists individuals, families, communities, and
societies to enhance, maintain, and recover health and to reduce and
ameliorate the effects of illness (Thorne et al., 1998).

NOTE: Many grand nursing theorists, and virtually all of the theoretical
commentators, incorporate these four terms into their conceptual or theoretical
frameworks
 C. Different Types of Theory

Nursing theories are classified according to:

1. Range/scope or abstractness (grand or macrotheory to practice or situation-

specific theory)
Scope of theory- refers to complexity and degree of abstraction.

Source: Theoretical Basis of Nursing McEwen, Melanie Wills, Evelyn M.

A. Metatheory- refers to a theory about theory. In nursing, metatheory focuses on

broad issues such as the processes of generating knowledge and theory
development, and it is a forum for debate within the discipline (Chinn & Kramer,
2015; Powers & Knapp, 2011).

Philosophical and methodologic issues at the metatheory or worldview level include

identifying the purposes and kinds of theory needed for nursing, developing and
analyzing methods for creating nursing theory, and proposing criteria for evaluating
theory (Hickman, 2011; Walker & Avant, 2011).

NOTE: Most abstract, focus is on knowledge and theory development. Includes

analysis of methods to create and evaluate nursing theories.

B. Grand Theories Grand theories are the most complex and broadest in scope. They
attempt to explain broad areas within a discipline and may incorporate numerous
other theories. The term macrotheory is used by some authors to describe a theory
that is broadly conceptualized and is usually applied to a general area of a specific
discipline (Higgins & Moore, 2000; Peterson, 2017).

Grand theories are nonspecific and are composed of relatively abstract concepts that
lack operational definitions. Their propositions are also abstract and are not
generally amenable to testing. Grand theories are developed through thoughtful and
insightful appraisal of existing ideas as opposed to empirical research (Fawcett &
DeSanto-Madeya, 2013).

NOTE: Grand or Macro- big. Complex and broad, inclusive of other theories. Abstract
and nonspecific. Developed through appraisal of ideas and not empirical research.
Examples: Orem’s Self Care Deficit Theory

The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated

theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the
theory of nursing systems, which is further classified into wholly compensatory,
partially compensatory and supportive-educative.

Other examples: Roy, and Rogers and a majority of nursing conceptual frameworks.

C. Middle Range Theories- lies between the grand nursing models and more
circumscribed, concrete ideas (practice or situation-specific theories).
-Are substantively specific and encompass a limited number of concepts and a
limited aspect of the real world. They are composed of relatively concrete concepts
that can be operationally defined and relatively concrete propositions that may be
empirically tested (Higgins & Moore, 2000; Peterson, 2017; Whall, 2016).

A middle range theory may be (1) a description of a particular phenomenon, (2) an

explanation of the relationship between phenomena, or (3) a prediction of the
effects of one phenomenon or another (Fawcett & DeSanto-Madeya, 2013).

Examples: social support, quality of life, and health promotion

NOTE: Middle range- somewhere in between. More concrete and empirically tested.

D. Practice Theories Practice theories are also called situation-specific theories,

prescriptive theories, or microtheories and are the least complex. Practice theories
are more specific than middle range theories and produce specific directions for
practice (Higgins & Moore, 2000; Peterson, 2017; Whall, 2016).

Examples: theories of postpartum depression, infant bonding, and oncology pain

management.

2. Type or purpose of the theory (descriptive, predictive, or prescriptive theory).

A. Descriptive (Factor-Isolating) Theories Descriptive theories are those that

describe, observe, and name concepts, properties, and dimensions.
Descriptive theory identifies and describes the major concepts of phenomena but
does not explain how or why the concepts are related.
The purpose of descriptive theory is to provide observation and meaning regarding
the phenomena.

It is generated and tested by descriptive research techniques including concept

analysis, case studies, literature review phenomenology, ethnography, and grounded
theory (Young et al., 2001).
NOTE: Describe concepts, properties, and dimensions. No explanation of why and
how.
Observation and meaning of a phenomena.

B. Explanatory (Factor-Relating) Theories Factor-relating theories, or explanatory

theories, are those that relate concepts to one another, describe the
interrelationships among concepts or propositions, and specify the associations or
relationships among some concepts.
Deals with why and how, cause and effect and correlations or rules that regulate
interactions.

They are developed by correlational research and increasingly through

comprehensive literature review and synthesis.

C. Predictive (Situation-Relating) Theories -Situation relating theories are achieved

when the conditions under which concepts are related are stated and the relational
statements are able to describe future outcomes consistently.

Situation-relating theories move to prediction of precise relationships between

concepts. Experimental research is used to generate and test them in most cases.

NOTE: DESCRIBE or PREDICT future outcomes

Example: Caregiving effectiveness model Smith and colleagues (2002)
In the model, caregiving effectiveness is dependent on the interface of a number of
factors:
the characteristics of the caregiver, interpersonal interactions between the patient
and caregiver, education of the caregiver, economic stability, and the caregiver’s
own health status and family adaptation and coping mechanisms.
The model shows the interaction of these factors and depicts how they collectively
work to impact caregiving effectiveness.
D. Prescriptive (Situation-Producing) Theories -Situation producing theories are those that
prescribe activities necessary to reach defined goals. Prescriptive theories address nursing
therapeutics and consequences of interventions. They include propositions that call for
change and predict consequences of nursing interventions. They should describe the
prescription, the consequence(s), the type of client, and the conditions (Meleis, 2012).

Prescriptive theories are among the most difficult to identify in the nursing literature. One
example is a work by Walling (2006) that presented a “prescriptive theory explaining medical
acupuncture” for nurse practitioners. The model describes how acupuncture can be used to
reduce stress and enhance well-being.

NOTE: PRESCRIBE ACTIVITIES. Focused on therapeutics and consequences of interventions

References: Mckenna H., Majda, P., Murphy F. Nursing Models, Theories and Practice 2nd Ed.
John Wiley & Sons, Ltd(2014).
McEwen M., Evelyn W., Theoretical Basis for Nursing 5th Ed. Wolters Kluwer Health(2019).
Gil Wayne. Nursing Theories and Theorists. Nurseslabs.com 2021