Chapter 1

Nursing Theory and the Discipline of Nursing

On completion of this chapter, students will be able
o:

1. Compare and contrast definitions of nursing.

2. Describe the usefulness of theory to everyday practice.
3. Identify four phenomena of interest to nursing.
4. Name the primary purpose of nursing theory.
5. Describe characteristics of nursing as a discipline.
6. Discuss the importance of conceptualizing nursing as a
discipline of knowledge.
7. Compare and contrast definitions of nursing theory.
 What is Nursing?

 Some define nursing by:

 Function and activity
 Elements of the nursing process
 Coordination of nursing care
Nursing as a Field of Study or Discipline

 Florence Nightingale taught us that nursing theories

describe:
 What is nursing
 What is not nursing
 The Discipline of Nursing

 Unique focus that directs inquiry

that distinguishes nursing from
other disciplines
 Nursing knowledge guides
professional practice
 Nursing is a professional discipline
 Disciplines

 Include network of:

 Philosophies,theories, concepts,
approaches to inquiry, research
findings
 Community of scholars share:
 Commitment to values, knowledge,
and process
 Distinct perspective
Expression of Human Imagination

 Theories are not discovered in nature

 They are invented
 Theories Are Reflections of Human

 Observations
 Projections
 Inferences
Domain

 Boundaries or focus of the discipline

 Phenomena of interest
 Problems

 Main content and methods

 Roles of discipline members
Domain of Nursing — Concerned
With

 Principlesthat govern life processes

and well-being
 Patterning of human behavior in
interactions with the environment
in critical life situations
 Processes by which positive changes
in health status are affected
Phenomena of Interest to Nursing

 Focus of nursing
 Person, group, or population nursed
 Relationship of nurse and nursed
 Hoped-for goals or purpose of
nursing
Metaparadigm

 Framework for nursing that sets

forth the phenomena of interest
 Very general
 Intended to reflect agreement
 Most abstract level of nursing
knowledge
 Closely mirrors nursing beliefs
 Provides a context for developing
nursing knowledge
Historical Metaparadigm Domains of
Nursing

 Person
 Environment
 Health
 Nursing
Alternative Metaparadigm
Domains

 Client
 Client-nurse encounters
 Practice
 Environment
 Kim, 1987, 1997

 Replace nursing with caring

 Stevenson, Tripp-Reimer, 1989
Philosophical Unity Roy & Jones (2007)

 Human being characterized by wholeness,

complexity, and consciousness
 Nursing involves nurse’s true presence in process of
human-to-human connections
 Nursing theory expresses values and beliefs of the
discipline – creates a structure to organize
knowledge
 Essence of nursing practice is the nurse-patient
relationship
Syntactical Structure

 Delineates the proper concern of nursing

 Guides what is to be studied
 Clarifies accepted ways knowing and using
content
 Grounded in the focus of the discipline
 Relates concepts within theories
 Helps us understand talents, skills, and
abilities that must be developed within
the community
Specialized Language and Symbols

 Complex concepts require language

that can be specific and understood
 Languageof nursing facilitates
communication
 Expert knowledge needed for full
understanding of the language
Tradition

 Use of knowledge over time

 Rich heritage of practice
Values and Beliefs

 Distinct views of person

 Strong commitment to compassionate
and knowledgeable care of persons
 Love and passion for nursing
 Shared values
 Differing values and beliefs reflected
in paradigms and philosophies of
nursing
Systems of Education

 Distinguishing mark of a discipline

 Nursing is a professional discipline
with an identifiable body of knowledge
 Knowledge of nursing is studied,
advanced, and used to guide practice
 Theories, methods of inquiry, and
practice
 Theories provide basis of education
Nursing Philosophy

 Statements of enduring values and

beliefs held by members of the
discipline
 Address major concepts of the discipline
 Set forth beliefs about what nursing is
 State how to think and do nursing
 Describe relationships of nursing
 Define environment of nursing
 Provide practical guides for examining
issues and clarifying priorities
Parsons (1949)

 “Theories help us know what we know and what we

need to know.”
Theory Definitions

 Theory is a set of concepts,

definitions, and propositions that
projects a systematic view of
phenomena by designating specific
interrelationships among concepts
for purposes of describing,
explaining, predicating, and/or
controlling phenomena.
 Chinn & Jacobs, 1987
Theory Definitions (continued)

 Theory is a creative and rigorous

structuring of ideas that projects a
tentative, purposeful, and
systematic view of phenomena.
 Chinn & Jacobs, 2004
 Theory Definitions (continued)

 Nursing theory is an inductively

and/or deductively derived collage
of coherent, creative, and focused
nursing phenomena that frame, give
meaning to, and help explain
specific and selective aspects of
nursing research and practice.
 Silva, 1997
Functions of Theory

 Guide actions
 Predict outcomes
 Organize knowing
 Provide evidence of
 Explain experience
achievements
 Interpret observation
 Describe relationships
Structure of Knowledge

 Domain of inquiry or metaparadigm

 Paradigm
 Conceptual models or grand theories
 Middle-range theories
 Practice level theories
 Research
 Practice traditions
 Paradigms

 Global general framework

 Made up of assumptions
 Kuhn (1970, 1977) used the term to
describe models that guide scientific
inquiry
 Broad shared perspectives or
“worldviews”
 New paradigms emerge to challenge
the existing worldview
Existing Nursing Paradigms

 Totality
 Humans are integrated beings with
biological, psychological, sociocultural,
and spiritual dimensions
 Simultaneity
 Human beings are unitary, irreducible,
and in continuous mutual process with
their environment
 Existing Nursing Paradigms

 Particulate-deterministic
 Interactive-integrative
 Unitary-transformative
 Particulate-deterministic

 Humans are known through parts

 Health is the absence of disease
 Predictability and control are
essential
 Interactive-integrative

 Humans viewed as systems with

interrelated dimensions interacting
with environment
 Change is probabilistic
Unitary-transformative

 Humans are patterned, self-

organizing fields within larger
patterned, self-organizing fields
 Change is characterized by
fluctuating rhythms of organization-
disorganization toward more
complex organization
 Health is a reflection of continuous
change
Conceptual Models of Nursing

 Sets of concepts and propositions that

provide perspectives on the major
concepts of the metaparadigm of
nursing
 Reflect values and beliefs of the discipline
 Reflect research and practice approaches
 Provide direction for research
 Less abstract than philosophy
 More abstract than theory
Reciprocal Interaction Worldview

 Partsare seen in the context of the

whole
 Reciprocalrelationship with the
environment
 Change is based on multiple factors
Simultaneous Action Worldview

 Human beings are known by pattern

 Inopen, ever-changing process with
the environment
 Change in unpredictable and
evolving toward greater complexity
Grand Theories and Conceptual Models

 Have the broadest scope

 Present general concepts and propositions
 Intended to be pertinent to all instances of
nursing
 Provide insight useful to practice
 Not designed for empirical testing
 Limited use in directing, explaining, and
predicting nursing in particular situations
Middle-Range Theory

 Broad enough to be useful in

complex situations
 Narrower in scope than grand
theory
 Appropriate for empirical testing
 Holds promise for increasing theory-
based research and practice
strategies
Nursing Practice Theory

 Most limited scope and lowest level of

abstraction
 Pertinent to a specific range of nursing
situations
 Provides framework for nursing
practice
 Predicts outcomes and impact of
nursing practice
 Interrelated with concepts from
middle-range theories
Nursing Theory and the Future

 Theory will be
 More fully integrated with all discipline
domains
 Increasingly interdependent with other
disciplines
 Theoristswill work in groups to
advance knowledge and
 Transcend competition and boundaries
 Appreciate links among theories
 Nursing Theory and the Future

 Philosophies and theories

 Willincreasingly reflect nursing’s
values
 International electronic think tanks
 Develop multicultural relevance
 References

Chinn, P., & Jacobs, M. (1987). Theory and nursing: A systematic approach. St. Louis, MO: C. V. Mosby.

Kim, H. (1987). Structuring the nursing knowledge system: A typology of four domains. Scholarly Inquiry for Nursing

Practice: An International Journal, 1(1), 99–110.

Chinn, P., & Kramer, M. (2004). Integrated knowledge development in nursing. St. Louis, MO: C. V. Mosby.

Kim, H. (1997). Terminology in structuring and developing nursing knowledge. In: I. King & J. Fawcett (Eds.), The

language of nursing theory and metatheory. Indianapolis, IN: Center Nursing Press.

Parsons, T. (1949). Structure of social action. Glencoe, IL: The Free Press.

Silva, M. (1997). Philosophy, theory, and research in nursing: A linguistic journey to nursing practice. In: I. King & J. Fawcett (Eds.),

The language of nursing theory and metatheory. Indianapolis, IN: Center Nursing Press.

Stevenson, J. S., & Tripp-Reimer, T. (Eds.). Knowledge about care and caring. Proceedings of a Wingspread

Conference. February 1–3, 1989. Kansas City, MO: American Academy of Nursing, 1990.