Introduction to Nursing Theory
Theory is a systematic explanation of an event in
which constructs and concepts are identified and
relationships are proposed and predictions made.
• is a creative and rigorous structuring of
ideas that project a tentative, purposeful,
and systematic view of phenomena.
• is a set of interpretative assumptions,
principles, or propositions that help
explain or guide action.
• Dickoff and James (1968) – theory is
invented rather than found in or discovered
from reality.
Half of the 20th century nursing was recognized as
a profession
Theory development is needed to develop a body
of substantive knowledge to guide nursing
practice to establish nursing as a profession.
Importance of Nursing Theories
• Guide critical thinking in nursing practice
• Provide the nurse with patient focus and a
framework to sort patient data in practice.
• Guide both thinking and nursing action.
• Informs practice and also that practice
informs theory
• Identify certain standards for nursing
practice
• Identify settings in which nursing practice
should occur and the characteristics of
what the model’s author considers
recipients of nursing care
• Identify distinctive nursing process and
technologies to be used
• Direct the delivery of nursing services
• Serve as the basis for clinical information
systems
• Guide the development of client
classification systems
• Direct quality assurance programs.
The systematic accumulation of knowledge is
essential to progress in any profession however,
theory without practice is empty and practice
without theory is blind
Nursing Theory is the backbone of clinical care.
To apply nursing theory in practice, the nurse
must have adequate knowledge of the theoretical
works of the nursing profession.
Theory Development in Nursing
• Florence Nightingale – the first modern
nursing theorist.
• First to advocate the teaching of symptoms
and what they indicate.
• taught the importance of rationale for
actions and stressed the significance of
“trained powers of observation and
reflection”
• Proposed basic premises for nursing
practice ( make observations of the sick,
their environment, record observations,
and develop knowledge about factors that
promote healing.
Stages in the Development of Nursing Theory
Silence Knowledge – blind obedience to medical
authority
Received Knowledge – learning through listening
to others
Subjective Knowledge – authority was
internalized to foster a new sense of self
Procedural Knowledge – includes both separate
and connected knowledge
Constructed Knowledge – combination of
different types of knowledge (intuition, reason,
and self-knowledge)
Integrated Knowledge – assimilation and
application of evidence from nursing and other
health care disciplines
Structural Level of Nursing Knowledge
Metaparadigm
Greek words
• Meta – with
• Paradeigma – pattern
- defined by Fawcett (2005) as the global
concepts that identify the phenomenon of
 central interest to a discipline, the global
propositions that describe the concepts,
and the global propositions that state the
relations between or among the concepts.
It is the most abstract view of discipline, and it
consists of the concepts that define the discipline.
This means that a metaparadigm has a set of
principles that provide structures for how a
discipline should function.
Metaparadigm of Nursing
Person - (also referred to as Client or Human
Beings) is the recipient of nursing care and may
include individuals, patients, groups, families, and
communities.
Environment (or situation) - is defined as the
internal and external surroundings that affect the
client. It includes all positive or negative
conditions that affect the patient, the physical
environment, such as families, friends, and
significant others, and the setting for where they
go for their healthcare.
Health is defined as the degree of wellness or
well-being that the client experiences. It may have
different meanings for each patient, the clinical
setting, and the health care provider.
The nurse’s attributes, characteristics, and actions
provide care on behalf of or in conjunction with
the client.
Philosophies of Nursing
Philosophy is the search for and communication
of a viewpoint
According to Fawcett (2005) the function of
philosophy is "to communicate what the members
of a discipline believe to be true in relation to the
phenomena of interest to that discipline.
Conceptual Models of Nursing
Also called a conceptual framework, conceptual
system, and disciplinary matrix.
Fawcette defines a conceptual model as a"set of
relatively abstract and general concepts that
address the phenomena of central interest to a
discipline, the propositions that broadly describe
those concepts, and the propositions that state
relatively abstract and general relations between
two or more of the concepts.
Conceptual models characterize relationships
among phenomena to shape a distinctive frame of
reference.
Concept of Nursing Theories
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. 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.
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, purpose, relationships, and structure of
a theory.
Scope of Theory
Refers to complexity and degree of abstraction
Metatheory – refers to a theory about the nature
of theory
- such as the processes of generating
knowledge and theory development
- a higher order theory about theories,
allowing one to analyze, compare, and
evaluate competing bodies of ideas. The
concept of a metatheory suggests that
theories derive from other theories so that
there are always prior theoretical
assumptions and commitments behind any
theoretical formulation.
Grand Theories – attempt to explain broad areas
within a discipline and may incorporate numerous
other theories.
Example:
Dorothea Orem developed the Self-Care Nursing
Theory or the Orem Model of Nursing. It is
considered a grand nursing theory, which
means the theory covers a broad scope with
general concepts applicable to all instances of
nursing.
- nonspecific, composed of relatively
abstract concepts that lack operational
definitions.
Middle – Range Theories – substantively
specific, encompass a limited number of concepts
and a limited aspect of real world.
- A description of a particular phenomenon
- An explanation of the relationship between
phenomena
- A prediction of the effects of one
phenomenon or another
- are narrower in scope than grand theories
and deal with some part of a discipline's
concerns related to particular topics.
Because of the narrower scope and
specificity of a middle-range theory, it is
more readily useable and testable in
research projects.
Practice Theories – called situation-specific
theories, prescriptive theories, or microtheories.
- Least complex, more specific, produce
specific directions for practice. Contain the
fewest concepts, refer to specific easily
defined phenomena
- are situation-specific theories that are
narrow in scope and focus on a specific
patient population at a specific time.
• provide frameworks for nursing
interventions and suggest outcomes or the
effect of nursing practice.
• Theories developed at this level have a
more direct effect on nursing practice than
more abstract theories.
• These theories are interrelated with
concepts from middle-range theories or
grand theories
Kinds and Definitions of Theories
Factor – isolating theories ( descriptive
theories) – identifies and describes the major
concepts of phenomena but does not explain how
or why the concepts are related
Purpose: Provide observation and meaning
regarding the phenomena.
Factor – relating theories ( explanatory
theories) – relate concepts to one another,
describe the interrelationships among concepts or
propositions, and specify the relationships among
some concepts.
Purpose: Attempt to tell how or why the concepts
are related and may deal with cause and effect and
correlation or rules that regulate interactions
Situation – relating theories ( predictive
theories or promoting or inhibiting theories) –
relational statements are able to describe future
outcomes consistently
Purpose: predict the relationships between the
components of a phenomenon and predict under
what conditions it will occur.
Situation – producing theories ( prescriptive
theories) – are those that prescribe activities
necessary to reach defined goals. They include
propositions that call for change and predict
consequences of nursing intervention.
Purpose: Address nursing therapeutics and
consequences of intervention.
Theory Evaluation: Steps
1. Theory description – the initial step in the
evaluation process. The work of the
theorist are reviewed with a focus on the
historical context of the theory. Related
works by others are examined.
2. Theory Analysis – the second step or
phase of evaluation process. It refers to a
systematic process of objectively
examining the origins, content, structure,
and function of a theory. Theory analysis is
conducted if the theory or framework has
potential for being useful in practice,
research, administration, or education.
This step is non-judgemental, detailed
examination of a theory, the main aim is to
understand the theory.
3. Theory Evaluation – called as theory
critique. The finale step I the evaluation
process. Assess the theory’s potential
contribution to the discipline’s knowledge
base. It is examined how well a theory
serves its purpose, how the theory is used
to direct nursing practice and interventions
and whether or not it contributes to
favorable outcomes.
The process of theory evaluation typically
includes examination of the theory’s origins,
meaning, logical adequacy, usefulness,
generalizability, and testability.
Grand Theories
Grand theories are abstract, broad in scope, and
complex, therefore requiring further research for
clarification.
• Grand nursing theories do not guide
specific nursing interventions but rather
provide a general framework and nursing
ideas.
• Grand nursing theorists develop their
works based on their own experiences and
their time, explaining why there is so much
variation among theories.
• Address the nursing metaparadigm
components of person, nursing, health, and
environment.
Grand Nursing Theories Based on Human
Needs
Florence Nightingale’s Environmental Theory
• defined Nursing as “the act of utilizing the
patient’s environment to assist him in his
recovery.”
• It involves the nurse’s initiative to
configure environmental settings
appropriate for the gradual restoration of
the patient’s health and that external
factors associated with the patient’s
surroundings affect the life or biologic and
physiologic processes and his
development.
Environmental Factors
1. Pure fresh air – “to keep the air he
breathes as pure as the external air without
chilling him.”
2. Pure water – “well water of a very impure
kind is used for domestic purposes. And
when the epidemic disease shows itself,
persons using such water are almost sure
to suffer.”
3. Effective drainage – “all the while the
sewer may be nothing but a laboratory
from which epidemic disease and ill health
are being installed into the house.”
4. Cleanliness – “the greater part of nursing
consists in preserving cleanliness.”
5. Light (especially direct sunlight) – “the
usefulness of light in treating disease is
very important.”
Health of Houses - “Badly constructed houses do
for the healthy what badly constructed hospitals
do for the sick.
Ventilation and Warming - “Keep the air he
breathes as pure as the external air, without
chilling him.”
Light - that direct sunlight was what patients
wanted.
Noise - patients should never be “waked
intentionally” or accidentally during the first part
of sleep.
Variety - need for color and form changes;
bringing the patient brightly colored flowers or
plants; rotating 10 or 12 paintings and engravings
each day, week, or month to provide variety for
the patient; reading, needlework, writing, and
cleaning to relieve the sick of boredom.
Bed and Bedding - bedding is changed and aired
frequently; bed should be placed in the lightest
part of the room and placed so the patient could
see out of a window; never to lean against, sit
upon, or unnecessarily shake the patient’s bed.
Personal Cleanliness - it is necessary to keep
pores of the skin free from all obstructing
excretions.”; “Every nurse ought to wash her
hands very frequently during the day.”
Nutrition and Taking Food - no business be
done with patients while they are eating because
this was a distraction; individuals desire different
foods at different times of the day and that
frequent small servings may be more beneficial to
the patient than a large breakfast or dinner.
Chattering Hopes and Advice - falsely cheer the
sick by making light of their illness and its danger
is not helpful;
Social Considerations - importance of looking
beyond the individual to the social environment in
which they lived.
Virginia Henderson’s Nursing Need Theory
The Need Theory emphasizes the importance of
increasing the patient’s independence and
focusing on the basic human needs so that
progress after hospitalization would not be
delayed.
Function of the nurse - that of acting for the
patient when he lacks knowledge, physical
strength, or the will to act for himself as he would
ordinarily act in health or in carrying out
prescribed therapy.
Nursing Metaparadigm in Henderson’s Theory
Individual - individuals have basic health needs
and require assistance to achieve health and
independence or a peaceful death. According to
her, an individual achieves wholeness by
maintaining physiological and emotional balance.
Environment - maintaining a supportive
environment conducive to health
Health - health was taken to mean balance in all
realms of human life. It is equated with the
independence or ability to perform activities
without aid in the 14 components or basic human
needs.
Nursing - “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 that he would perform
unaided if he had the necessary strength, will or
knowledge. The nurse’s goal is to make the patient
complete, whole, or independent. In turn, the
nurse collaborates with the physician’s therapeutic
plan.
14 Components
Physiological Components
1. Breathe 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
Psychological Aspects of Communicating and
Learning
10. Communicate with others in
expressing emotions, needs, fears, or
opinions.
14. Learn, discover, or satisfy the curiosity
that leads to normal development and
health and use the available health
facilities.
Spiritual and Moral
11. Worship according to one’s faith
Sociologically Oriented to Occupation and
Recreation
12. Work in such a way that there is a
sense of accomplishment
13. Play or participate in various forms of
recreation
 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
Faye G. Abdella’s 21 Nursing Problems Theory
and personal spiritual goals.
17. To create or maintain a therapeutic
She views nursing as an art and a science that
environment.
molds the attitude, intellectual competencies, and
18. To facilitate awareness of self as an
technical skills of the individual nurse into the
individual with varying physical,
desire and ability to help individuals cope with
emotional, and developmental needs.
their health needs, whether they are ill or well.
19. To accept the optimum possible goals in
the light of limitations, physical and
She used Henderson’s 14 basic human needs and
emotional.
nursing research to establish the classification of
20. To use community resources as an aid in
nursing problems.
resolving problems that arise from an
illness.
The 21 nursing problems fall into three categories:
21. To understand the role of social problems
physical, sociological, and emotional needs of
as influencing factors in the cause of
patients; types of interpersonal
illness.
relationships between the patient and nurse; and
common elements of patient care.
10 Steps to Identify the patient’s problem
The 21 NursingProblems
1. Learn to know the patient.
2. Sort out relevant and significant data.
1. To maintain good hygiene and physical
3. Make generalizations about available data
comfort.
concerning similar nursing problems
2. To promote optimal activity: exercise,
presented by other patients.
rest, sleep
4. Identify the therapeutic plan.
3. To promote safety by preventing accidents,
5. Test generalizations with the patient and
injuries, or other trauma and preventing
make additional generalizations.
the spread of infection.
6. Validate the patient’s conclusions about his
4. To maintain good body mechanics and
nursing problems.
prevent and correct the deformity.
7. Continue to observe and evaluate the
5. To facilitate the maintenance of a supply
patient over a period of time to identify
of oxygen to all body cells.
any attitudes and clues affecting his or her
6. To facilitate the maintenance
behavior.
of nutrition for all body cells.
8. Explore the patient and their family’s
7. To facilitate the maintenance of
reactions to the therapeutic plan and
elimination.
involve them in the plan.
8. To facilitate the maintenance of fluid and
9. Identify how the nurses feel about the
electrolyte balance.
patient’s nursing problems.
9. To recognize the physiologic responses of
10. Discuss and develop a comprehensive
the body to disease conditions—
nursing care plan.
pathologic, physiologic, and
compensatory.
The 11 Nursing Skills
 1. observation of health status
2. skills of communication Instructing Helping
3. application of knowledge
4. the teaching of patients and families
5. planning and organization of work Instructing nursing Helping the individual W
6. use of resource materials personnel and family to adjust to his h
7. use of personnel resources to help the individual limitations and p
8. problem-solving do for himself that emotional problems h
9. the direction of work of others which he can within n
10. therapeutic uses of the self his limitations in
11. nursing procedure

A Comprehensive Service

Recognizing - Recognizing the nursing problems Nursing Process

of the patient
- Assesment
Deciding – Deciding the appropriate course of - Nursing Diagnosis
action to take in terms of relevant nursing - Planning
principles - Implementation
- Evaluation
Providing – Providing continuous care of the
individual’s total needs • Dorothea Orem’s Self-Care Deficit
- Providing continuous care to Theory
relieve pain and discomfort and provide • Dorothy Johnson’s Behavioral System
immediate security for the individual Model
• Betty Neuman’s Systems Model
Adjusting – Adjusting the total nursing care plan
to meet the patient’s individual needs

Helping – Helping the individual to become

more self-directing in attaining or maintaining a
healthy state of body and mind