Panduan Tugas DK 2: Berbagai

Tingkatan Teori dalam

Keperawatan
Tim Sains Keperawatan FIK UI
2019

10/4/21

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• Membedakan antara philosophical,

conceptual models & nursing theories
(grand theories, middle range theories &
practice theory)
• Menganalisis berbagai tingkatan
Pengetahuan keperawatan:
Capaian Ø Philosophies

Pembelajaran Ø Conceptual Models

Ø Grand Theories
Ø Middle Range Theories
Ø Practice theories

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Sasaran Pembelajaran
1 2
Menguraikan berbagai
tingkatan teori (Philosophical,
conceptual model, grand
theory, dan middle range
theory) dalam keperawatan
10/4/21
Menganalisis berbagai
tingkatan teori keperawatan
terpilih dari setiap tingkatan
teori ((Philosophical,
conceptual models, grand
theory, dan middle range
theory) menggunakan
pedoman analisis teori
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Membandingkan perbedaan
dan persamaan antara
berbagai teori tersebut
berfokus pada asumsi theorists
terhadap konsep-konsep
sentral (metaparadigm) dalam
disiplin ilmu keperawatan
3
 Sesi 1 Sesi 2
(5 Oktober 2021) (12 Okt 2021)
Pengantar tugas
dan diskusi Diskusi FG

Jadwal kelompok FG (sharing LTM)

Kegiatan Sesi 3 Sesi 4

(19 Okt 2021) (26 Okt 2021)
Diskusi HG Presentasi HG

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 Kegiatan Kelompok FG
(2 sesi)
• Mahasiswa bekerja dalam kelompok
• Diskusikan dalam kelompok perbedaan filosofi, model
konseptual, dan teori (grand, middle range & practice theory)
menggunakan bagan structure holarchy of contemporary nursing
knowledge by Fawcett (2005).
• Analisis berbagai tingkatan teori keperawatan terpilih dari setiap
tingkatan teori ((Philosophical, conceptual models, grand theory,
dan middle range theory) menggunakan pedoman analisis teori
• Tiap kelompok mendapat tugas untuk menganalisis 2 teori dari
kelompok yang berbeda (1 Filosofi & 1 Grand Theory atau 1
Conceptual Model & 1 Middle Range Theory)
• Tiap kelompok memilih teori yang berbeda
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 Kegiatan Kelompok HG (2 sesi)
• Mahasiswa bekerja dalam kelompok HG
• Sesi tgl 19 Okt: Sharing hasil diskusi kelompok FG (tiap
anggota menyampaikan hasil diskusi FG dan
mendiskusikan dalam HG)
• Dalam kelompok HG, coba bandingkan perbedaan dan
persamaan antara berbagai teori tersebut berfokus
pada asumsi theorists terhadap konsep-konsep sentral
(metaparadigm) dalam disiplin ilmu keperawatan
• Siapkan materi presentasi kelompok untuk sesi kedua
(submit H-1= 25 Okt 2021)

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Philosophies
• Florence Nightingale (Modern Nursing)
• Virginia Henderson (Nursing Need Theory)
• Hildegard Peplau (Interpersonal Relation in Nursing)
• Ida Jean Orlando (Nursing Process Theory)
• Jean Watson (Watson’s Philosophy & Theory of Transpersonal
Caring/Human caring)
• Marilyn Anne Ray (Theory of Bureaucratic caring)
• Patricia Benner (Caring, Clinical wisdom, & Ethics in Nursing Practice)
• Kari Martinsen (Philosophy of Caring)
• Katie Eriksson (Theory of Caritative caring)

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Nursing Conceptual Models
• Myra Estrin Levine ( The Conservation Model)
• Martha E. Rogers (Unitary Human Beings)
• Dorothea E. Orem (Self-care Deficit Theory of Nursing)
• Imogene King (Conceptual System)
• Betty Neuman (Systems Model)
• Sister Callista Roy (Adaptation Model)
• Dorothy Johnson (Behavioral System Model)

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Nursing Theories (Grand Theories)
• Anne Boykin & Savina O. Schoenhofer ( Theory of Nursing as Caring: A
Model for transforming Practice)
• Afaf Ibrahim Meleis (Transition Theory)
• Nola J. Pender (Health Promotion Model)
• Madeleine M. Leininger (Culture Care Theory of Diversity & Universality)
• Margaret A. Newman (Health as Expanding Consciousness)
• Rosemarie Rizzo Parse (Human becoming)
• Erickson, Tomlin & Swain (Modelling & Role Modelling)
• Gladys Husted & James H. Husted (Symphonological Bioethical Theory)

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Middle range theories
• Ramona T. Mercer (Maternal Role Attainment- Becoming a Mother)
• Merle H. Misher (Uncertainty in Illness Theory)
• Pamela G. Reed (Self-Transcendence Theory)
• Carolyn L. Wiener & Marylin J. Dood (Theory of Illness Trajectory)
• Eakes, Burke & Hainsworth (Theory of Chronic Sorrow)
• Phil Barker (Tidal Model of Mental health Recovery)
• Katherine Kolcaba (Theory of Comfort)
• Cheryl Tatano Beck (Postpartum Depression Theory)
• Kristen M. Swanson (Theory of Caring)
• Cornelia Ruland & Shirley Moore (Peaceful End of Life Theory)

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Komponen dan tingkat abstraksi Pengetahuan Keperawatan Kontemporer
(Fawcett, 2005, bab 1)

Komponen Tingkat abstraksi

Metaparadigm Most abstract

Philosophies

Conceptual models

Theories

Empirical indicators Most Concrete

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• Fawcett (2005) membedakan langkah2 untuk

menganalisis model konseptual dan teori
• Analisis model konseptual (bab 3)
Step 1 Origins of the nursing model
Step 2 Unique focus of the nursing model
Step 3 Content of the nursing model
Analisis Teori • Analisis teori: memeriksa secara detail (bab 11)
1) Theory scope
2) Theory context
3) Theory content

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• According to Levine (1994) in Fawcett (2005) Analysis

of a nursing model, requires a systematic, detailed
review of all available primary sources, including
publications and presentations by the author of the
model, to determine exactly what has been said,
Analysis of rather than relying on inferences about what might
have been meant or by referring to other authors’
Nursing interpretations of the nursing model.
Models • When the author of the nursing model has not been
clear about a point or has not presented certain
information, it may be necessary to make inferences
or to turn to other reviews of the model. That,
however, must be noted explicitly, so that the
distinction between the words of the nursing model
author and those of others is clear (Levine, 1994,
from Fawcett, 2005).

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 • Step 1 Origins of the nursing model
• Step 2 Unique focus of the nursing model
Analysis of • Step 3 Content of the nursing model
the Nursing
Models Based on Chapter 3 Framework for Analysis
and Evaluation of Nursing Models (Fawcett,
2005)

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Step 1 Origins of the nursing model

The first step in the analysis of a nursing model is examination of four

aspects of its origins.
• First, the historical evolution of the nursing model is described, and the
author’s motivation for developing the nursing model is explicated.
• Second, the author’s philosophic claims about nursing and the
knowledge development strategies used to formulate the nursing model
are examined.
• Third, the influences on the author’s thinking from nurse scholars and
scholars of adjunctive disciplines are identified.
• Fourth, the world view reflected by the nursing model is specified.
Step 1 Origins of the nursing model (2)

The questions that should be asked when analyzing the origins of the nursing model are:
● What is the historical evolution of the nursing model?
● What motivated development of the nursing model?
● On what philosophical beliefs and values about nursing
is the nursing model based?
● What strategies for knowledge development were used
to formulate the nursing model?
● What scholars influenced the model author’s thinking?
● What world view is reflected in the nursing model?
Step 2 Unique Focus of the Nursing Model

• The second step in the analysis of a nursing model is examination of its unique focus.
• The need to identify the unique focus of the nursing model stems from the
understanding that although most authors start with the same view of the general
purpose of nursing, in final form the nursing models present distinctive views of the
metaparadigm concepts (Johnson, 1974).
• Different models are concerned with different problems in nursing situations or
different problems in interactions between human beings and their environments
(Christensen & Kenney, 1995; Duffey & Muhlenkamp, 1974).
• They also are concerned with different actual and potential deviations from desired
health conditions and with different modes of nursing intervention (Johnson, 1987).
Step 2 Unique focus of the nursing model

• The factors thought to influence the development of problems or deviations

and to direct types of nursing interventions also vary from model to model.
• The unique focus of a nursing model is specified by its classification regarding
one or more categories of nursing knowledge.
• The relevant categories are developmental, systems, interaction, needs,
outcomes, client focused, person-environment interaction focused, nursing
therapeutics, energy fields, intervention, conservation, substitution,
sustenance/support, and enhancement.
• The question is:
● What is the unique focus of the nursing model?
Step 3 Content of the nursing model

• The third step in the analysis of a nursing model is examination of its content.
• The content of a nursing model is presented in the form of abstract and general
concepts and propositions. Most authors of nursing models have not presented their
ideas in the form of explicit statements about each of the meta paradigm concepts.
• Therefore this part of the analysis is most readily accomplished first by categorizing
the content of the model into the concepts that represent human beings, the
environment, health, and nursing.
• Next, the non relational propositions that define and describe those concepts are
identified. Finally, the relational propositions that link the concepts are extracted and
categorized according to linkages among the four meta paradigm concepts
Step 3 Content of the nursing model (2)

The questions about the content of the nursing model are:

● How are human beings defined and described?
● How is environment defined and described?
● How is health defined? How are wellness and illness
differentiated?
● How is nursing defined?
● What is the goal of nursing?
● How is nursing practice described?
● What statements are made about the relations among
the four metaparadigm concepts?
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According to Fawcett (2005), analysis

of theory involves a nonjudgmental,
Analysis of Nursing detailed examination of:
1) Theory scope
Theories
2) Theory context
3) Theory content

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Analysis step 1: Theory Scope

• To classify the theory scope

• Grand theories are broad in scope and substantively nonspecific; their concepts and
propositions are relatively abstract
• Middle range theories, in contract are more circumscribed and substantively specific;
their concepts and propositions are relatively concrete
• The questions that should be asked is: What is the scope of the theory?

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Analysis step 2: Theory context

• According to Barnum (1998) in Fawcett (2005), context of a nursing theory: “the

environment in which nursing acts occur. It tells the nature of the world of nursing and, in
most cases, this involves describing the salient characteristics of the patient’s
surroundings.”
• Context according to Fawcett (2005), goes beyond Barnum’s description to encompass
identification of the concepts and propositions of the nursing meta paradigm addressed
by the theory, the philosophical claims on which the theory is based, the conceptual
model from which the theory was derived, and the contributions of knowledge from
nursing and adjunctive disciplines to the theory development effort

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Analysis step 2: Theory context (2)

The meta paradigm of nursing made up of four global concepts and four global propositions.
The questions about the meta paradigm concepts and propositions are:
1. Which meta paradigm concepts are addressed by the theory?
● Does the theory deal with human beings?
● Does the theory deal with the environment?
● Does the theory deal with health?
● Does the theory deal with nursing processes or goals?

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Analysis step 2: Theory context (3)

2. Which meta paradigm propositions are addressed by the theory?

● Does the theory deal with human processes of living and dying?
● Does the theory deal with patterning of human health experiences within the context of
the environment?
● Does the theory deal with nursing actions or processes that are beneficial to human
beings?
● Does the theory deal with human processes of living and dying, recognizing that human
beings are in a continuous relationship with their environments?

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Analysis step 2: Theory context (4)

Other questions about context focus on the philosophical claims on which the theory is
based. Philosophical statements, explicate values and beliefs about nursing, as well as the
world view of the relationship between human beings and the environment.
The questions are:
● On what philosophical claims is the theory based?
● What world view is reflected in the theory?
Another question dealing with the context of a theory focuses on the conceptual model
from which the theory was derived. A conceptual model is more abstract than a theory and
serves as a guide for theory development. The question is:
● From what conceptual model was the theory derived?

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Analysis step 2: Theory context (5)

• The final question dealing with theory context highlights the knowledge from nursing and
other disciplines used by the theorist. This question reflects recognition that “nursing
theories do not spring forth fully formed” (Levine, 1988, p. 16). Instead, most nurse
theorists draw on existing, or antecedent, knowledge from nursing and adjunctive
disciplines as they construct and refine their theories.
• The question is: What antecedent knowledge from nursing and adjunctive disciplines was
used in the development of the theory?

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Analysis step 3: Theory content

• Theory Content is the content, or subject matter, of a theory is articulated through the
theory’s concepts and propositions
• The concepts of a theory are words or groups of words that express a mental image of some
phenomenon. They represent the special vocabulary of a theory.
• The concepts give meaning to what can be imagined or observed through the senses. They
enable the theorist to categorize, interpret, and structure the phenomena encompassed by the
theory. Concepts can be unidimensional, or they can have more than one dimension.
• The propositions of a theory are declarative statements about one or more concepts,
statements that assert what is thought to be the case.
• Non relational propositions describe concepts by stating their constitutive definitions.
• Relational propositions express the associations or linkages between two or more concepts.

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Analysis step 3: Theory content (3)

• Analysis of the content of a theory requires systematic examination of all available

descriptions of the theory by its author.
• The questions are:
v What are the concepts of the theory?
v What are the propositions of the theory?
v Which propositions are non relational?
v Which propositions are relational?

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References
Fawcett,J. (2005). Contemporary nursing knowledge: Analysis and Evaluation
of Nursing Models and Theories. 2nd ed. Philadelphia: F.A. Davis Company

Marriner-Tomey & Alligood (2010). Nursing Theorists and Their Works. 7th
Ed. St. Louis: Mosby Elsevier, Inc.

Alligood (2014). Nursing Theorists and Their Works. 8th Ed. St. Louis: Mosby
Elsevier, Inc.

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