TOPIC 1
OVERVIEW OF TFN
• By giving nurses a sense of identity,
nursing theory can help patients, managers and
other healthcare professionals to recognize the
unique contribution that nurses make to the
healthcare service (Draper 1990). THEORY
ORIGIN: “THOERIA” – speculate THEORY
THEORIES are set of interrelated concepts that
give a systematic view of a phenomenon (an
observable fact or event) that is explanatory &
predictive in nature.
concept
proposition theory assumption
definiton
CONCEPT
 A mental idea of a phenomenon.
 A comprehensive idea or
generalization.
 An idea that brings diverse elements
into a basic o relationship.
 A unit of knowledge abstracted from a
set of o characteristics attributed to a
class of objects, o relations or entities.
o A unit of thought.
 A general idea formed in the mind.
 Something understood or retained in
the mind, from experience, reasoning,
and/or imagination, a generalization or
abstraction of a particular set of
instances or occurrences. • Examples:
person, health, environment, nursing
DEFINITION
 The definition within the description of
a theory conveys the general meaning
of the concepts in a manner that fits the
theory. These definitions also describe
the activity necessary to measure the
constructs, relationships, or variables
within a theory. (Chinn and Kramer
2004).
ASSUMPTIONS
 Are statements that describe concepts
or connect two concepts that are
factual. Assumptions are the “taken for
granted” statements that determine
the nature of the concepts, definitions,
purpose, relationships, and structure of
the theory.
PRINCIPLE
 A basic generalization that is accepted
as true and that can be used as a basis
for reasoning or conduct. NURSING
THEORY o A body of knowledge that
describes or explains nursing and is
used to support nursing practice. o An
organized and systematic articulation of
a set of statements related to questions
in the discipline of nursing.
PHILOSOPHY
 The most basic beliefs, concepts, and
attitudes of an individual or group o An
analysis of the grounds of and concepts
expressing fundamental beliefs o Is the
next knowledge level after
metaparadigm. It specifies the
definition of metaparadigm concepts.
KNOWLEDGE
 Information, skills and expertise
acquired by a person through
formal/informal learning.
PHENOMENON
 A set of empirical data or experiences
that can be physically observed or
tangible such as crying or grimacing
when in pain.
NURSING
 Nursing encompasses autonomous and
collaborative care of individuals of all
ages, families, groups and communities,
sick or well and in all settings. It
includes the promotion of health, the
prevention of illness, and the care of ill,
disabled and dying people. (WHO)
PARADIGM
 In science and philosophy, a paradigm is
a distinct set of concepts or thought
patterns, including theories, research
methods, postulates, and standards for
what constitutes legitimate
contributions to a field.
HYPOTHESIS
 Translates a research question into a
prediction of expected outcomes. -
research question identifies the
variables/ concepts under investigation
and asks how the concepts might be
related - hypothesis is the predicted
answer
RESEARCH
 Research comprises "creative and
systematic work undertaken to increase
the stock of knowledge, including
knowledge of humans, culture and
society, and the use of this stock of
knowledge to devise new applications.
PURPOSES OF NURSING THEORY IN
RELATION TO: (AREAS OF NURSING)
1. Education
• nursing theory was used primarily to
establish the profession’s place in the
university.
• provide a general focus for
curriculum design.
• guide curricular decision making
2. Research
• nursing research identifies the
philosophical assumptions or
theoretical frameworks from which it
proceeds.
• offer a framework for generating
knowledge and new ideas.
• assist in discovering knowledge gaps
in specific field of study.
• offer a systematic approach to
identify questions for study, select
variables, interpret findings and
validate nursing interventions.
3.PRACTICE
• the primary contribution of nursing
theory when employed in a clinical
setting is the facilitation of reflection,
questioning, and thinking about what
nurses do.
• assist nurses to describe, explain, and
predict everyday experiences.
• serve to guide assessment,
intervention, and evaluation of nursing
care.
• provide a rationale for collecting
reliable and valid data about the health
status of clients, which are essential for
effective decision making and
implementation.
TYPES OF NURSING THEORY
Meta-theory - the theory of theory. Identifies
specific phenomena through abstract concepts.
Grand theories – broad and complex Middle-
range theories- address specific phenomena
and reflect practice
Practice theory - explores one particular
situation found in nursing. It identifies explicit
goals and details how these goals will be
achieved.
Descriptive theories – first level of theory
development
Prescriptive Theories – address nursing
interventions and predict their consequences
TOPIC 2
HISTORY OF NURSING THEORY
 The history of professional nursing
began with 1. Florence Nightingale. She
envisioned nurses as a body of
educated women at a time when
women were neither 2. educated nor
3. employed in public service. Following
her service of organizing and caring for
the wounded in Scutari, during the
4. Crimean War, her vision and
establishment of a 5. School of Nursing
at St. Thomas’ Hospital in London
marked the birth of modern nursing.
 Nightingale’s pioneering activities in
nursing practice and subsequent
writings describing nursing education
became a guide for establishing nursing
schools in the United States at the
beginning of the twentieth century
(Kalisch & Kalisch, 2003; Nightingale,
1859/1969).
HISTORICAL DEVELOPMENT
 In the early part of nursing’s history,
knowledge was extremely limited and
almost entirely task oriented.
 Role of nurses where questioned; what
they do, for whom where and when
were determined.
 The professionalization of nursing has
been and is being brought about
through the development and use of
nursing theory.
HISTORY OF NURSING
 The word nurse is derived from the
Anglo-French nurice and the Latin word
nutrica, both of which mean NOURISH.
» Florence Nightingale pioneer
activities in nursing practice & her
subsequent writings about nursing
served as a guide for establishing
nursing schools in the US at the
beginning of 20th century.
» In the last century, nursing began
with a strong emphasis on practice.
» Throughout that century, nurses
work toward the development of the
profession in what has been viewed as
successive
Nightingale’s vision of nursing has been
practiced for more than a century, and theory
development in nursing has evolved rapidly
over the past 5 decades, leading to the
recognition of nursing as an academic discipline
with a substantive body of knowledge
HISTORICAL ERAS
CURRICULUM ERA
•Moving nursing education from hospital -
based diploma programs into college and
universities
RESEARCH ERA
• Research is the path to new knowledge
• Part of the curricula of developing
graduate programs.
GRAD EDU ERA
• Masters program in nursing emerged to
meet the need for nurses with specialized
education in nursing
 THEORY ERA
• Outgrowth of research era
• Research without theory produced
isolated information; however research and
theory produced nursing science
MID 1800’S & 1960’S
MID 1800’S
 Nursing Knowledge is distinct from
medical knowledge (Nightingale)
 Nursing as a Vocational heritage more
than professional vision
MID 1970’S
 Evaluation of 25 years of nursing
research revealed that nursing lacked
conceptual connections and theoretical
frameworks.
 MILESTONES:
14. The standardization of curricula for
nursing master’s education
15. Doctoral education for nurses should be
in nursing o Transition from vocation to
profession
 Nursing practice is based on Nursing
Science.
MID 1980’S
 Preparadigm period to Paradigm period
o Introduced an organizational
structure for nursing knowledge
development to the nursing literature
 Utilization phase of the Theory Era –
emphasis shifts from thedevelopment
to the use and application of what
FIRST CONFERENCE NURSING THEORY
 Brought leading scholars and theorists
to discuss and debate on issues
regarding nursing science and theory
development. (1969)
CHANGES OF EDUCATION IN NURSING
1874 – the St. Catherine Training School
was the first hospital diploma school in
Canada where the nursing program went
from an apprenticeship to an educational
model.
1881 – the school for Nurses at the
Toronto General Hospital was established.
1896 – Mary Agnes Snively developed 3-
year course with 84 hours of practical
nursing and 119 hours of instruction by the
medical staff.
1918 - following World War 1, the
widespread influenza pandemic led to
support forpublic health programs and new
patterns of health care delivery.
1919 – was the year the first
undergraduate nursing degree program was
established at the University of British
Columbia.
1932 – demanded for transfer of
responsibility for nursing education to
general educational system. 1950’s and
1960’s – experiments with two-year
programs for nursing began and the
movement to separate nursing education
from the authority of hospitals began. 1967
– Laurentian University started student
intake.
2000 – all professional nurses are required
to have a bachelor at degree
THE NURSING THEORY
 Provides a basis of nursing practice.
 It is important to nurses because it
helps to interpret data, make decisions
based on relevant information, plan for
care, and predict and evaluate
outcomes.
 It helps to differentiate nursing from
other disciplines.
 TOPIC 3
SIGNIFICANCE OF THEORY FOR NURSING AS
A DISCIPLINE & A PROFESSION
 Discipline is specific to academia
and a branch of education, a
department of learning or field of
knowledge.
 Profession refers to specialized
field of practice, which is founded
upon the theoretical structure of
the science or knowledge of that
discipline and the accompanying
practice abilities.
The theoretical works have taken nursing to
higher levels of education and practice as a
nurses
SIGNIFICANCE OF THEORY FOR NURSING AS A
DISCIPLINE
o University baccalaureate programs
proliferated, master’s programs in nursing were
developed, and a standardized curriculum was
realized through accreditation.
o Attention to the importance of nursing
conceptualizations for the research process and
the role of a conceptual framework in the
purpose and design of research production of
science and nursing theoretical works also
began to publish.
o Works began to be recognize for their
theoretical nature, such as Henderson,
Nightingale and Orlando, Peplau, and
Wiedenbach were recognized for the
theoretical nature of their earlier wings.
SIGNIFICANCE OF THEORY FOR NURSING AS A
PROFESSION
o Clearly nursing is recognized as a profession
today having used the criteria for a profession
to guide development\
o Nursing development was the subject of
numerous studies of numerous studies by
sociologists
NURSING THEORY AND THE PRACTICING
NURSE
Theory assists the practicing nurse to: o
Organize patient data
o Understand patient data
o Analyze patient data
o Make decisions about nursing interventions
o Plan patient care
o Evaluate patient outcomes
WHAT IS A PROFESSION?
o A profession is an occupation with ethical
components, i.e, devoted to the promotion of
human and social welfare.
o The services and knowledge by a profession
are based on specialized skills.
o Professions are those occupations possessing
a particular combination of characteristics.
o Nursing profession is an Occupation based on
the specialized intellectual study and training,
the purpose of which is to supply skilled
services with ethical components.
CRITERIA OF PROFESSION
o Bixler and Bixler Criteria of Profession
o Abraham Flexner’s criteria for a profession
o Kelley’s Criteria BIXLER AND BIXLER CRITERIA
FOR PROFESSION
o Genevieve and Roy Bixler who were against
the status of Nursing as a profession 1945,
appraised nursing according to their original
seven criteria as follows:
1. Utilizes in its practice a well defined and well
organized body of knowledge, which is on the
intellectual level of the higher training.
2. Constantly enlarges the body of knowledge
its uses and improves and improves its
techniques of education and service by the use
of the scientific method.
3. Entrusts the education of its practitioners to
institutions of higher education.
4. Applies its body of knowledge in practical
service, which is vital to human beings and
social welfare.
5. Functions autonomously in the formulation
of professional policy and in control of
professional activities thereby.
6. Attracts individuals of intellectual and
personal qualities who exalt service above
personal gain and who can recognize their
chosen profession as lifelong.
7. Strives to compensate its practitioners by
providing freedom of action, opportunity for
continuous professional growth and economic
security
ABRAHAM FLEXNER'S CRITERIA FOR A
PROFESSION
Flexner believed that professional work:
1. Is basically intellectual (as opposed to
physical) and is accompanied by a high degree
of individual responsibility.
2. Is based on a body of knowledge that can be
learned and is refreshed and refined through
research
3. Is practical in addition to being theoretical.
4. Can be taught through a highly specialized
education. professional
5. Has a strong internal organization of
members and a welldeveloped group
consciousness.
6. Has practitioners who are motivated by
altruism( the desire to help others) and who are
responsive to human interests.
KELLEY'S CRITERIA
Kelley(1981) reiterated and expanded Flexner's
criteria in her 1981 listing of characteristics of a
profession.
1. The services provided are vital to humanity
and the welfare of the society
2. There is a special body of knowledge that is
continually enlarged through research.
3. The services involve intellectual activities;
individual responsibility (accountability) is a
strong feature.
4. Practitioners are educated in institutions of
higher learning
5. Practitioners are relatively independent and
control their own policies and activities
(autonomy).
6. Practitioners are motivated by service
(altruism) and consider their work as an
important component of their lives.
7. There is a code of ethics to guide the
decisions and conduct of practitioners.
8. There is an organization (association) that
encourages and support high standards of
practice
CHARACTERISTICS OF PROFESSIONS
1. GREAT RESPONSIBILITY
 Professionals deal in matters of vital
importance to their clients and are
therefore with grave responsibilities.
And entrusted obligations.
 Given these inherent obligations,
professional work typically involves
circumstances where carelessness,
inadequate skill, or breach of ethics
 would be significantly damaging to the clients (either directly or as
client and/or his fortunes. preconditions for their ongoing agency
employment).
2. ACCOUNTABILITY
6. CLIENTS RATHER THAN CUSTOMERS.
 Professionals hold themselves
ultimately accountable for the quality of  Members of a profession exercise
their work with the client. discrimination in choosing clients rather
 The profession may or may not have than simply accepting any interested
mechanisms in place to reinforce and party as a customer (as merchants do).
ensure adherence to this principle
among its members. If not, the 7. DIRECT WORKING RELATIONSHIPS
individual professionals will (e.g.
 Professionals habitually work directly
guarantees and/or contractual
with their clients rather than through
provisions).
intermediaries or proxies.
3. BASED KNOWLEDGE ON SPECIALIZED,
8. ETHICAL CONSTRAINTS.
THEORETICAL
 Due to the other characteristics on this
 Professionals render specialized
list, there is a clear requirement for
services based on theory, knowledge,
ethical constraints in the professions.
and skills that are most often peculiar
Professionals are bound to a code of
to their profession and generally
conduct or ethics specific to the distinct
beyond the understanding and/or
profession (and sometimes the
capability of those outside of the
individual). Professionals also aspire
profession. Sometimes, this
toward a general body of core values,
specialization will extend to access to
which are centered upon an
the tools and technologies used in the
uncompromising and unconflicted
profession (e g. medical equipment)
regard for the client's benefit and best
4. INSTITUTIONAL PREPARATION interests.

 Professions typically require a period of 9. MERIT-BASED

hands-on, practical experience in the
 In a profession, members achieve
protected company of senior members
employment and success based on
before aspirants are recognized as
merit and corresponding voluntary
professionals. After this provisional
relationships rather than on corrupted
period, ongoing education toward
ideals such as social principle,
professional development is
mandated support, or extortion (e.g.
compulsory. A profession may or may
union members are not professionals).
not require formal credentials and/or
Therefore, a professional is one who
other standards for admission.
must attract clients and profits due to
5. AUTONOMY the merits of his work. In the absence of
this characteristic, issues of
 Professionals have control over and, responsibility, accountability, and
correspondingly, ultimate responsibility ethical constraints become irrelevant,
for their own work. Professionals tend negating any otherwise-professional
to define the terms, processes, and characteristics.
conditions of work to be performed for
10. CAPITALIST MORALITY
 The responsibilities inherent to the
practice of a profession are impossible
to rationally maintain without a moral
foundation that flows from a
recognition of the singular right of the
individual to his own life, along with all
of its inherent and potential sovereign
value; a concept that only capitalism
recognizes, upholds and protects.
TOPIC 1 REVIEW
THEORY - A well-substantiated explanation
of some aspect of the natural world; an
organized system of accepted knowledge
that applies in a variety of
situations/hypotheses
CONCEPT- An idea that brings diverse
elements into a basic relationship or
Something understood or retained in the
mind, from experience, reasoning, and/or
imagination; a generalization or abstraction
of a particular set of instances or
occurrences.
PRINCIPLE- A basic generalization that is
accepted as true and that can be used as a
basis for reasoning or conduct
PHILOSOPHY- The most basic beliefs,
concepts, and attitudes of an individual or
group
CONCEPTUAL FRAMEWORK/MODEL-
identify concepts and describe their
relationships to the phenomena of central
concern to the discipline: person,
environment, health and nursing
THEORETICAL FRAMEWORKS/MODELS- Are
highly established set of concepts that are
testable.
KNOWLEDGDE- Information, skills and
expertise acquired by a person through
formal/informal learning. PHENOMENON-
Experiences that can be physically observed
or tangible such as crying or grimacing
when in pain. Or A set of empirical data or
experiences that can be physically observed
or tangible such as crying or grimacing
when in pain.
HYPOTHESIS- Predicted answer
PHENOMENON- Help to describe or label
phenomena
EDUCATION- Nursing theory was used
primarily to establish the profession’s place
in the university.
CHARACTERISTICS OF A THEORY:
a. Interrelating concepts in such a way as to
create a different way of looking at a
particular phenomenon
b. Logical in nature
c. Generalizable
d. Basis for hypothesis that can be tested
e. Increasing the general body of
knowledge within the discipline through the
research implemented to validate them f.
Used by practitioners to guide and improve
their practice
g. Consistent with other validated theories,
laws, and principles but will leave open
unanswered questions that need to be
investigated
TYPES OF NURSING THEORY
a. Meta-Theory
b. Grand Nursing Theory
c. Mid-Range Nursing Theories
d. Nursing Practice
Theories COMPONENTS OF NURSING
THEORY
a. Concept
b. Assumption
c. Definition
d. Proposition
NURSING METAPARADIGM CONCEPTS
a. Person
b. Nursing
c. Environment
d. Health
NURSING- The attributes, characteristics,
and actions provide care on behalf of or in
conjunction with the client
PERSON- the recipient of nursing care and
may include individuals, patients, groups,
families, and communities
HEALTH- defined as the degree of wellness
or well- being that the client experiences
ENVIRONMENT- 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.
TOPIC 4
HISTORY AND PHILOSOPHY OF SCIENCE
“Philosophy in its broadest sense is
wondering and being curious about the
“big” or fundamental questions that
humans have grappled with throughout the
history. Questions about “what is real?”
(ontology), “what is knowable?
(epistemology), “is this just?” (ethics), and
“is there an art to caring?” (aesthetics) are
considered indispensable reflections in
nursing Practice.” -BRUCE, RIETZE KIM 2014
NURSING AS A SCIENCE
1. Science is logical, systematic, & coherent
way to solve problems and answer
questions.
2. It is a collection of facts known in area
and the process used to obtain that
knowledge.
NURSING AND PHILOSOPHY
 Philosophy studies concepts that
structure thought processes,
foundations, and presumptions.
 It is an approach for thinking about the
nature of people, the methods that
should be used to create a scientific
knowledge and the ethics involved. It
denotes a perspective, implying a
certain broad, “taken for granted”
assumptions
EPISTEMOLOGY
 a branch of philosophy that is
concerned with the nature and scope of
knowledge. It is referred to as the
“theory of knowledge” HISTORICAL
VIEWS OF THE NATURE OF SCIENCE
01 RATIONALISM It is the use of the
rational senses in ensuring the truthfulness
of a phenomenon
02 EMPIRICISM It is the way of looking at
reality using the five general senses of sight,
touch, hearing, taste, and smell
EARLY 12TH CENTURY VIEWS OF SCIENCE &
THEORY
Philosophers focused on the analysis of
theory structure whereas, o Scientists
focused on empirical research
o Positivism (imposed on the mind by
experience) is the philosophy of science
that information is derived from logical and
mathematical treatments and reports of
sensory experience is the exclusive source
of all authoritative knowledge
EMERGENT VIEWS IN THE LATE 20TH CENTURY
OF SCIENCE & THEORY
• Empiricists argue that for science to
maintain its objectivity, data collection and
analysis must be independent of a theory.
Brown argues that the new epistemology
challenged the empiricist view of perception by
acknowledging that theories play a significant
role in determining what the scientist will
observe and how it will be interpreted. He
identified 3 different views of the relationship
between theories and observation:
o Scientists are merely passive observers of
occurrences in the empirical world. Observable
data are objective truth waiting to be
discovered.
o Theories structure what the scientists
perceived in the empirical world.
o Presupposed theories and observable data
interact in the process of scientific investigation
INTERPENDENCE BETWWEN THEORY &
RESEARCH
o A theory should be judged based on the basis
of scientific o consensus.
o The acceptance of scientific hypothesis
through research depends on the appraisal of
the coherence of theory
o Dubin identified when scientific consensus is
necessary:
1. on the boundaries of the theory; the
phenomenon it addresses and what it excludes
2. on the logic used in constructing the theory
to further understanding from a similar
perspective
3. that the theory fits the data collected and
analyzed though research ISSUES IN NURSING
PHILIOSOPHY & SCIENCE DEVELOPMENT Four
fundamental patterns of knowledge in Nursing
(Carper, 1978)
o Empirical knowledge
o Esthetic knowledge
o Moral knowledge
o Personal knowledge
▪ 1980s - Further acceptance of nursing theory
and its incorporation in the nursing curricula;
publication of several nursing journals
▪ 1990s - Nursing as a basic science, an applied
science, or a practical science
▪ Progress in the Discipline of Nursing (Meleis)
o Practice
o Education and Administration
o Research o Development of Nursing Theory
o ▪ Peplau developed the first theory of nursing
practice in her book, Interpersonal Relations in
Nursing (1952) ▪ Journal of Nursing Research
(1952) ▪ 1960s and 1970s – analysis and debate
on the metatheoretical issues related to theory
development
➢ Postpositivism focuses on discovering the
patterns that may describe a phenomena.
➢ Interpretive paradigm tends to promote
understanding by addressing the meanings the
participants social interaction that emphasize
situation, context and multiple cognitive
constructions that individuals create on
everyday events.
➢ Critical paradigm for knowledge
development in nursing , provides framework
for inquiring about the interaction between the
social, political, economic, gender and cultural
factors and experiences of health and illness.
“Philosophy of science without history of
science is empty; history of science without
philosophy of science is blind - Imre Lakatos