1. Theories of Nursing Practice

2. 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)
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3. 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).
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4. 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)
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5. 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
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6. 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
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7. Purposes of nursing theory
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8. 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
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9. 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
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10. 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)
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11. “The study and use of nursing theory in nursing practice must have roots in the everyday practice of nurses (Gordon, Parker, and Jester, 2001).

12. 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)
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13. How do student nurses begin to use nursing theory?
By asking yourself two very important questions…..
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14. Student nurse questions
What is the nature of knowledge needed for the practice of nursing?
What does it mean to me to practice nursing?
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15. Nursing also utilizes non-nursing theories
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16. Commonly used non-nursing theories
Systems theory
Basic Human Needs theory
Health and Wellness Models
Stress and Adaptation
Developmental Theories
Psychosocial Theories
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17. 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
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18. Current trends that influence nursing theory
Medical science
Nursing education
Professional nursing organizations
Evolving research approaches
Global concerns
Consumer demands
Technologies
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19. Leah Curtin, RN, MS, FAAN (1989) Former Editor, Nursing Management
“ 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

20. 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.
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21. 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)
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22. Characteristics of a profession
Utilizes in its practice a well-defined and well organized body of specialized knowledge on the intellectual level of the higher learning.
Constantly enlarges the body of knowledge it uses and improves its techniques of education and service by the use of scientific method.
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23. 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.
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24. 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.
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25. Definitions of theory Pinnel and Menesis (1986)
Systematic set of interrelated concepts, definitions and deductions that describe, explain or predict interrelationships
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26. 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
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27. Definition of a theory 3. Chinn and Krammer
creative and vigorous structuring of ideas that project a tentative, purposeful and systematic view of phenomena
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28. Definitions of a theory
Ellis
coherent set of hypothetical, conceptual and pragmatic principles forming a general frame of reference for a field of inquiry
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29. Some commonalities Purpose Concepts Definitions Propositions
Structured ideas
Tentative
Describe a phenomenon or occurrence
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30. 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
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31. Components/Elements of 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)
3. Major concepts may not be present in the theory but a main concept is usually presnt and the author is usually
Known for that example Orem’s Self Care Theory
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32. Components/Elements of 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.
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33. Characteristics of a Theory
Systematic, logical and coherent
(orderly reasoning,no contradictions)
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)
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34. Prof. Dawn M. Capaque MIT, School of Health Sciences
Theory Development
Prof. Dawn M. Capaque
MIT, School of Health Sciences

35. How does a theory develop?
Four strategies of theory development
Theory practice theory ( theory developed in other discipline and used in nursing situations)
2. Practice – theory
evolved from clinical practice
Theories used using the practice theory strategy evolved from clinical practice. Example Orlando’s nursing process theory
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36. 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.
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37. 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
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38. 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
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39. 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
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40. theory
Group of related concepts that propose actions that guide practice
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41. Nursing theory
Group of related concepts that derive tfrom the nursing models. Some derive from other nursing discipline like LEininger which comes from anthropology
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42. Uses of theory 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.
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43. 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
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44. Theory Development in Nursing: Historical Overview
DMCAPAQUE

45. 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
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46. 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
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47. Historical development
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
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48. 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
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49. First Conference in Nursing theory
Brought leading scholars and theorists to discuss and debate on issues regarding nursing science ad theory development.
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50. Historical Development
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
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51. Historical Development
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.
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52. 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
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53. 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.
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54. 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.
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55. 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
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56. 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.
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57. Types of theories According to range - Grand theory
Middle range theory
Micro theory
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)
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.
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 becomes operational for both research and practice purposes. Ex. Peplau’s Psychodynamic Nursing and Orlando’s Nursing Process Theory
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 with specific and naroow defined phenomena
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58. 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)
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59. 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.
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60. 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
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61. 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
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62. According to Orientation or focus of the theory
Client centered: Nightingale, Henderson
Client-nurse dynamics: Watson
Client-nurse environment : Leininger
. This category includes theories developed by the following : Nightingale,Abdellah,Henderson,Orem,Pender, Roy, Levine, Hall.
Nurse-client-dynamics focus on interaction between the nurse and client. This category includes theories developed by the following: Peplau, Watson, King and Orlando
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.
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63. Categories of nursing theories
nurse
client `
environment
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64. Client centered theory
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.
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65. 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
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66. 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.
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67. 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
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68. 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.
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69. 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.
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70. 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.
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71. 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
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72. Concepts Theories are formed by linking concepts together.
A conceptual framework links global concepts together.
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73. Conceptual Model
The “symbolic representation of empiric experience in words, pictorial, or graphic diagram, mathematical notations or physical material.”
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74. 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.
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75. 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.
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76. 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
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77. 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.
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78. Process of Knowledge Development
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79. Scope of Theories Grand Theories Middle-Range Theories
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80. Grand Theory
Provides an overall framework for structuring broad, abstract ideas.
Composed of concepts representing global and extremely complex phenomena.
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81. 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
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82. 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).
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83. 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.
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84. 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.
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85. 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
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86. Knowledge Development 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
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87. Knowledge Development in Nursing
Two individuals with different paradigmatic views can look at the same phenomenon and view the phenomenon differently.
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88. Knowledge Development 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.
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89. Knowledge Development 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.
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90. Knowledge Development in Nursing
Four Levels of Knowing
Empirical
Aesthetic
Personal
Ethical
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91. 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.
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92. Maslow’s Hierarchy of Needs
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93. 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.
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94. 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
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95. Contemporary Nursing Theorists
Myra Levine’s Conservation Theory (1969)
Four universal principles of conservation designed to apply concepts of nursing practice in different environments
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96. Dorothea Orem Self-Care Deficit Theory of Nursing Theory of Self-Care
Theory of Self-Care Deficit
Theory of Nursing Systems
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97. 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.
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98. Roy Adaptation Model
The goal of nursing is “the promotion of adaptation” in each of four adaptive modes.
Physiologic
Self-concept
Role function
Interdependence
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99. 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
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100. 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.
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101. 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.
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102. 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.
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103. 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.
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