THEORETICAL FOUNDATIONS OF NURSING OUTLINE

1. Basic concepts of Nursing, Theory, and Nursing Theory

a. Nursing as a discipline, occupation, job and profession
b. Theory
i. Concept definition
ii. Relational statements
iii. Linkages and ordering
c. Classification of theories
2. Metaparadigms of nursing theories
3. Maslow’s hierarchy of needs
4. Needs/problem-oriented theories
a. Modern nursing by Florence Nightingale
b. Self-care deficit theory of nursing by Dorothea Orem
5. System-oriented theories
a. Behavioral system model by Dorothy Johnson
b. Adaptation Model by Sister Callista Roy
6. Interaction-oriented theories
a. Psychodynamic Nursing by Hildegard Peplau
b. Systems model by Betty Neuman
c. Nursing process Theory by Ida Jean Orlando
7. Transcultural Nursing by Madeleine Leininger
8. Human to Human Relationship Model by Joyce Travelbee
9. Theory of Transpersonal Caring by Jean Watson
10. Theories on caring
11. Philippines Nursing Conceptual Models and Theories
a. Prepare Me Theory by Carmencita Abaquin
b. COMPARE Theory by Carmelita Divinagracia
c. Retirement and Role Discontinuities by Sister Letty Kuan
d. Quantitative & Phenomenological Approach by Elsie Antiporta-Tee
e. …. others
12. The Professional Filipino Louisian Nurse

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THEORETICAL FOUNDATIONS OF NURSING

What is Nursing?
 Starts in 1902
 A service that is beneficial to the society and can be received by different clientele.
 An autonomous & collaborative care of individuals of all ages, families, groups & communities, sick or
well and in all settings (ICN).
 It is a unique perspective as field of study or discipline

Levels of Clientele
1. Individuals
2. Families
3. Communities
4. Population

Healthcare Services
1. Promotive – regular check so they can promote all current status of being.
 Playing, got wound, get an intervention - something that enters the balanced state.
2. Curative – something gives an intervention for a disease.
3. Rehabilitative
4. Dying [death care/ post common care] – requires giving the outmost respect with regards on how the body is
treated.

Nursing as a discipline, occupation, job and profession

A. Academic Discipline – ✓
 A division of education
 Refine knowledge base
i. Higher education to develop unique body of knowledge
 science:
i. natural science X
ii. social science – ✓
iii. applied science – nursing
iv. pure/basic science – ✓
 institution
i. philosophy
- perspective/lens
- way one views the world
ii. humanities
iii. Health is multifunctional
iv. Science: a process [through scientific process] & a product [through body of knowledge]
B. Occupation: ✓
 It pays, practice where you were paid for.
C. Profession: ✓
 Specialized field of practice
 Specialized body of knowledge – study BSN for 4 years
 Training of skills
 Long term practice – completed RLEs
 License
 Code of conduct (moral guidelines/ code of ethics)

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  Autonomy (nurses association)
 Accountable to the society (noble): noble profession
 Control and limitations
D. Job: ✓
 It pays you to make a living
 All of these can be a justification on why nursing is considered as a profession.

Note: All of the professions including nurses that are working, they are also used as a source of income but not all
occupations are profession since not all occupation are professionals. Some occupations doesn’t require a standard
unlike profession, there is a standard.

Developmental Path of Nursing

Concepts  conceptual frameworks  models  theories  practice level middle range theories

Definition of Terms
 Knowledge: information, skills and expertise acquired by a person through various life experiences or
through formal or informal learning such as formal education, self-study, vocational.
 Phenomenon: sets of empirical data or experiences that can be physically observed or tangible such as
crying or grimacing when in pain.
 Model: graphic or symbolic presentations of phenomena
 Foundation: talking about the principles
 Principle: underlying truth are facts, they have been studied and brought out under scientific process to
provide us a body of knowledge.
 Theory: explains a phenomenon, organized system of accepted knowledge that composed of concepts,
propositions, definitions, & assumptions intended to explain a set of fact, event or phenomena.
Sometimes theories are implicit or explicit
o Phenomena: events, occurrence, reality of life. (describes the concept)
 Example is career decision.
o Concept: an idea formulated by the mind or an experience perceived and observed such as
justice, love, war and disease; building blocks a theories
 TYPES
 Concrete or Empirical concept: experimental, specific, observable events,
objects or properties which can be seen, felt or heard.
o nurse
 Abstract concept: intangible, deep, not clearly observable directly or indirectly
o Love, social support
 Inferential concept: indirectly observable concepts
o Pain, dyspnea, temperature
 Most of the theories use abstract concepts and it should be defined as observable
(concrete) concepts when applied in Research, education and practice. We transform the
abstract concepts to concrete concepts based on local needs.
o Is a concept is the same of phenomena? No, concepts describe the phenomenon. Concepts are
subtopics of phenomena.
o Construct: highest level of a concept (most complex) eg. romantic
o Propositions – explains the relationships of different concepts. These are simply statements that
imply the relationships of concepts.

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  Example: children who do not want to stay in the hospital because of their fear of
injections.
o Assumptions – statement that specifies the relationship or connection of a factual concepts or
phenomena. These are statements that the theorists hold as factual.
 Example: all patients who are not able to take good care of themselves need nurses.
o Definition: composed of various descriptions which convey a general meaning and reduces the
vagueness in understanding of set of concepts.
 Conceptual definition: meaning of a word based on how a certain theory or relevant
literature perceives it to be.
 roles or concepts of nurse, patient care, and environment
 Operational definition: based on the method of how it was measured or how the
person come up with that perception.
 Significance of pain perception and practice nursing intervention
 Example: Nursing formulated by Peplau.
o Induction: type of reasoning that uses specific details to form a general conclusion.
o Deduction: type of reasoning wherein general conclusions are made based from specific
concepts.

MODEL VS. THEORY

MODE THEORY
L
- Overview of theory (represents the facts & theory) - Discussion, purpose, concepts, propositions, etc.
- Schematic representation of a theory
- Concept map
- Graphic organizer

FRAMEWORK OR MODELS
THEORETICAL
- meaning base on structure of
concepts which exist or tested in
literature
- ready-made map
- highly established set of
concepts that are testable
CONCEPTUAL
- it is a structure of concepts or
theories which are pulled
together
- map for the study
- definition from literature
- derived from a persons’
own point of view
- can be represented thru
diagram or narrative.
OPERATIONAL
- meaning of the word base on how it was
measured or how the person come up with
that perception
- defines how concept will be
determined

THEORY describes, explains, predicts, prescribes NURSING CARE.

Nursing Theory – group of interrelated concepts that developed from various studies of disciplines and related
experiences which aims to view the essence of nursing care.
 These are theories that talk about how nursing develop from the past tot the present.
 Talks about nursing practice

Characteristics of Theories in Nursing

 Correlate concepts in such a way as to generate a different way of looking at a certain fact or
phenomenon.

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  Logical in nature
 Simple but generally broad in nature
 Source of hypotheses that can be tested for it to be elaborated.
 Enriching the general body of knowledge through the studies implemented to validate them.
 Can be used by practitioners to direct and enhance their practice
 Consistent with other validated theories, laws and principles but will leave open unanswered issues that
need to be tested.

Classification Of Theories In Nursing

 BASE ON RANGE OR SCOPE
o Metatheory/Philosophy – theory about theory, deals with processes of generating knowledge
and debating broad issues
 It refers to “theory of theories”.
 Characteristics of Metatheory:
 Focus on generating Knowledge and theory development.
 Focus on philosophical issues and methodological issues of nursing
 theory.
 Focus on developing criteria for analysis and evaluating nursing theory.
 Example of Metatheory- J.Dickoff’s and P.James’s Theory of Theories
o Grand theories – most complex and broadest in scope (e.g., career decisions of millennials)
 Characteristics of Grand theories:
 Focus on broad and general areas and concepts.
 It deals with nonspecific and relatively abstract concepts.
 Concepts mentioned in grand theories lack operational definitions.
 Grand theories are not directly amenable to testing.
 These can be used in variety of setting and populations.
 Example of Grand theories- Orem, Roy, Rogers, career decisions of millennials
o Middle range theories – more circumscribed concrete ideas (details)
 Middle-range theories target specific phenomena or concepts, such as pain and stress;
they are limited in scope yet general enough to encourage research. It deals with
concrete and relatively operational concepts and amenable to empirical testing. These
theories are highly specific to nursing. These theories are relatively simple to
understand and apply.
 Characteristics of Middle Range theories: These are characteristics of good mid-range
theory as described by Whall (1996):
 Its concepts and propositions are specific to nursing;
 it is readily operationalized;
 it can be applied to many situations;
 propositions can range from causal to associative, depending on their
application; and
 Assumptions fit the theory.
 It should be relevant for potential users of the theory, i.e. nurses; and
 It should be oriented to outcomes that are important for patients, not merely
describe what nurses do.
 It should describe nursing-sensitive phenomena that are readily associated
with the deliberate actions of nurses.

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  Example: Benner Model of skill acquisition in Nursing. Corbin and Strauss ”Chronic
illness trajectory framework”
o Practice theories – situation – specific theories, perspective theories or micro theories
(career decision of SHS theories)
 Practice theories are narrowly defined; they address a desired goal and the specific
actions needed to achieve it.
 Characteristics of Practice theories:
 Least complex in nature.
 More specific than middle range.
 Provides specific directions.
 Limited to specific populations.
 Often use of knowledge of other discipline.
 Specific to population and setting (oncology).
 Cannot be applied in all setting.

Comparison of Grand, Middle Range And Practice Theories

Characteristic Grand Theories Middle-Range Theories Practice Theories

Complexity/ Comprehensive, global view
abstractness, point (all aspects of human
scope experience)
Nonspecific, general
Generalizability/ application to the discipline
specificity irrespective of setting or
specialty area
Characteristics of Concepts abstract and not
concepts operationally defined
Characteristics of Propositions not always
propositions explicit
Testability Not generally testable
Developed through thoughtful
Source of appraisal and careful
development consideration over many years
Less comprehensive than Focused on a narrow
grand theories, middle view of view of reality, simple
reality and straightforward
Some generalizability
Linked to special
across settings and
populations or an
specialties, but more
identified field of
specific than grand
practice
theories
Limited number of concepts
Single, concrete
that are fairly concrete and
concept that is
may be
operationalized
operationally defined
Propositions are clearly
Propositions defined
stated
May generate testable Goals or outcomes
hypotheses defined and testable
Evolve from grand theories,
Derived from practice or
clinical practice, literature
deduced from middle-
review, practice guidelines
range or grand theory

 BASE OF PURPOSE OF THEORY

o Descriptive – factor-isolating theories

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  Identify and explains the major concepts of a phenomenon.
 Primary level of theory development
 To know the properties and workings of a discipline.
 Do not explain the relationship of the concepts.
 Main purpose is to present a phenomenon based on the 5 senses together with their 5
senses.
 Classification descriptive theory – categorize the concepts
 EXAMPLE: a descriptive research about the Filipino nursing practices like use of
herbal medicines.
o Explanatory – factor-relating theories
 It present relationship among concepts, propositions or phenomena.
 Aim to provide information on how or why concepts are related.
 Cause and effect relationship are well explained in this theory.
 EXAMPLE: a research study about the factors affecting newborns in failing to thrive.
o Predictive – situation-relating theories
 It predict the effects of one phenomenon on another
 Foresees what will happen in the future
 Achieved when the relationship of concepts under a certain condition are able to
describe future outcomes consistently.
 EXAMPLE: a theoretical model based on the observation of the effects of unsanitary
environmental condition on the recovery of the post-operative parents.
o Prescriptive – situation-producing theories
 Used to produce or control a desired phenomenon
 Highest level. Tells what you will do.
 Deals with nursing actions and test the validity and certainty of a specific nursing
intervention.
 EXAMPLE: Laurente’s theory validates and explains the different nursing
management in emergency room in relieving anxiety among its clients.
 BASE ON DICSIPLINE
o Borrowed vs. Unique Theories in Nursing
 Since 1960’s, sharing or borrowing theory from other disciplines has been raised.
 Disciplines
 Sociology
 Family Systems Theory
 Feminist theory
 Role theory
 Critical Social Theory
 Behavioral
 Biomedical
 Leadership and medical
 ACCORDING TO NURSING DOMAINS
NEEDS INTERACTION OUTCOME CARING/BECOMING(h
(what we want to have) ow to become a nurse in a
holistic way)
FOCUS Problems Interaction Energy Human-universe health
process
Nurse’s function Illness as Homeostasis
experience Mutual relations

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 Outcome of care
Unitary being
HUMA Set of needs Interacting Set Adaptive Man-living-health
N developmental
BEING Problems of needs human being Continuously
becoming
Developmental Validated needs
being
Human experience
PATIENT Needs deficit Helpless being Lacks adaptation Unique human being

System deficiency Transformation

ORIENTATION Illness/disease Illness/disease Illness/disease Health

Human becoming
NURSE’S Fulfills needs Helping process External regulatory Connect Be
ROLE requisite mechanism
Self as therapeutic agent present
Begin
independent Nursing process Exact meaning
function
DECISIO Health care Health care Health care Mutual
N provider provider provider
MAKER

Stages of Theory Development (Knowledge)

Stages Source of knowledge Impact on theory
Silent Blind obedience to medical Little attempt to develop a theory
authority
- listens, no guidelines
Received Learning through listening Theories were borrowed from other
- from doctors, practitioners disciplines.
- herbal Primarily educational research or
sociologic research,
Subjective Authority was internalized to foster a A negative attitude toward borrowed
new sense of self theories and science emerged.
- nurses started to think of Nursing scholars focused on defining
themselves nursing and on developing theories about
- set of duties and for
nursing. Nursing research focused on
nurse.

Procedural Includes both separate and Proliferation of approaches to

connected knowledge theory development. Application of
- skill passage from one person to theory in practice was frequently
another underemphasized.
Integrated Assimilation and application of Nursing theory will increasingly
- applies evidence from nursing and other health incorporate information.
everything they care discipline.
know

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Virginia Henderson’s Need Theory
 Nithangle of modern nursing
 Emphasize on importance of increasing patients’ independence
 Categorize nursing activities in 14 components
1. Breathing
2. Eating and drinking
3. Elimination
4. Movement and posture
5. Sleep and rest
6. Clothing
7. Body temperature maintenance
8. Cleaning and grooming
9. Avoidance of danger
10. Communication
11. Worship
12. Work
13. Play and recreation
14. Learning

Based on range or scope Based on purpose Based on discipline Based on nursing

domains
Based on McEwen: Explanatory: explains the Unique: own needs
Grand Theory factors
Based on Alligood:
Philosophy

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