Theoretical and Conceptual

Foundation in Nursing

Post Graduate Program

Salale University, College of Health Sciences

2022/23

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 Theoretical and Conceptual Foundation in Nursing
Course objectives
 At the end of the course, the learner will be able to:
• Discuss the central concepts related to the development of nursing theory
• Discuss the strategies of development of the nursing theory.
• Analyze the central and other concepts of the field
• Discuss, analyze, and critically evaluate nursing theories.
• Discuss the development trends of nursing theory.
• Apply theoretical knowledge in nursing practice.
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Demonstrate skills of analytic and conceptual thinking. 2
 Unit I- Introduction

Definition
Terminologies
The nature of nursing

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 NURSING
AMERICAN NURSES ASSOCIATION

“The protection, promotion and optimization of health and abilities,

prevention of illness and injury, facilitation of healing, alleviation of suffering

through the diagnosis and treatment of human response and advocacy in

the care on individuals, families, groups ,communities and population”.

(ANA, 2003, p. 6)
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 ICN
The use of clinical judgment in the provision of care to enable people to
improve, maintain, or recover health, to cope with health problems, and
to achieve the best possible quality of life, whatever their disease or
disability until death.

to assist the individual sick or well in the performance of those activities
contributing to health or its recovery that would perform unaided if he
had the necessary strength, will or knowledge.

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 Florence Nightingale
Nursing is the act of utilizing the environment of the patient to
assist him/her in his/her recover.

American Nursing Association (ANA)

Nursing is a diagnosis and treatment of human response to
actual and potential problems (1980).

Dorothea Orem “Nursing is giving of direct assistance to a

person because of inabilities in self-care
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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 (World Health

Organization (WHO)
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‘Assisting individuals to gain independence in relation to the

performance of activities contributing to health or its recovery’.

(Virginia Henderson,1921)

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 “Nursing is an art and science. It may be defined as service to

the individual which helps him/her to obtain or maintain a

healthy state of mind or body and the relief of pain and

discomfort.”

-Hemmer and Henderson

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Martha Rogers- “an art and science that is humanistic and

humanitarian”

Legal definition

• Nursing is the protection of human/legal rights and securing of

care for all clients to make informed decision about their own

health and lives.

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The word ‘Nursing’ comes from the Latin word ‘nutritious’ which

means to nourish, to cherish, to protect, to sustain

A review of the nursing literature from the late 1970s until the

present shows sporadic discussion of whether nursing is a

profession, a science, or an academic discipline.

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Concepts are terms that refer to phenomena that occur in nature or in
thought.
 Concept has been defined as an abstract term derived from particular
attributes and “a symbolic statement describing a phenomenon or a class of
phenomena”.

 Concepts may be abstract (e.g., hope, love, desire) or relatively concrete

(e.g., airplane, body temperature, pain).

 Concepts are formulated in words that enable people to communicate their

meanings about realities in the world and give meaning to phenomena that
can 12/2/22
directly or indirectly be seen, heard, tasted, smelled, or touched 12
 A concept may be a word (e.g., grief, empathy, power, pain), two words

(e.g., job satisfaction, need fulfillment, role strain), or a phrase (e.g.,

maternal role attachment, biomarkers of preterm labor, health-promoting

behaviors).

 Finally, when they are operationalized, concepts become variables used in

hypotheses to be tested in research.

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 are ideas and mental images that help to describe phenomena

= An abstract idea or notion.

• Concepts are building blocks of theory – ideas, mental images of

a phenomenon, an event or object that is derived from an

individual’s experience and perception

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Phenomenon – Subject matter of a discipline. Nurses identified it as

human beings and their environment

A phenomenon is the term, description, or label given to describe an idea

or responses about an event, a situation, a process, a group of events, or

a group of situations (Meleis, 2011).

” a fact or situation that is observed to exist or happen, especially one

whose cause or explanation is in question.”

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 Nursing theories focus on the phenomena of nursing and nursing care. Examples of

phenomena of nursing include caring, self-care, and patient responses to stress

• Phenomenon- a fact or situation that is observed to exist or happen,

especially one whose cause or explanation is in question.”

• Concept - a plan or intention.” and “an idea or invention to help sell or

publicize a commodity.”

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• Models. Models are representations of the interaction among and between the

concepts showing patterns.

• They present an overview of the theory’s thinking and may demonstrate how

theory can be introduced into practice.

• Nursing models were developed to define what nursing is and could be.

They describe the beliefs, values, and goals of nursing and the knowledge and

skills needed to practice nursing.

• They12/2/22
offer a framework to guide practice and education. 17
Conceptual Model: A group of interrelated concepts described to suggest

relationships among them.

• Show relationship between concepts

• Generally abstract and not easily observable

• a conceptual model of nursing is defined as a set of relatively abstract

and general concepts and propositions about those concepts that address

the 12/2/22
concepts of the nursing metaparadigm. 18
Assumptions- statements that describe concepts

• May be accepted “truths” that are basic and fundamental to the theory. Or value assumptions

where what is good or right or ought to be.

• 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.

• Eg. The assumptions of Florence Nightingale in her Environmental Theory are as follows: Florence

Nightingale believed that five points were essential in achieving a healthful house: “pure air, pure

water, efficient drainage, cleanliness, and light.” A healthy environment is essential for healing.
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 Prepositions- theoretical statements that specify the relationship between the concepts

• Asserts what is proposed to be true and testable in the form of hypothesis

• Eg:- Nightingale proposed a beneficiary relationship between fresh air and health

• Propositions are expressions of relational statements between and among the concepts.

It can be expressed as statements, paradigms or figures .

• The delivery of nursing care within the nursing process is directed by the way specific

conceptual frameworks and theories define the person (patient), the environment, health

and nursing.

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 Paradigm
• Paradigm. A paradigm refers to a pattern of shared understanding and assumptions
about reality and the world, worldview, or widely accepted value system.

meaning-para(beside) and degim (to show)

(a typical example or pattern of something; a pattern or model)

How do you see the world?

Whether you know it or not, you have an established worldview or paradigm.

A paradigm
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Paradigms are also philosophical foundations that support our approaches to
research.

A nursing Paradigm is a concept that has developed over time from the belief
and practices of professionals in the health care sector.

According to Nursing Theories, a nurse paradigm is a pattern that shows the

relationship between a person, the environment in which she lives and her
health.

Eg. An example of paradigm is evolution. An example of paradigm is the

earth being round.
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Metaparadigm

Meta-with, paradigm-pattern

Define and describe relationship between major ideas and values

It places a boundary on the subject matter of a discipline

= Concepts that identify the domain of a discipline.

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Nursing Metaparadigm

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 Relationships Among the Metaparadigm Concepts

• The concepts of nursing’s metaparadigm have been linked in four

propositions identified in the writings of Donaldson and Crowley (1978) and

Gortner (1980). These are as follows:

1. Person and health: Nursing is concerned with the principles and laws that

govern human processes of living and dying.

2. Person and environment: Nursing is concerned with the patterning of

human health experiences within the context of the environment.

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3. Health and nursing: Nursing is concerned with the nursing actions or

processes that are beneficial to human beings.

4. Person, environment, and health: Nursing is concerned with the

human processes of living and dying, recognizing that human beings

are in a continuous relationship with their environments (Fawcett & De

Santo-Madeya, 2013, p. 6).

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Person refers to a being composed of physical, intellectual,

biochemical, and psychosocial needs; a human energy field; a

holistic being in the world; an open system; an integrated whole

and an adaptive system

 Nursing theories are often most distinguishable from each other by

the various ways in which they conceptualize the person or

recipient of nursing care.

 Most nursing models organize data about the individual person as a

focus of the nurse’s attention, although some nursing theorists have

expanded to include family or community as the focus (Thorne et

al., 1998).
Health –is it the same as the absence of illness?

Doheny et al.(1997) referred to health in the following way:

Health is a dynamic and ever changing, not a stagnant state. Health can be

measured only in relative terms. No one is absolutely healthy, or ill.

is the ability to function independently; successful adaptation to life’s

stressors; achievement of one’s full life potential; and unity of mind, body,

and soul (Wagner, 1986).

• Health has been a phenomenon of central interest to nursing since its

inception.
Environment typically refers to the external elements that affect the person;

internal and external conditions that influence the organism; significant others

with whom the person interacts; and an open system with boundaries that

permit the exchange of matter, energy, and information with human beings

(Wagner, 1986).

• A multilayered view of the environment encourages understanding of an

individual’s perspective and immediate context and incorporates the sociopolitical

and economic structures and underlying ideologies that influence reality (Thorne et

al., 1998).
Nursing is a science, an art, and a practice discipline and

involves caring.

• Goals of nursing include care of the well, care of the sick,

assisting with self-care activities, helping individuals attain their

human potential, and discovering and using nature’s laws of

health.
• The purposes of nursing care include placing the client in the best condition

for nature to restore health, promoting the adaptation of the individual,

facilitating the development of an interaction between the nurse and the client

in which jointly set goals are met, and promoting harmony between the

individual and the environment (Wagner, 1986).

• Furthermore, nursing practice facilitates, supports, and assists individuals,

families, communities, and societies to enhance, maintain, and recover health

and to reduce and ameliorate the effects of illness (Thorne et al., 1998).
 Theory

“Theories are explanations of natural or social behavior, event, or

phenomenon.

More formally, a scientific theory is a system of constructs (concepts) and

prepositions (relationships between those constructs) that collectively

presents a logical, systematic, and coherent explanation of a phenomenon

of interest within some assumptions and boundary conditions.”

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A belief, policy, or procedure proposed or followed as the basis of action.
It refers to a logical group of general propositions used as principles of
explanation. Theories are also used to describe, predict, or control
phenomena

A theory, as a general term, is a notion or an idea that explains

experience, interprets observation, describes relationships, and projects
outcomes.

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Nursing theory: A framework; a set of interrelated concepts that

are testable; a way of seeing the factors that contribute to

nursing practice and nursing thought.

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 Characteristics of a Theory
1. Systematic, logical and coherent (orderly reasoning, no contradictions)

2. Creative structuring of ideas mental images of one’s experiences and

create different ways of looking at a particular event or object.

3. Tentative in nature ( change over time or evolving but some remain valid

despite passage of time)

 What are Nursing Theories?

• Nursing theories are organized bodies of knowledge to define

what nursing is, what nurses do, and why they do it.

• Nursing theories provide a way to define nursing as a unique

discipline that is separate from other disciplines (e.g., medicine).

• It is a framework of concepts and purposes intended to guide

nursing practice at a more concrete and specific level.

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 What are Nursing Theories?...

• To distinguish this foundation of knowledge, nurses need to identify,

develop, and understand concepts and theories in line with nursing.

• As a science, nursing is based on the theory of what nursing is, what

nurses do, and why. Nursing is a unique discipline and is separate from

medicine.

• It has its own body of knowledge on which delivery of care is based. 41

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 Science is concerned with causality (cause and effect).

The scientific approach to understanding reality is characterized

by observation, verifiability, and experience; hypothesis testing

and experimentation are considered scientific methods.

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 Characteristics of Science
1. Science must show a certain coherence.

2. Science is concerned with definite fields of knowledge.

3. Science is preferably expressed in universal statements

4. The statements of science must be true or probably true.

5. The statements of science must be logically ordered.

6. Science must explain its investigations and arguments.

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Philosophy is concerned with the purpose of human life, the nature of being

and reality, and the theory and limits of knowledge.

These are beliefs and values that define a way of thinking and are generally

known and understood by a group or discipline.

Intuition, introspection, and reasoning are examples of philosophical

methodologies.

Science and philosophy share the common goal of increasing knowledge

The science of any discipline is tied to its philosophy, which provides the basis

for understanding
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and developing theories for science 44
o Philosophy has been defined as “a study of problems that are ultimate,

abstract, and general.

o These problems are concerned with the nature of existence, knowledge,

morality, reason, and human purpose” (Teichman & Evans, 1999, p. 1).

o Philosophy tries to discover knowledge and truth and attempts to identify

what is valuable and important

o Philosophy as the love of wisdom

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Philosophy is basically the study of the fundamental nature of knowledge,
reality, and existence.

Theory is a supposition or a system of ideas that is intended to explain

something.

• A philosophy of nursing is a statement that outlines a nurse's values, ethics, and

beliefs, as well as their motivation for being part of the profession.

• It covers a nurse's perspective regarding their education, practice, and patient

care ethics.

 Philosophy of nursing states our thoughts on what we believe to be true about

the nature of the profession of nursing and provide a basis for nursing activities.
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Nightingale's philosophy is environmentally oriented. ... She

believed that the environment of the patient should be altered to

allow nature to act on the patient.

 Her work focuses mostly on the patient and the environment but

also includes the nurse and health.

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Dorothea Orem's Self-Care Deficit Theory defined Nursing as “The

act of assisting others in the provision and management of self-care

to maintain or improve human functioning at home level of

effectiveness.”

 It focuses on each individual's ability to perform self-care defined as

'the practice of activities that individuals initiate and perform on their own

behalf in maintaining life, health, and well-being

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• Professions are valued by society because the services professionals provide are
beneficial for members of the society. Characteristics of a profession include

1) Defined and specialized knowledge base,

2) control and authority over training and education,

3) credentialing system or registration to ensure competence,

4) altruistic service to society,

5) a code of ethics,

6) formal training within institutions of higher education,

7) lengthy socialization to the profession, and

8) autonomy
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(control of professional activities) 49
Professions must have a group of scholars, investigators, or researchers

who work to continually advance the knowledge of the profession with the

goal of improving practice (Schlotfeldt,1989).

Any type of work that needs special training or a particular skill, often one

that is respected because it involves a high level of education.

Finally, professionals are responsible and accountable to the public for

their work(Hood, 2010).

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Nursing is an art and a science by which people are assisted in

learning to care for themselves whenever possible and cared

for by others when they are unable to meet their own needs.

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Nursing has evolved from an unstructured method of caring for the ill to a

scientific profession.

The result has been movement from the mystical beliefs of primitive times

to a “high-tech, high-touch” era.

Nursing combines art and science.

Using scientific knowledge in a humane manner, nursing combines critical

thinking
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skills with caring behaviors. 52
Nursing requires a delicate balance of promoting clients’ independence

and dependence.

Nursing focuses not on illness but rather on the client’s response to

illness.

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Nursing promotes health and helps clients move to a higher

level of wellness.

This aspect of nursing also includes assisting a client with a

terminal illness to maintain comfort and dignity in the final stage

of life
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 Characteristics of profession

• A Caring Attitude-caring is the heart of the nursing profession

• Integrity- Respecting the dignity and moral wholeness of every person without

conditions or limitation.

• Authenticity- Know yourself and know your purpose as nurse. To develop

connections with other including patients and colleagues.

• Good listening skills- A successful nurse, in addition to having sound clinical

skills,12/2/22
is compassionate and has the ability to listen to their clients and peers.
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• Persistence- sometimes it will take a while to achieve a goal, but
successful nurse don’t give up

• Willingness to follow- Successful nurses are often great leaders and

great leaders know when to lead and follow.

• A desire to keep learning- Good nurse knows what she doesn’t

know and therefore regularly updates skills and knowledge in both
formal and informal.

• Creativity- Be open to trying new things and coming up with

creative solutions to problems.
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 Qualities of Nurse
Responsible and accountable

Hamble and honest

Self confident

Cooperative

Good listener and keen observer

Good administrator and supervisor

Impartial

Goodly judgmental and advocate

Loyal12/2/22
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