Course Title: Theoretical Foundation of Nursing

Course Code: TFN

Course Description: This course deals with the meta-concepts of a personhealth,

environment and nursing as viewed by the different theorists. Likewise it includes non-
nursing theories such as systems, development and change to nursing practice. It
further deals with health as a multi factorial phenomenon and the necessary core
theoriesIt presents how this concepts and theories serve as guide competencies that
the nurse needs to develop.

Course Credit: 3 units, 3 hours lecture per week for 18 weeks

Independent Study: 30-45 hours ( 20- 30%)

Placement : First Year, First Semester

Pre- requisites: None

Program Outcomes
1.Apply knowledge of physical, social, natural and health sciences and
humanities in the practice of nursing
2. Provide safe, appropriate and holistic care to individuals, families,
population, group and community utilizing nursing process;
3. Apply guidelines and principles of evidence-based practice in the delivery
of care;
4. Practice nursing in accordance with existing laws, legal, ethical and moral
principles;
5. Communicate effectively in speaking, writing and presenting using
culturally appropriate language;
6. Report and document up to date client care accurately and
comprehensively;
7. Work effectively in collaboration with inter-intra and multidisciplinary, multi-
cultural teams;
8. Practice beginning meta-concepts of a person, health, environment
skills in the delivery of client care;
9. Conduct research with an experienced researcher;
10. Engage in lifelong learning with a passion to keep current with national
and global developments in general and nursing and health development
in particular;
11. Demonstrate responsible citizenship and pride of being a Filipino.
12. Apply techno-intelligent care systems and processes in managing
resources and programs;
13. Display nursing core values in theoretical foundations of nursing.
14. Apply entrepreneurial skills in theoretical foundations of nursing.
 
Course Outcomes

1. Apply the appropriate knowledge of nursing theories in the care of a

client
2. Provide appropriate nursing care using an appropriate nursing theory
relevant to health and healing.
3. Apply guidelines and principles of evidence-based practice related to
an appropriate nursing theory in delivery of carte in any setting .
4. Practice nursing in accordance with core competency standards (based
on existing laws, legal, ethical and moral principles)
5. Effectively communicate in writing and speaking the nursing theory
applicable to various clients.
6. Document nursing theories applied/used in client care.
7. Work effectively in teams in the study of various nursing theories.
8. Identify a nursing theory which may be used as a framework in
conducting a future research study.
9. Update and search on recent studies or theories derived from existing
nursing theories.
10. Demonstrate pride and knowledge on Filipino Nursing Theories to be
applied in the client care.
11. Utilize techno-intelligent systems in the study of nursing theories,
useful in patient care
12. Identify and adopt the nursing core values.
Learning Outcomes:

At the end of classroom discussion, students are expected to;

1. Define the concepts related to Theoretical Fouandation in Nursing
2. Recognize and practice the four ways of knowing which is a result of a good
foundation in knowledge
3. Compare and contrast Development of Nursing Science during the early and
late 20th Century.
4. Differentiate the three categories that relate to the scope of theory.
5. Distinguish the focus of nursing to other profession
6. Determine the distinct and unique role of nurse in the promotion of health.
7. Appreciate non-nursing theories based on human care
8. Determine whether the theory is contributing to the knowledge
base of nursing.
9. Discuss characteristics of nursing as a profession.
10. Differentiate Personal and Professional Qualities of a Nurse.
11. Apply the different views of Person, Health, Environment and
Nursing as depicted accordingly by the different theories in nursing.
12. Identify nursing models their theories of greatest interest for own
practice.
13. Evaluate the significance of a nursing theory to a nurse practitioner.
14. Appreciate the profession of Nurses with competence and
compassion.
Theory – set of statements that tentatively describe, explain, or predict
relationships among concepts that have been systematically selected &
organized as an abstract representation of some phenomenon (McEwen
and Wills, 2019
Nursing Theory -  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.
NURSING
NURSING
- latin word “nutrix” means “to nourish.”
- To nourish is to feed, nurture, encourage, promote, cultivate, reassure, support,
& foster. It means nursing encourages people to live healthy lives, cultivate a
caring and healthy attitude among them, & foster mutually beneficial
relationships with each other
- Nursing, as a profession, is committed to recognizing its own unparalleled body
of knowledge vital to nursing practice—nursing science. 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
American Nursing Association (2003)
- “Nursing is the protection, promotion, and optimization of health and
abilities, prevention of illness and injury, alleviation of suffering through the
diagnosis and treatment of human response, and advocacy in the care of
individuals, families, communities and populations”.
Florence Nightingale
- “Act of utilizing ENVIRONMENT of the patient to assist him in his recovery”.
Virginia Henderson
- 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 (or to
peaceful death) that he would perform unaided if he had the necessary strength,
will, or knowledge, and to do his in such a way as to help him gain independence
as rapidly as possible.
Nursing Paradigm
Four major concepts are
frequently interrelated and
fundamental to nursing
theory: person,
environment, health, and
nursing. These four are
collectively referred to
as metaparadigm for
nursing.
Person - 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 - 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 - 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.
Nursing
The nurse’s attributes, characteristics, and actions provide care on behalf of or in
conjunction with the client. There are numerous definitions of nursing, though
nursing scholars may have difficulty agreeing on its exact definition. The ultimate
goal of nursing theories is to improve patient care.
You’ll find that these four concepts are used frequently and defined differently
throughout different nursing theories. Each nurse theorist’s definition varies by
their orientation, nursing experience, and different factors that affect the theorist’s
nursing view. The person is the main focus, but how each theorist defines the
nursing metaparadigm gives a unique take specific to a particular theory.
Components of Nursing Theories

For a theory to be a theory, it has to contain concepts, definitions, relational

statements, and assumptions that explain a phenomenon. It should also explain
how these components relate to each other.
1. 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.
- Examples of phenomena of nursing include caring, self-care, and patient
responses to stress. For example, in Neuman’s systems model (2011),
phenomena focus on stressors perceived by the patient or caregiver. The
theoretical model is an open systems model that views nursing as being primarily
concerned with nursing actions in stress-related situations. These stressors may
include, but are not limited to, patient responses, internal and external
environmental factors, and nursing actions.
2. 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.
Example
Abstract Concept Concrete Concept
1. Telemetry Unit Echocardiogram, 15- lead ECG

2. Laboratory CBC, ANA, ALT, AST, BUN,

Creatinine
3. Bronchodilator Albuterol, Salmeterol

4. Cardiovascular Disease CAD, PAD, Cardiomyopathy

3. Definitions - are used to convey the general meaning of the concepts of the
theory. Definitions can be theoretical or operational.
A. Theoretical Definitions - defines a particular concept based on the
theorist’s perspective.
B. Operational Definitions - how concepts are measured.
Example
Concept Theoretical Definitions Operational Definitions
Vital signs are measurements of the body’s basic The vital signs doctors typically measure and monitor
1. Vital Sign functions. Vital signs are useful in detecting or are, body temperature heart rate (the rate of your
monitoring health issues and alerting medical heartbeat) respiratory rate (rate of breathing)
professionals to potential concerns. blood pressure oxygen saturation (the amount of
oxygen circulating in your blood)

Perceptions of the effects of heart failure and its The physical, emotional, social, and mental
2. Quality of treatment on daily life dimensions of daily life when diagnosed with heart
Life failure as measured with the Minnesota Living with
Heart Failure Questionnaire.
Why are Nursing Theories Important?
Nursing theories are the basis of nursing practice today. In many cases, nursing
theory guides knowledge development and directs education, research, and
practice. Historically, nursing was not recognized as an academic discipline or as
a profession we view today. Before nursing theories were developed, nursing was
considered to be a task-oriented occupation. The training and function of nurses
were under the direction and control of the medical profession. Let’s take a look at
the importance of nursing theory and its significance to nursing practice:

 Nursing theories help recognize what should set the foundation of practice by
explicitly describing nursing.
 Defining nursing, a nursing theory also helps nurses understand their purpose
and role in the healthcare setting.
Theories serve as a rationale or scientific reasons for nursing interventions and
give nurses the knowledge base necessary for acting and responding
appropriately in nursing care situations.
Nursing theories provide the foundations of nursing practice, generate further
knowledge, and indicate which direction nursing should develop in the future
(Brown, 1964).
By providing nurses a sense of identity, nursing theory can help patients,
managers, and other healthcare professionals to acknowledge and understand the
unique contribution that nurses make to the healthcare service (Draper, 1990).
Nursing theories prepare the nurses to reflect on the assumptions and question
the nursing values, thus further defining nursing and increasing the knowledge
base.
Nursing theories aim to define, predict, and demonstrate nursing phenomenon
(Chinn and Jacobs, 1978).
Provide a common language and terminology for nurses to
use in communication and practice.
Serves as a basis for the development of nursing education
and training programs.
In many cases, nursing theories guide knowledge
development and directs education, research, and practice,
although each influences the others. (Fitzpatrick and Whall,
2005).

Purposes of Nursing Theories

The primary purpose of theory in nursing is to improve practice by positively

influencing the health and quality of life of patients. Nursing theories are essential
for the development and advancement of the nursing profession. Nursing theories
are also developed to define and describe nursing care, guide nursing practice, and
provide a basis for clinical decision-making. In the past, the accomplishments of
nursing led to the recognition of nursing in an academic discipline, research, and
profession.

1. In Academic Discipline - Much of the earlier nursing programs identified the

major concepts in one or two nursing models, organized the concepts, and build an
entire nursing curriculum around the created framework. These models’ unique
language was typically introduced into program objectives, course objectives,
course descriptions, and clinical performance criteria. The purpose was to explain
the fundamental implications of the profession and enhance the profession’s status.
2. In Research
The development of theory is fundamental to the research process, where it is
necessary to use theory as a framework to provide perspective and guidance to the
research study. Theory can also be used to guide the research process by creating
and testing phenomena of interest. To improve the nursing profession’s ability to
meet societal duties and responsibilities, there needs to be a continuous reciprocal
and cyclical connection with theory, practice, and research. This will help connect
the perceived “gap” between theory and practice and promote the theory-guided
practice.
3. In the Profession
Clinical practice generates research questions and knowledge for theory. In a
clinical setting, its primary contribution has been the facilitation of reflecting,
questioning, and thinking about what nurses do. Because nurses and nursing
practice are often subordinate to powerful institutional forces and traditions,
introducing any framework that encourages nurses to reflect on, question, and
think about what they do provide an invaluable service.
Three Levels of Nursing Theory

There are generally three levels of nursing theory, which begin with abstract ideas and
become more specific according to each level. The three main categories of nursing theories
are grand nursing theories, middle-range nursing theories and practice-level nursing theories.
Different levels of nursing theories may influence others. The following details each type .

1. Grand Nursing Theory- are the broadest category. They’re the most abstract and
complex concepts and propositions that provide a general nursing care framework. A grand
nursing theory can apply to a variety of nursing care environments and situations.
ex. Ida Jean Orlando-Pelletier’s  (Deliberative Nursing Process Theory)
This theory examines the definition of the function of nursing and the interaction
between the nurse and the patient. It explains how to use the nursing process to improve patient
outcomes.
2. Middle-Range Nursing Theories
- Middle-range nursing theories are more specific in focus compared to grand nursing
theories, but they’re broader than the more specific practice-level nursing theories. Middle-
range nursing theories may derive from theories of similar disciplines, nursing research or
nursing practice.
- Since they’re less abstract than grand nursing theories, middle-range theories tend to be
more verifiable through testing. These theories attempt to explain, describe or predict specific
issues in clinical nursing practice.
Example: Imogene King’s (Goal Attainment theory)
- This theory focuses on the factors that affect the attainment of certain life goals
and explains how a nurse and a patient can communicate, set goals together and take actions to
achieve goals. The theory examines how the personal system, the interpersonal system and the
social system affect goal attainment.
3. Practice-Level Nursing Theories/Micro-Theories
- Practice-level nursing theories are situation-specific. They’re the most narrow in scope
and focus of the three levels of nursing theories. They may be based on concepts from grand
nursing theories and middle-range nursing theory but provide specific frameworks for specific
nursing interventions.
- Nurses and nurse researchers may apply a practice-level nursing theory when it relates to a
defined patient population at a specific time. Since these theories are more specific and unique,
they may draw upon multiple theories to create the optimal recommended practice for that
particular patient group.
Four Ways of Knowing
1. Empirical Knowing
- evidenced based practice, involves accurate and thoughtful decision making
about health care delivery for clients. Based on the result of the most relevant and
supported evidence.
- there is a scientific, research-based, theoretical, & factual
information that is being use.
Ex. Research, Books
2. Aesthetic Knowing
- EMPHATIC (Primary form) aspect of Nursing.
- Art and act of nursing through practice and critique.
- Related to understanding what is of significance to particular such asa
feelings, attitudes
- Shows compassion, mercy
- Uses laymen terms in explaining the needs of a patient.
Ex. When a nurse place himself in the “patient’s shoes” when
communication, giving judgment and providing care.
3. Ethical Knowing
- describes, analyzes, and clarifies moral obligation and values in nursing.
- Moral directions of Nursing
- Requires knowledge or different philosophical positions what is good and right
in making moral actions and decisions, particularly in the theoretical
- Code of morals or code of ethics that leads the conduct of nurses is the main
basis for Ethical Knowing.
Ex. Presents patient advocate and defends his client’s right to
choose care.
4. Personal Knowing
- Therapeutic use of self
- Takes a lot of time to fully know the nature of oneself in relation to fully
know the nature of oneself in relation to the world around
- Stresses that human beings are not in a fixed state but are
Ex. Good relationship between you and the patient
Nursing Theory Development
- The history of professional nursing began with Florence Nightingale. It was
Nightingale who envisioned nurses as a body of educated women at a time
when women were neither educated nor employed in public service. Following
her service of organizing and caring for the wounded in Scutari, during the
Crimean War, her vision and establishment of a 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). Nursing began with a strong emphasis on
practice, but throughout the century, nurses worked toward the development
of nursing as a profession through successive periods recognized as historical
eras (Alligood, 2006a).
• The curriculum era addressed the question of what prospective nurses should
study to learn how to be a nurse. In this era, the emphasis was on what courses
nursing students should take, with the goal of arriving at a standardized
curriculum (Alligood, 2006a). By the mid-1930s, a standardized curriculum had
been published. However, it was also in this era that the idea of moving nursing
education from hospital-based diploma programs into colleges and universities
emerged. Even so, it was the middle of the century before this goal began to be
acted upon in many states (Kalisch & Kalisch, 2003).
• As nurses increasingly sought degrees in higher education, a research emphasis
era, as it is deemed, began to emerge. This era came about as more and more
nurses embraced higher education and arrived at a common understanding of
the scientific age, that is, that research is the path to new nursing knowledge.
Nurses began to participate in research, and research courses began to be
included in the nursing curricula of many developing graduate programs
(Alligood, 2006a).
- The research era and the graduate education era developed in tandem.
Master’s degree programs in nursing emerged to meet the public need for nurses
with specialized clinical nursing education. Many of these programs included a
nursing research course. It was also in this era that most nursing master’s
programs began to include courses in concept development or nursing models
that introduced students to early nursing theorists and the knowledge
development process (Alligood, 2006a).
- The theory era was a natural outgrowth of the research and graduate education
eras. As our understanding of research and knowledge development increased, it
soon became obvious that research without theory produced isolated
information, and that it was research and theory together that produced nursing
science (Batey, 1977; Fawcett, 1978; Hardy, 1978). In the early years of the theory
era, doctoral education in nursing flourished with an emphasis on theory
development.
- In the theory utilization era, emphasis was placed on middle range theory for
theory-based nursing practice, as well as on theory development (Alligood &
Tomey, 1997, 2002, 2006; Batey, 1977; Chinn & Kramer, 2008; Fawcett, 2005; 
Tomey & Alligood, 2006).

- Each era addressed nursing knowledge in a unique way that contributed to and
is observable in the history of nursing. Within each era, the pervading question
“What is the nature of the knowledge that is needed for the practice of nursing?”
seems to have been addressed at the level of understanding that prevailed at
that time (Alligood, 2006a).
- Nightingale’s (1859/1969) 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 (Alligood, 2006a, 2006b; Alligood & Tomey, 2006; 
Chinn & Kramer, 2008; Fawcett, 2005; Tomey & Alligood, 2006; Walker & Avant, 2005).

- In the mid-1800s, Nightingale wrote that nursing knowledge is distinct from medical
knowledge. She described a nurse’s proper function as putting the patient in the best
condition for nature (God) to act upon him or her. She proposed that care of the sick is
based on knowledge of persons and their surroundings—a different knowledge base
than that used by physicians in their practice. Despite this early edict from Nightingale
in the 1850s, it was 100 years later, during the 1950s, that the nursing profession began
to engage in serious discussion about the need to develop, articulate, and test nursing
theory (Alligood, 2006d; Alligood, 2004; Chinn & Kramer, 2008; Meleis, 2007; 
Walker & Avant, 2005)).
- Until the emergence of nursing as a science in the 1950s, nursing practice was
based on principles and traditions that had been passed on through an
apprenticeship model of education and hospital-kept procedure manuals
(Alligood, 2002a; Kalisch & Kalisch, 2003.

- Although some nursing leaders aspired for nursing to be recognized as a

profession and become an academic discipline, nursing practice continued to
reflect its vocational heritage more than a professional vision. The transition
from vocation to profession included successive eras of history as nurses
searched for a body of substantive knowledge on which to base nursing
practice. The curriculum era emphasized course selection and content for
nursing programs and gave way to the research era, which focused on learning
the research process and meeting the long-range goal of acquiring substantive
knowledge to guide nursing practice.
- In the mid-1970s, an evaluation of the first 25 years of the journal Nursing Research revealed
that nursing studies lacked conceptual connections and theoretical frameworks (Batey, 1977).
An awareness of the need for concept and theory development coincided with two other
significant milestones in the evolution of nursing theory. One was the standardization of
curricula for nursing master’s education provided by the National League for Nursing
accreditation criteria for baccalaureate and higher degree programs, and the second was the
decision that doctoral education for nurses should be in nursing (Alligood, 2006a).

- The nursing theory era, coupled with an awareness of nursing as a profession and as an
academic discipline in its own right, emerged from debates and discussions in the 1960s
regarding the proper direction and appropriate discipline for nursing knowledge development.
The explosive proliferation of nursing doctoral programs and nursing theory literature
substantiated that nursing doctorates should be in nursing (Nicoll, 1986, 1992, 1997; 
Reed, Shearer, & Nicoll, 2003; Reed & Shearer, 2008). In the 1970s, nursing continued to make
the transition from vocation to profession as more and more nurses asked, “Will nursing be
other-discipline based or be nursing based?” The history records the answer, “Nursing practice
needs to be based on nursing science” (Alligood, 2006a; Fawcett, 1978; Nicoll, 1986).
- The 1980s was a period of major developments in nursing theory characterized as
a transition from the pre-paradigm to the paradigm period (Fawcett, 1984; 
Hardy, 1978). The prevailing nursing paradigms (models) provided perspectives for
nursing practice, administration, education, research and further theory
development. In the 1980s, Fawcett’s seminal proposal of four global nursing
concepts presented a nursing metaparadigm that served as an organizing structure
for existing nursing frameworks, and introduced a way of grouping what previously
had been viewed as individual theoretical works (Fawcett, 1978, 1984, 1993).

- Classifying the nursing models as paradigms within a metaparadigm of the

concepts person, environment, health, and nursing systematically united the
nursing theoretical works for the discipline. This system clarified and improved
comprehension of a knowledge development process by embedding the theorists’
works in a larger context, thus facilitating understanding of the growth of nursing
science from a paradigm perspective (Alligood & Tomey, 2006; Fawcett, 2005). The
body of nursing science and research, education, administration, and practice
continues to expand through nursing scholarship.
- Podium presentations at national and international conferences, newsletters,
journals, and books written by communities of scholars associated with the
various nursing models and theories describe a theoretical basis for practice
and research presenting their scholarship on a selected model or theory from a
paradigm perspective (Alligood, 2004; Alligood & Tomey, 2006; Fawcett, 2005; 
Parker, 2006).
- These observations of nursing theory development bring Kuhn’s (1970)
description of normal science to life. His philosophy of science clarifies our
understanding of the evolution of nursing theory through paradigm science. It is
important historically that it was individual efforts that led to the first theory as
nurse leaders in various areas of the country published their works, which later
came to be viewed collectively within a systematic structure of knowledge (
Fawcett, 1984, 2000, 2005). Theory development emerged as a product of
professional scholarship and growth among nurse leaders, administrators,
educators, and practitioners who sought higher education.
- These leaders recognized limitations of theory from other disciplines to
describe, explain, or predict nursing outcomes, and they labored to establish a
scientific basis for nursing management, curricula, practice, and research. The
use of theory to convey an organizing structure and meaning for these
processes led to the convergence of ideas that resulted in what is recognized
today as the nursing theory era (Alligood, 2006b; Alligood & Tomey, 2006; 
Nicoll, 1986, 1992, 1997; Reed, Shearer & Nicoll, 2003; Reed & Shearer, 2008).

- The accomplishments of normal science opened the theory utilization era as

emphasis shifted to theory application in nursing practice, education,
administration, and research (Alligood, 2006c; Wood & Alligood, 2006). The
theory utilization era restored balance between research and practice for
knowledge development in the discipline of nursing. The reader is referred to
the fourth edition Nursing Theory: Utilization & Application (Alligood, 2010, in
press) for case applications and discussion of utilization of nursing theoretical
works in practice.
- This brief history provides a context for your study of the nursing theorists and
their work. The theory era continues with emphasis on development and use of
nursing theory to produce evidence for professional practice. Particular utility of
middle range theories to guide the thought and action of nursing practice is
noted (Alligood, 2006c; Alligood & Tomey, 2006; Fawcett, 2005; Peterson, 2008; 
Smith & Leihr, 2008). Therefore, preparation for practice in the profession of
nursing requires knowledge of the theoretical works of the discipline.
Historical Evolution Of Nursing
1. Period of Intuitive Nursing/Medieval Period
- Nursing was “untaught” and instinctive. It
was performed of compassion for others, out
of the wish to help others.
- Nursing was a function that belonged to
women. It was viewed as a natural nurturing
job for women. She is expected to take good
care of the children, the sick and the aged.
- No caregiving training is evident. It was
based on experience and observation.
- Primitive men believed that illness was
caused by the invasion of the victim’s body of
evil spirits. They believed that the medicine
man, Shaman or witch doctor had the power
to heal by using white magic, hypnosis,
charms, dances, incantation, purgatives,
massage, fire, water and herbs as a mean of
driving illness from the victim.
-Trephining – drilling a hole in the skull with a
rock or stone without anesthesia was a last
resort to drive evil spirits from the body of the
afflicted.
2. Period of Apprentice Nursing/Middle Ages
- Care was done by crusaders, prisoners,
religious orders
- Nursing care was performed without any
formal education and by people who were
directed by more experienced nurses (on the
job training). This kind of nursing was
developed by religious orders of the Christian
Church.
- Nursing went down to the lowest
levelWrath/anger of Protestantism
confiscated properties of hospitals and
schools connected with Roman Catholicism.
- Nurses fled their lives; soon there was
shortage of people to care for the sick
 - Hundreds of Hospitals closed; there was no provision for the sick, no
one to care for the sick
- Nursing became the work of the least desirable of women –
prostitutes, alcoholics, prisoners
- Pastor Theodore Fliedner and his wife, Frederika established the
Kaiserswerth Institute for the training of Deaconesses (the 1st formal
training school for nurses) in Germany.
- This was where Florence Nightingale received her 3-month course of
study in nursing
3. Period of Educated Nursing/Nightingale Era 19th-20th century
- The development of nursing during this period was strongly
influenced by:
1. Trends resulting from wars – Crimean, civil war
2. Arousal of social consciousness
3. Increased educational opportunities offered to women.
- Florence Nightingale was asked by Sir Sidney Herbert of the British
War Department to recruit female nurses to provide care for the sick
and injured in the Crimean War.
- In 1860, The Nightingale Training School of Nurses opened at St.
Thomas Hospital in London
- The school served as a model for other training schools. Its graduates
traveled to other countries to manage hospitals and institute nurse-training
programs.

- Nightingale focus vision of nursing Nightingale system was more on

developing the profession within hospitals. Nurses should be taught in
hospitals associated with medical schools and that the curriculum should
include both theory and practice.

- It was the 1st school of nursing that provided both theory-based knowledge
and clinical skill building.

- Nursing evolved as an art and science

- Formal nursing education and nursing service begun

4. Period of Contemporary Nursing/20th Century
- Licensure of nurses started
- Specialization of Hospital and diagnosis
training of Nurses in diploma program
- Development of baccalaureate and advance degree programs
- Scientific and technological development as well as social changes
marks this period.
1. Health is perceived as a fundamental human right
2. Nursing involvement in community health
3. Technological advances – disposable supplies and equipments
4. Expanded roles of nurses was developed
5. WHO was established by the United Nations
5. Aerospace Nursing was developed
6. Use of atomic energies for medical diagnosis, treatment
7. Computers were utilized-data collection, teaching, diagnosis,
inventory, payrolls, record keeping, and billing.
8. Use of sophisticated equipment for diagnosis and therapy
HISTORICAL PERSPECTIVE

A. 1860 to 1959
1. In 1860, Florence Nightingale developed her Environmental Theory.
2. In 1952, the journal Nursing Research was established, encouraging
nurses to become involved in scientific inquiry.
3. In the same year, Hildegard Peplau published Interpersonal Relations
in Nursing; her ideas have influenced later nursing theorists.
4. In 1955, Virgina Henderson published Definition of Nursing.
5. In the mid-1950s, Teachers College, Columbia University, New York
City, began offering master's and doctoral programs in nursing education
and administration, resulting in student participation in theory
development and testing.
B. 1960 to 1969
1. During the 1960s, Yale University School of Nursing, New Haven, Conn.,
defined nursing as a process, interaction, and relationship.
2. Also during the 1960s, the U.S. government began funding master's doctoral
education in nursing.
3. In 1960, Faye Abdellah published Twenty-One Nursing Problems.
4.In 1961, Ida Orlando published her theory in The Dynamic Nurse-Patient
Relationship: Function, Process, and Principles of Professional Nursing.
5. In 1962, Lydia Hall published Core, Care, and Cure model.
6. In 1964, Ernestine Wiedenbach published her theory in Clinical Nursing: A
Helping Art
7. In 1965, the American Nurses Association published a position paper
8. In 1966, Myra Levine published Four Conservation Principles.
C. 1970 to 1979
1. During the 1970s, Case Western Reserve University, Cleveland, sponsored symposia
to stimulate theory development.
2. During the mid 1970s, the National League for Nursing established an accreditation
requirement that nursing schools base their curricula on a nursing conceptual framework.
3. In 1970, Martha Rogers published her model in An Introduction to the Theoretical
Basis of Nursing.
4. In 1971, Dorothea Orem published Self-Care Deficit Therory of Nursing, Imogene
King published Theory of Goal Attainment, and Joyce Travelbee published Interpersonal
Aspects of Nursing. Travelbee published Interpersonal Aspects of Nursing.
5. In 1972, Betty Neuman published Health Care Systems Model.
6. In 1976, Sister Callista Roy published Adaptation Model.
7. In 1978, Madeleine Leininger published Humanistic Nursing.
8.In 1979, Jean Watson published Nursing: Human Services and Human Care - A
Theory of Nursing.
D. 1980 TO THE PRESENT
1. In 1982, Joyce Fitzpatrick published Life Perspective Model.
2. In 1984, Patricia Benner published from Novice to Expert:
Excellence and Power in Clinical Nursing Practice and Power in
Clinical Nursing Practice
3. In 1986, Margaret Newman published Model of Health
4. In 1994, Rogers proposed "Occupational Health Nursing Model"
WAYS IN ANALYSIS AND
EVALUATION OF
NURSING THEORY
1. Clarity- “How clear is this theory?”
- Words often have multiple meanings
within and across disciplines;
therefore words should be defined
carefully and specifically to the
framework (philosophy, conceptual
model, or theory) from which it is
derived.
- Diagrams and examples may
facilitate clarity and should be
consistent.
2. Simplicity- “How simple is the theory?”

- Theory should have as few concepts as possible with

simplistic relations to aid clarity.
- “The most useful theory provides the greatest sense of
understanding.”
3. Generality- “How general is this theory?”
- To determine the generality of theory, the scope of concepts
and goals within the theory are examined.
- “The broader the scope, the greater the significance of the
theory.”
4. Empirical precision- “How accessible is the theory?”

- Empirical precision is linked to the testability and ultimate use

of a theory and it refers to the”extent that the defined concepts are
grounded in observable reality”.
5. Derivable Consequences- “How important is this theory?”

- Propose that if research, theory, and practice are to be

meaningfully related, then nursing theory should lend itself to
research testing and research testing should lead to knowledge
that guides practice.
- Indicates that to be considered useful, “it is essential for theory
to develop and guide practice
RN Na
Ba Sa
2027?
NON NURSING THEORIES
Maslow’s Hierarchy Of Needs
1. Physiological needs - these are biological
requirements for human survival, e.g., air, food,
drink, shelter, clothing, warmth, sex, and sleep.
- Our most basic need is for physical survival, and
this will be the first thing that motivates our
behavior. Once that level is fulfilled, the next level
up is what motivates us, and so on.
- If these needs are not satisfied, the human
body cannot function optimally. Maslow considered
physiological needs the most important as all the
other needs become secondary until these needs
are met.
- Once an individual’s physiological needs are
satisfied, the needs for security and safety become
salient.
2.  Safety needs –  people want to experience order, predictability, and control in
their lives
- Safety needs can be fulfilled by the family and society (e.g., police, schools,
business, and medical care).
- For example, emotional security, financial security (e.g., employment, social
welfare), law and order, freedom from fear, social stability, property, health and
wellbeing (e.g., safety against accidents and injury).
- After physiological and safety needs have been fulfilled, the third level of
human needs is social and involves feelings of belongingness.
3. Love and belongingness needs – belongingness refers to a human
emotional need for interpersonal relationships, affiliating, connectedness, and
being part of a group.
- Examples of belongingness needs include friendship, intimacy, trust,
acceptance, receiving and giving affection, and love.
- This need is especially strong in childhood and can override the need for safety
as witnessed in children who cling to abusive parents.
4. Esteem needs are the fourth level in Maslow’s hierarchy and include self-
worth, accomplishment, and respect.
- Maslow classified esteem needs into two categories: (i) esteem for oneself
(dignity, achievement, mastery, independence) and (ii) the desire for reputation
or respect from others (e.g., status, prestige).
- Esteem presents the typical human desire to be accepted and valued by
others. People often engage in a profession or hobby to gain recognition. These
activities give the person a sense of contribution or value.
- Low self-esteem or an inferiority complex may result from imbalances
during this level in the hierarchy.
- Maslow indicated that the need for respect or reputation is most important
for children and adolescents and precedes real self-esteem or dignity.
5. Self-actualization needs are the highest level in Maslow’s hierarchy, and
refer to the realization of a person’s potential, self-fulfillment, seeking personal
growth, and peak experiences.
SYSTEM THEORY
Systems theory may be considered as a specialization of systems thinking and a
generalization of systems science.
 First proposed by Ludwig von Bertalanffy (1901-1972) as General Systems
theory.

CHARACTERISTICS OF SYSTEM THEORY

 "Systems" refer specifically to self-regulating systems.
Systems are self-correcting through feedback.
Systems have a structure that is defined by its parts and processes.
Systems are generalizations of reality.
Systems tend to function in the same way.
Every living organism is essentially an open system.
Example
CHANGE THEORY
- The Change Theory of Nursing was developed by Kurt Lewin, who is
considered the father of social psychology. This theory is his most
influential theory. He theorized a three-stage model of change known as
unfreezing-change-refreeze model that requires prior learning to be
rejected and replaced.
1. Unfreezing - is the process which involves finding a method of
making it possible for people to let go of an old pattern that was somehow
counterproductive. It is necessary to overcome the strains of individual
resistance and group conformity. There are three methods that can lead to
the achievement of unfreezing. The first is to increase the driving forces that
direct behavior away from the existing situation or status quo. Second,
decrease the restraining forces that negatively affect the movement from the
existing equilibrium. Thirdly, finding a combination of the first two methods.
2. Change - the change stage, which is also called “moving to a new
level” or “movement,” involves a process of change in thoughts,
feeling, behavior, or all three, that is in some way more liberating or
more productive.
3. Refreezing - he refreezing stage is establishing the change as the
new habit, so that it now becomes the “standard operating procedure.”
Without this final stage, it can be easy for the patient to go back to old
habits.