Nursing Theories

Theories of Nursing
Practice
What is a theory?
 A set of concepts,
definitions, relationships,
and assumptions that
project a systematic view
of a phenomena
 It may consist of one or
more relatively specific
and concrete concepts
and propositions that
purport to account for, or
organize some
phenomenon (Barnum,
1988)
Copyright 2004 by Delmar Learning, a division of Thomson Learning,
Inc. 3-2
What are the components of a
theory?
 Concepts – ideas and mental

images that help to describe
phenomena (Alligood and
Marriner-Tomey, 2002)
 Definitions – convey the
general meaning of the
concepts
 Assumptions – statements
that describe concepts
 Phenomenon – aspect of
reality that can be consciously
sensed or experienced
(Meleis, 1997).

Inc. 3-3
What is a paradigm?
 A model that
explains the linkages
of science,
philosophy, and
theory accepted and
applied by the
discipline (Alligood
and Marriner –
Tomey, 2002)
Inc. 3-4
What is a domain?
 The view or
perspective of the
discipline
 It contains the
subject, central
concepts, values and
beliefs, phenomena
of interest, and the
central problems of
the discipline
Inc. 3-5
How does domain relate to
nursing theory?
 Nursing has
identified its domain
in a paradigm that
includes four
linkages:
1) person/client
2) health
3) environment
4) nursing
Inc. 3-6
Purposes of nursing theory

Inc. 3-7
What are the purposes of nursing
theory?
 It guides nursing
practice and
generates knowledge
 It helps to describe
or explain nursing
 Enables nurses to
know WHY they are
doing WHAT they
are doing

Inc. 3-8
Types of nursing theories
 Grand theories – broad

and complex
 Middle-range theories-
address specific
phenomena and reflect
practice
 Descriptive theories –
first level of theory
development
 Prescriptive theories –
address nursing
interventions and predict
their consequences

Inc. 3-9
Why on earth do we study
nursing theory?
 Everyday practice enriches
theory
 Both practice and theory are
guided by values and beliefs
 Theory helps to reframe our
thinking about nursing
 Theory guides use of ideas
and techniques
 Theory can close the gap
between theory and research
 To envision potentialities
(Gordon, Parker, & Jester,
2001)

Inc. 3-10
“The study and use of
nursing theory in
nursing practice must
have roots in the
everyday practice of
nurses (Gordon,
Parker, and Jester,
2001).
So how do nurses use theory in
everyday practice?
 Organize patient data

 Understand patient data
 Analyze patient data
 Make decisions about
nursing interventions
 Plan patient care
 Predict outcomes of care
 Evaluate patient
outcomes
(Alligood, 2001)
Inc. 3-12
How do student nurses begin to
use nursing theory?
 By asking yourself
two very important
questions…..

Inc. 3-13
Student nurse questions
 What is the nature of

knowledge needed for
the practice of nursing?
 What does it mean to me

to practice nursing?

Inc. 3-14
Nursing also utilizes non-nursing
theories

Inc. 3-15
Commonly used non-nursing
theories
 Systems theory
 Basic Human Needs
theory
 Health and Wellness
Models
 Stress and Adaptation
 Developmental
Theories
 Psychosocial Theories

Inc. 3-16
What is the link between nursing
theory and the research
process?
 Theory provides direction
for nursing research
 Relationships of
components in a theory
help to drive the research
questions for
understanding nursing
 Chinn and Kramer
(2004), indicate a spiral
relationship between the
two
Inc. 3-17
Current trends that influence
nursing theory
 Medical science
 Nursing education
 Professional nursing
organizations
 Evolving research
approaches
 Global concerns
 Consumer demands
 Technologies
Inc. 3-18
“ Practicing nurses who despise
theory are condemned to
performing a series of tasks -
either at the command of a
physician or in response to
routines and policies.”
Leah Curtin, RN, MS, FAAN
(1989)
Former Editor, Nursing
Management
Objectives
 Define theory and list characteristics of a

theory
 Describe the components of a theory and
its use
 Trace the development of a nursing
theory
 Describe the different types of theories
and examples of each.
Inc. 3-20
Introduction to Theory
 Nursing as a profession
There has been questions about whether nursing is
a profession or an occupation.
 An occupation is a job a career.
 A profession is a learned vocation or occupation
that has status of superiority and precedence
within a division of work. It needs widely varying
levels of training or education, skills and variable
knowledge base. All professions are occupations
but not all occupations are professions
(Logan,Franzen, Butcher,2004;Schwiran , 1998)

Inc. 3-21
Characteristics of a profession
1. Utilizes in its practice a well-defined and

well organized body of specialized
knowledge on the intellectual level of
the higher learning.
2. Constantly enlarges the body of
knowledge it uses and improves its
techniques of education and service by
the use of scientific method.

Inc. 3-22
Characteristic of a profession
3) Entrusts the education of its practitioners

to institutions of higher education.
4) Applies its body of knowledge in
practical services that are vital to human
and social welfare.
5) Functions autonomously in the
formulation of professional policy and in
the control of professional activity.

Inc. 3-23
Characteristics of a profession
 6. Attracts individuals of intellectual and

personal qualities who exalt service above
personal gain and who
recognize their chosen occupation as a life
work.
7. Strives to compensate its practitioners by
providing freedom of action, opportunity for
continuous professional growth and economic
security.

Inc. 3-24
Definitions of theory
1. Pinnel and Menesis (1986)

Systematic set of interrelated concepts,
definitions and deductions that
describe, explain or predict
interrelationships

Inc. 3-25
Definitions of a theory
2. Walker and Avant (1983)

Internally consistent group of relational
statements (concepts, definitions and
propositions) that presents a systematic
view of phenomenon and which is useful
for description, explanation, prediction
and control

Inc. 3-26
Definition of a theory
3. Chinn and Krammer

creative and vigorous structuring of ideas
that project a tentative, purposeful and
systematic view of phenomena

Inc. 3-27
Definitions of a theory
 Ellis
coherent set of hypothetical, conceptual
and pragmatic principles forming a
general frame of reference for a field of
inquiry

Inc. 3-28
Some commonalities
Purpose
Concepts
Definitions
Propositions
Structured ideas
Tentative
Describe a phenomenon or occurrence
Inc. 3-29
Components/Elements of
theory
1.Purpose “Why is the theory formulated”

2.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

Inc. 3-30
theory
3.Has a major concept like nursing, person,

health or environment.
4. Definitions give meaning to concepts

which can either be descriptive or
procedural (stipulate-use of term within
the theory)

Inc. 3-31
theory
Propositions are expressions of
relational statements between and
among the concepts. It can be
expressed as statements, paradigms
or figures . AKA as theoretical
assertions
Assumptions- accepted “truths” that are
basic and fundamental to the theory.
Or value assumptions where what is
good or right or ought to be.
Inc. 3-32
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)
Inc. 3-33
Theory Development
Prof. Dawn M.
Capaque
MIT, School of Health
Sciences
How does a theory develop?
 Four strategies of theory development

1. Theory practice theory ( theory
developed in other discipline and used
in nursing situations)
2. Practice – theory
evolved from clinical practice

Inc. 3-35
How does a theory develop?
3. Research theory or inductive method
Must evolve from research findings or
empirical evidence.
4. Theory research theory

theories developed by other
disciplines are utilized but given unique
nursing perspective. Original theory
examined and given a new research
findings.
Inc. 3-36
TERMINOLOGY
METAPARADIGM
- Most abstract level of knowledge. In
nursing this is main concepts that
encompasses the subject matter and the
scope of the discipline
- Central concepts of person, environment,
health and nursing

Inc. 3-37
TERMINOLOGY
 Philosophy
- Knowledge level which specifies the
definitions of the metaparadigm concepts
in each of the conceptual models of
nursing.
- Nightingale is considered philosophical
approach
- Out of these philosophies theory maybe
formalized
Inc. 3-38
Conceptual models
 Frameworks or paradigms that provide a

broad frame of reference for the
systematic approaches to the
phenomena with which the discipline is
concerned.
 -different views nursing like Roy focuses
on adaptation, King on interaction and
Abdellah on interventions
Inc. 3-39
theory
 Group of related concepts that propose

actions that guide practice

Inc. 3-40
Nursing theory
 Group of related concepts that derive

tfrom the nursing models. Some derive
from other nursing discipline like
LEininger which comes from
anthropology

Inc. 3-41
Uses of theory
1. Theory guides and improve nursing

practice
Theory provides goal for nursing care

and with goals, nursing practice is
rendered more effective and efficient.
theories help to focus the goals, making
nurses more confident about the
practice.
Inc. 3-42
Uses of theory
2. Theory guides research

according to Meleis, primary use of
theory is to guide research. It validates
and modifies the theory.
3. Theory contributes to the development
of the disciplines body of knowledge
4. Theory enhances communication

Inc. 3-43
Theory Development
in Nursing: Historical
Overview
DMCAPAQUE
Where do I begin?
Florence Nightingale
- Considered first modern nursing theorist
- First one to delineate what is considered the
nursing goal and practice domain.
- “ placing the client in the best condition for
nature to act upon him”
- Taught about symptoms and what they
indicate, rationale for actions and trained
powers of observation and reflection
Inc. 3-45
Historical Development of Nursing
Theories: Significant Events
 Nightingale until the 50’s

 Florence Nightingale Notes on Nursing
control of the environment to care for the individual
(ventilation, light, warm , noise absence or
reduction, cleanliness & diet )
1952 Nursing Research Journal publication
1960’s nature of nursing practice was debated,

defined nursing practice, or develop nursing
theory, and created a substantive body of
knowledge
Inc. 3-46
Historical development
 1960-1970 proliferation of conceptual

models and frameworks, and philosophy
of nursing.
Examples: Abdellah 21 nursing problems
and Hall’s Core, care and cure
(person,body,disease)
 1969 first conference on nursing theory

Inc. 3-47
Historical Development
 Role of nurses where

questioned; what
they do, for whom
where and when
were determined.
 purpose of nursing,
process of theory
development was
discussed

Inc. 3-48
First Conference in Nursing theory
Brought leading scholars and theorists to discuss

and debate on issues regarding nursing
science ad theory development.

Inc. 3-49
 Writings of Dickoff,
James and Wiedenbach
“Theory in a Practice
Discipline” influenced the
theoretical thinking in
nursing . They presented
a definition of nursing
theory and goals for
theory development in
nursing, approaches
where discussed

Inc. 3-50
1980’s characterized by acceptance of the

significance of theory in nursing. Less
debates on whether or not to use theory,
practice theory or borrowed ones.
More and more publication up to the
present.

Inc. 3-51
Stages of Theory Development
according to Kidd and Morrison
1. Silent Knowledge stage

- Blind obedience to medical authority
- Training schools were hospital based,
emphasis on carrying out physicians
orders and few books, depended on
physicians diagnosis, exploited as
workers and as students.
- Persisted for more than 80 years
Inc. 3-52
2. Received Knowledge Stage
 Learning through listening to others

- Nursing now challenged to be in the
university as opposed to apprenticeship
that happens to most hospital programs.
- Nurses acquired non nursing degrees
relying on the authority of educators,
sociologist, psychologists, physiologists,
and anthropologists to provide answers
to nursing problems.
Inc. 3-53
3. Subjective Knowledge stage
 Authority was internalized and a new

sense of self emerged.
- Negative attitude toward borrowed
sciences or theories
- Defining on nursing and developing
theories about and for nursing
- Research focused on the nurse rather on
he clients and clinical situations.
Inc. 3-54
4.Procedural Knowledge
 Includes both separate and connected
knowledge
- Proliferation of approaches to theory
development applying theory in practice
was frequently underemphasized
- Emphasis was on procedures used to
acquire knowledge, with over attention
to appropriateness of methodology the
criteria for evolution and statistical
procedures

Inc. 3-55
5. Constructed Knowledge
 Integration of different types of

knowledge ( intuition, reason and self-
knowledge)
 Nursing theory based on empirical
studies theoretical literature client
reports, clinical experiences and nurses
scholar intuition.

Inc. 3-56
Types of theories
 According to range
 - Grand theory
 Middle range theory
 Micro theory

Inc. 3-57
Types of theories
 Grand Theory consist of broad conceptual

frameworks that reflect wide and expansive
perspectives for practice and ways of
describing, explaining, predicting and looking
at nursing phenomena. They are the most
complex and broadest in scope.
 Henderson’s The Nature of Nursing ; Levine’s
The Four Conservation Principles of Nursing,
Roy’s Adaptation Model, and Orem’s Self-Care
(Marriner-Tomey)
Inc. 3-58
Types of Theories
 Mid Range- less complex and narrower in

scope than grand theory and micro theory. A
more workable level is the middle range.more
limited in scope and less variables, and
testable.

Inc. 3-59
Types of Theories
Mid range Example: grand theory on stress and

adaptation might not yield any interpretable
guidelines on practice but if the theory is
focused on chronic lingering illness as the
stressor on family, the stress theory becomes
operational for both research and practice
purposes. Ex. Peplau’s Psychodynamic
Nursing and Orlando’s Nursing Process Theory

Inc. 3-60
Types of theories
 Micro theories- are the least complex.

They contain the least complex concepts
and are narrowest in scope. They deal
with a small aspect of reality, generally a
set of theoretical statements
 - Deals with specific and narrow defined
phenomena

Inc. 3-61
According to Orientation or focus of
the theory
1. Client centered: Nightingale, Henderson

2. Client-nurse dynamics: Watson
3. Client-nurse environment : Leininger

Inc. 3-62
Categories of nursing theories
client nurse
`
environment

Inc. 3-63
Client centered theory
1. Client centered theories are those

focused on the needs and problems of
clients which are met, resolved or
alleviated by nursing interventions
 This category includes theories
developed by the following :
Nightingale,Abdellah,Henderson,Orem,
Pender, Roy, Levine, Hall.
Inc. 3-64
Nurse – client dynamics
2.Nurse-client-dynamics focus on
interaction between the nurse and client.
This category includes theories
developed by the following: Peplau,
Watson, King and Orlando

Inc. 3-65
Client Nurse Environment
Dynamics
3. CLIENT NURSE ENVIRONMENT- focus

on the interaction between nurse and
client in an environment that includes
broader dimensions of time and space.
As well as culture, cultural diversity, and
universality. Theories of Neuman and
Leininger are discussed under this
category.

Inc. 3-66
Framework to Analyze the Nursing
theory
I What are the major concepts?

- Person, nursing, health and environment
II Based on Focus
- Client centered, nurse-client dynamics,
nurse client-environment dynamics
How similar and how different are their
concepts of persons, nursing, health,
environment
Inc. 3-67
Framework to Analyze the Nursing
theory
III Key concepts unique to the theory.

Some theories have several key
concepts and it may have sub-concepts.

Inc. 3-68
The Theoretical Foundation of
Nursing
 Nursing theory provides the theoretical

foundation of the profession.
 Theory defines what nursing is, what it
does, and the goals or outcomes of
nursing care.
 Nursing is the synthesis of many
theories.

Inc. 3-69
Components of the Theoretical
Foundation
 A theory is a set of concepts and

propositions that provides an orderly way
to view phenomena.
 Concepts and propositions are the
structural elements of a theoretical
foundation.

Inc. 3-70
Concepts
 Building blocks of a theory

 Labels or names for
phenomena/observable facts
 Assist us in formulating a mental image
about an object or situation

Inc. 3-71
Concepts
 Theories are formed by linking concepts

together.
 A conceptual framework links global
concepts together.

Inc. 3-72
Conceptual Model
 The “symbolic representation of empiric

experience in words, pictorial, or graphic
diagram, mathematical notations or
physical material.”

Inc. 3-73
Propositions
 A proposition is a statement that

proposes a relationship between
concepts.
 Propositional statements in a theory
represent the theorist’s view of which
concepts fit together.

Inc. 3-74
Theories
 A theory helps us to organize our

thoughts and ideas.
 In science, the purpose of a theory is to
guide research, support existing
knowledge, or generate new knowledge.
 The term theory is not restricted to the
scientific world.

Inc. 3-75
Importance of Nursing Theories
 Framework for thought in which to

examine situations
 Structure for organization, analysis, and
decision making
 Structure for communicating with other
nurses and other health team members

Inc. 3-76
Importance of Nursing Theories
 Assist the nursing discipline in clarifying

beliefs, values, and goals.
 Help to define the unique contribution of
nursing in the care of clients.
 Standards of clinical practice are
developed out of nursing theories.

Inc. 3-77
Process of Knowledge
Development

Inc. 3-78
Scope of Theories
 Grand Theories
 Middle-Range Theories

Inc. 3-79
Grand Theory
 Provides an overall framework for

structuring broad, abstract ideas.
 Composed of concepts representing
global and extremely complex
phenomena.

Inc. 3-80
Middle-Range Theory
 Provides a perspective from which to

view complex situations and a direction
for interventions in three levels of
abstractness.
• High middle-range
• Middle middle-range
• Low middle-range

Inc. 3-81
Florence Nightingale’s Influence on
Knowledge Development in Nursing
 Described nursing as both an art and a

science.
 Stressed the importance of caring for the
ill person rather than the illness.
 Viewed a person’s health as the direct
result of environmental influences
(cleanliness, light, pure air, pure water,
efficient drainage).
Inc. 3-82
Florence Nightingale’s Influence on
Knowledge Development in Nursing
 The turn of the 20th century marked the

beginning of hospital-based schools of
nursing.
 Nightingale’s principles were
incorporated into modern nursing theory.

Inc. 3-83
The Evolution of Nursing
Theory
 Since the early 1950s, many nursing

theories have been systematically
developed to help describe, explain, and
predict the phenomena of concern to
nursing.

Inc. 3-84
Knowledge Development
in Nursing
 Paradigm
• A particular viewpoint or perspective
• A “worldview” about the phenomena of
concern in a discipline (Kuhn, 1970)
 Metaparadigm
• The major concepts in a discipline that
names the phenomena of concern

Inc. 3-85
in Nursing
 Metaparadigm of Nursing
• Person: Individual, family or group
• Health: Continuum of wellness to terminal
illness
• Environment: Place or community where
care is provided
• Nursing: Actions; interactions of the nurse
with the person

Inc. 3-86
in Nursing
 Two individuals with different

paradigmatic views can look at the same
phenomenon and view the phenomenon
differently.

Inc. 3-87
in Nursing
 The prevailing paradigm in a discipline

represents the dominant view of
particular concepts.
 A paradigm revolution is the turmoil and
conflict that occur in a discipline when a
competing paradigm gains acceptance
over the dominant paradigm.

Inc. 3-88
in Nursing
 A paradigm shift refers to the acceptance

of the competing paradigm over the
prevailing paradigm or a shifting away
from one worldview toward another
worldview.
 Members of a discipline cannot subscribe
to two competing paradigms at the same
time.
Inc. 3-89
Knowledge Development in
Nursing
 Four Levels of Knowing

• Empirical
• Aesthetic
• Personal
• Ethical

Inc. 3-90
Early Nursing Theorists
 Hildegard Peplau
• Defined concepts of stages of nurse-client
relationships.
 Virginia Henderson
• Defined basic human needs as the unique
focus of nursing practice.

Inc. 3-91
Maslow’s Hierarchy of Needs

Inc. 3-92
Early Nursing Theorists
 Faye Abdellah
• Identified 21 nursing problems that became
the foundation of nursing diagnoses.
 Joyce Travelbee, Josephine Paterson
and Loretta Zderad
• Emphasized the humanistic and existential
basis of nursing practice to understanding
the uniqueness of patients.

Inc. 3-93
Contemporary Nursing
Theorists
 The work of contemporary theorists form

the theoretical basis for many
interventions in current nursing practice.
• Myra Levine
• Dorothea Orem
• Sister Callista Roy

Inc. 3-94
Contemporary Nursing
Theorists
 Myra Levine’s Conservation Theory

(1969)
• Four universal principles of conservation
designed to apply concepts of nursing
practice in different environments

Inc. 3-95
Dorothea Orem
 Self-Care Deficit Theory of Nursing

• Theory of Self-Care
• Theory of Self-Care Deficit
• Theory of Nursing Systems

Inc. 3-96
Roy Adaptation Model
 Developed by Sister Callista Roy, 1976.

 Combined general systems theory with
adaptation theory.
 Goal of nursing is “promotion of
adaptation” in each of four modes of
adaptation.
 Applicable to the home setting.

Inc. 3-97
Roy Adaptation Model
 The goal of nursing is “the promotion of

adaptation” in each of four adaptive
modes.
• Physiologic
• Self-concept
• Role function
• Interdependence

Inc. 3-98
Theories for the New
Worldview of Nursing
 Describe, explain, and predict the

phenomena of concern to nursing from a
more holistic perspective.
• Jean Watson
• Martha Rogers
• Rosemarie Parse

Inc. 3-99
The Theory of Human Caring
 Developed by Jean Watson in the 1980s.

 Conceptualizes human-to-human
transactions that occur daily in nursing
practice.
 Ten carative factors are classified as
nursing actions or caring processes.

Inc. 3-100
The Science of Unitary
Human Beings
 Developed by Martha Rogers in 1990.

• The person is characterized as a human
energy field that unites all aspects of the
person into a unified whole.
• Nursing aims to repattern the rhythm and
organization of these energy fields to
heighten the integrity of the person.

Inc. 3-101
Gordon’s Functional Health
Patterns
 Influenced by Maslow’s Hierarchy of

Basic Human Needs and Von Bartlaffny’s
general systems theory.
 Offer a holistic approach to the
development of nursing diagnoses and
client care.
 Provides an appropriate method for
organization of textbook topics.
Inc. 3-102
Continuing Evolution of Nursing
Theory
 Nursing is always in a state of change.

 Nursing knowledge continues to expand
in a multiplicity of ways.
 New theories will come from a global
perspective and international nursing
leaders in the 21st century.

Inc. 3-103
Inc. 3-104

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Theories of Nursing

 Concepts – ideas and mental

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

 Grand theories – broad

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

 Organize patient data

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 What is the nature of

 What does it mean to me

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

 Define theory and list characteristics of a

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

1. Utilizes in its practice a well-defined and

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

3) Entrusts the education of its practitioners

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 6. Attracts individuals of intellectual and

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1. Pinnel and Menesis (1986)

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2. Walker and Avant (1983)

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3. Chinn and Krammer

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Copyright 2004 by Delmar Learning, a division of Thomson Learning,

1.Purpose “Why is the theory formulated”

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3.Has a major concept like nursing, person,

4. Definitions give meaning to concepts

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1. Systematic, logical and coherent

 Four strategies of theory development

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4. Theory research theory

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 Frameworks or paradigms that provide a

 Group of related concepts that propose

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 Group of related concepts that derive

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

1. Theory guides and improve nursing

Theory provides goal for nursing care

2. Theory guides research

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

 Nightingale until the 50’s

1952 Nursing Research Journal publication

1960’s nature of nursing practice was debated,

 1960-1970 proliferation of conceptual

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

 Role of nurses where

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

Brought leading scholars and theorists to discuss

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

1980’s characterized by acceptance of the

Copyright 2004 by Delmar Learning, a division of Thomson Learning,

1. Silent Knowledge stage

 Learning through listening to others

 Authority was internalized and a new