N207 – Module 1

Definition of Theory

Pinnel and Menesis (1986)

● Systematic set of interrelated concepts, definitions and deductions that describe,
explain or predict interrelationships

Walker and Avant (1983)

● Internally consistent group of relational statements (concepts, definitions and
propositions) that presents a systematic view about a phenomenon and which is
useful for description, explanation, prediction, and control

Chin and Krammer (1991)

● Creative and vigorous structuring of ideas that project a tentative, purposeful and
systematic view of phenomena

Dickoff and James (1968)

● Conceptual system or framework invented for some purpose

Ellis (1968)
● Coherent set of hypothetical, conceptual, and pragmatic principles forming a general
frame of reference for a field of inquiry

SUMMARY:
1. set of concepts, definitions and propositions that are interrelated
2. has a purpose
3. systematic, logical and coherent
4. basis for inquiry
5. creative structuring of ideas
6. dynamic and tentative
7. evolving and enriched by practice and research

Components / Elements of Theory

1. Purpose - answers the question, “why is the theory formulated?” It also specifies the
context and situation within which the theory is formulated.

2. Concept - are the building blocks of theory. They are ideas, mental images of a
phenomenon, an event or object that is derived from an individual’s experience and
perception.
four common major concepts, namely:
1. Person
2. Nursing
3. Health
4. Environment

3. Definitions - give meaning to concepts. They make concepts clearer and more
understandable. There are two types of definitions:
● Descriptive or conceptual - accepted meaning of the term already used,
where
 ● Operational or stipulative - specific use or definition of the term within the
theory.

4. Propositions - expressions of relational statements between and among concepts.

Propositions can be expressed as statements, paradigms or figures. Theoretical
assertions are the same as propositions.

5. Assumptions - accepted “truths” that are basic and fundamental to the theory. They
are what we call givens.
● Factual assumptions are those knowable or potentially knowable by empirical
experience.
● Value assumption asserts or implies what is right, good or ought to be

Characteristics of a Theory
1. Systematic, logical and coherent
2. Creative structuring of ideas
3. Tentative in nature

Theory Development
Meleis (1985) identified four strategies of theory development in nursing.
1. theory-practice-theory
Ex: Peplau’s theory of Interpersonal Relations in Nursing which was based on the
Interpersonal Theory of Sullivan
2. practice-theory
Ex: Orlando’s Nursing Process Theory
3. research-theory -- inductive method
Ex: Johnson’s Behavior Systems Model
4. theory-research-theory
Ex: Conceptual or theoretical frameworks in nursing research studies

**One can begin at any point in the circle. The direction can be clockwise or counter-clockwise.
This also indicates that the process of moving from one to the other is continuous and indefinite.

Uses of Theory
1. Theory guides and improves nursing practice.
2. Theory guides research.
3. Theory contributes to the development of the discipline’s body of knowledge.
4. Theory enhances communication.

Historical Development of Nursing Theory

1. Prior to 1960
a. Nightingale’s works and writings
b. Formal education of nurses
c. Publication of Nursing Research

2. 60s and 70s

a. Scientific era: nurses questioned purpose of nursing
b. Publications dealing with philosophy of nursing, conceptual models and frameworks
c. Process of theory development discussed among professional nurses
d. Symposia held on theory development in nursing
e. Borrowed theories from other disciplines
3. 80s
a. Acceptance of the significance of theory in nursing
b. Revision and further development of theories
c. More substantive debate on issues related to theory development

4. 80s to present
a. Publication of books and articles on analysis, application, evaluation, and further
development of nursing theories
b. Courses on theories offered at the graduate school level

Types of Theories

1. according to range
2. according to orientation or focus of the theory

According to Range

1. Grand Theory - the most complex and broadest in scope

● Henderson’s The Nature of Nursing
● Levine’s The Four Conservation Principles of Nursing
● Roy’s Adaptation Model
● Orem’s Self-Care
2. Middle Range Theory - fill the gap between the grand theory and micro theory
● Peplau’s Psychodynamic Nursing and
● Orlando’s Nursing Process Theory

3. Micro Theory - contain the least complex concepts and are narrowest in scope

According to Orientation or Focus

1. client-centered - focused on the needs and problems of clients which are met,
resolved or alleviated by nursing interventions.
● Nightingale
● Abdellah
● Henderson
● Orem
● Pender
● Roy
● Levine
● Hall

2. client-nurse dynamics - focus on interaction between the nurse and client.

● Peplau
● Watson
● King
● Orlando

3. nurse-client-environment dynamics - focus on the interaction between nurse and

client in an environment
● Neuman
● Leininger
N207 - Module 2
CLIENT-CENTERED NURSING THEORIES
HENDERSON
THEORY Definition of Nursing
Major Concept
whole, complete and
independent being with
biological,sociological,
and spiritual components which
1.
are operationalized in the 14
Person
fundamental or basic human
needs
Quated with independence;
individual will achieve or maintain
health if they have the necessary
strength,will or knowledge.
2.
Health is viewed in terms of the
Health
patient’s ability to independently
perform the 14 basic needs.
assisting the individual, sick or
well, in the performance of those
activities contributing to health or
its recovery or to peaceful death
3. Nursing
OREM
Self-care Deficit Theory of Nursing
integrated whole— a unity
functioning biologically,
symbolically and socially. She also
described man as self-reliant and
responsible for selfcare and
well-being of his or her
dependents. Self-care is a
requisite for all.
a state of wholeness or integrity of
the individual human being, his
parts, and his modes of
functioning. This concept is
inherent in her nursing systems
since the goal in each system is
optimal wellness relative to that
system.
as a community service, an art,
and a technology. To her, nursing
is a service of deliberately
selected and performed actions to
assist ndividuals or groups to
maintain self-care, including
structural integrity, functioning,
and development.
 “the aggregate of all the external environment encompassed the
conditions and influences
affecting the life and
development of an organism”
Henderson listed 7 essentials in
the environment: light,
temperature, air movement,
atmospheric pressure,
appropriate disposal of waste,
4. Environment minimal quantities of injurious
chemicals, and cleanliness
of surfaces and furnishings
coming in contact with the
individual.
elements external to man. But she
consdered man and environment
as an integrated system related to
self-care.
Environmental conditions
conducive
to development include
opportunities to be helped: being
with other persons or groups
where care is offered;
opportunities for solitude and
companionship; provision of help
for personal and group concerns
without limiting individual
decisions and personal pursuits;
shared respect, belief, and trust;
recognition and fostering of
developmental potential.

the nurse plans the care - The theory of self-care (which

appropriate to assisting the describes and explains self-care)
individual in activities contributing - The theory of self-care deficit
to his/her health. She further (which describes and explains
stated that individuals will why people can be helped
achieve or maintain health if they through nursing), and
Key Concept have the necessary strength, will - The theory of nursing systems
or knowledge. She considered (which describes and explains
the 14 fundamental or basic relationships that must be brought
needs as the basis for the about and maintained).
nurses’ basic functions.
Person, Nursing function,
Nursing care

Henderson 14 fundamental or basic human needs, namely:

1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable position
5. Sleep and rest
6. Select suitable clothes—dress and undress
7. Maintain body temperature within normal range by adjusting clothing and modifying the
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 by 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

Goal of Nursing
- independence in the satisfaction of the human being’s 14 fundamental or basic needs.

Theoretical assertions

The nurse-patient relationship

1. Subtitute
2. Helper
3. Partner

Henderson’s Component of Nursing Process

1. Assessment - With which of the 14 basic needs does your client need assistance? What
has caused the lack of independence in the fulfillment of these needs?
2. Implementation - Interventions aim to help client meet 14 basic needs. These
interventions may include drug administration and treatment prescribed by the MD.
3. Planning - Negotiate client-centered goals which aim for a return of the client to
independence.
4. Evaluation - Formative – Is the client able to meet basic needs without nursing
assistance? Summative – What are the strengths and limitations of Henderson’s model
in directing interventions?
The Orem Self-Care Deficit Theory of Nursing

Major Concept ( see table above)

Man/person/individual/client: An integrated whole

Orem’s definition of the patient requires three conditions to be satisfied:
1. There must be some self-care demand (universal, developmental or health-deviation) to
be met for another person.
2. The individual must be motivated to do some self-care activities
3. A deficit relationship must exist between a person’s self-care demands and his ability to
meet those demands.

Health: State of wholeness

- the responsibility of a total society and all its members

Nursing: A service, an art, and a technology

- art of nursing - as the ability to assist others in the design, provision, and management of
systems of self-care to improve or to maintain human functioning at some level of
effectiveness.

Environment - elements external to man

Underlying assumptions
Assumptions involving the concept of self-care include:
1. Self-care is a requirement of every person.
2. Universal self-care involves meeting basic human needs.
3. Health-deviation self-care is related to disease or injury.
4. Each adult has both the right and the responsibility to care for his/her self in order to
maintain rational life and health. He/she also has responsibilities to dependents.
5. Self-care is learned behavior processed by the ego and influenced by both self-concept
and level of maturity.
6. Self-care is deliberative action.
7. Awareness of relevant factors and their meaning is a prerequisite condition for self-care
action

Key concepts of Orem’s theory and definitions

Self-care requisites Self-care Nursing system

Universal self-care Demands Wholly compensatory

Developmental self-care Capabilities Partly compensatory
Health-deviation self-care Deficits Supportive-educative

Self-Care Deficit is the qualitative or quantitative inadequacy of the self-care agency as related
to therapeutic self-care demand.