Anda di halaman 1dari 98

Philosophy of nursing theory

Learning objectives
Define theory, concept, construct, Metaparadigm , proposition
and model
Discuss the importance of using nursing theories
Describe concepts of nursing theories
Explain the types of nursing theories
Describe the application of different nursing theories
Criticize/analyze different nursing theories

Definitions of theory and related terms
Nursing theory
Importance of nursing theories
Development of nursing theories
Major nursing theories
Non-nursing theories used in nursing

A set of related statements that describes/explains phenomena
in a systematic way.
Theory comes from the Greek word, theoria, which means a
be holding, spectacle or speculation.
Theories are always speculative in nature and are never
considered to be true or proven.
They are always subjected to further development and revision
or may even be discarded if not supported by empirical
Concepts are building blocks of a theory.
A concept is a word picture or mental idea of a phenomenon.
They are words or ideas that symbolize some aspect of reality.
A concept may be very concrete such as human heart or very
abstract such as love.
Concrete concepts may be specified and defined more easily
than abstract concepts.
Construct is highly abstract phenomenon or concept.
It is the term used to indicate a phenomenon that cannot be
directly observed but must be inferred by certain concrete or
less abstract indicators of the phenomenon.
Examples of construct include wellness, mental health, self
esteem and assertiveness.
Each of these concepts can be identified by the presence of
some measurable concepts
Proposition is a statement or assertion of the relationship
between concepts.
Propositional statements derived from theories or from
generalizations based on empirical data.
These statements may indicate the relationship between
concepts in several ways and may assert two events tend to
vary together.
Proposition . . .
Example, there is a relationship between pulse rate and
respiratory rate.
Propositional statements may also assert that one variable
causes on other variable.
Example, bacteria causes disease.

Model is a symbolic representation of some phenomenon or
It represents some aspect of reality, concrete or abstract.
It may be structural, pictorial, diagrammatic, or mathematical.
Difference between theory and model; theory focuses on
statements or explanations of the relationship between
phenomena, a model focuses on the structure or composition
of phenomena.
Phenomena - It is an idea or fact or event that appears or is
Paradigm - the network of science, philosophy and theory
accepted by a discipline or person.
The prevailing paradigm directs the activities of a discipline.
Metaparadigm - the most global perspective of a discipline,
singles out the phenomena with a discipline deals in a unique
manner, i.e. person, environment, health, illness, etc.
Nursing theory
Nursing theory is the term given to the body of knowledge that
is used to support nursing practice.

In their professional education, nurses will study a range of
interconnected subjects which can be applied to the practice

This knowledge may be derived from experiential learning,
from formal sources such as nursing research or from non-
nursing sources.
Nursing theory
Nursing is many things to many people.
Most universally agreed upon is that Nursing is a science
involving people, environment and process fueled by a vision
of transcendence in the context of healthcare.
It is interesting to note that 90% of all nursing theories have
been generated in the last 25 years.
Many schools encourage students to formulate personal
philosophies or mid-range theories of Nursing as part of their
Some might argue that this multiplicity of theory is detrimental
(harmful) to the practice and undermines common vision.
Nursing theory . . .
Others would say that the nature of the young science is
sufficiently far reaching to require such tactics in order to elicit
true consensus.
Nursing theory provides the foundation of nursing knowledge
and gives direction to nursing practice.
Nursing theory should guide the development and future
direction of nursing research.
Nursing theory . . .
Barnum (1994) offers this vivid analogy to describe nursing
A theory is like a map of a territory as opposed to an aerial
photograph. The map does not display the full terrain
(building, roads, moving, vehicles, or grazing livestock):
instead it peaks out these parts that are important for its
purpose. If its aim is to guide travelers, the map will highlight
the roads; if its purpose is to describe its terrain, it will show
its mountains, plains and rivers. But no map or theory reflects
all that is contained with in a phenomenon. Such a map will
defeat its purpose; giving one a handle on the phenomenon.
The handle is created by making the essential parts stand out
in relief.

Importance of nursing theories
used to describe, develop, disseminate, and use present
knowledge in nursing.
provide a framework for nurses to systematize their nursing
What to ask, what to observe, what to focus on and what to
think about.
They provide a framework to develop new and validate
current knowledge.
used to define commonalities of the variables in a stated field
of inquiry;
guide nursing research and actions
predict practice outcomes
predict client response.

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
Classification of nursing theories
A. Depending On Function
Descriptive-to identify the properties and workings of a discipline
Explanatory-to examine how properties relate and thus affect the
Predictive-to calculate relationships between properties and how
they occur
Prescriptive -to identify under which conditions relationships
Classification of nursing theories
B. Depending on the Generalizability of their principles
Grand theory: provides a conceptual framework under which
the key concepts
Leiningers Theory of Culture Care Diversity and
Newmans Theory of Health as Expanding Consciousness
Orems Self-Care Deficit Nursing Theory
Parses Theory of Human Becoming

Classification of nursing theories
Middle range theory: is more precise and only analyses a
particular situation with a limited number of variables.
Practice /prescriptive/micro theory: explores one particular
situation found in nursing.
It identifies explicit goals and details how these goals will be
Classification of nursing theories
D. Based on the philosophical underpinnings of the theories
Needs theories
Interaction theories
Outcome theories
Humanistic theories
1. Needs theories
These theories are based around helping individuals to fulfill
their physical and mental needs.
Needs theories have been criticized for relying too much on
the medical model of health and placing the patient in an
overtly dependent position.

Classification of nursing theories
2.Interaction theories
As described by Peplau (1988), these theories revolve around
the relationships nurses form with patients.
Such theories have been criticized for largely ignoring the
medical model of health and not attending to basic physical
3. Outcome theories
Outcome theories portray the nurse as the changing force, who
enables individuals to adapt to or cope with ill health.
Classification of nursing theories
Outcome theories have been criticized as too abstract and
difficult to implement in practice.
4. Humanistic Theories
Humanistic theories developed in response to the psycho-
analytic thought that a persons destiny was determined early
in life.
Humanistic theories emphasize a persons capacity for self-
Classification of nursing theories
Humanists believe that the person contains within himself the
potential for healthy & creative growth.
Carl Rogers developed a person centered model of
psychotherapy that emphasizes the uniqueness of the
The major contribution that Rogers added to nursing practice
is the understandings that each client is a unique individual, so,
person-centered approach now practice in nursing.

Development of nursing theory
The development of nursing theory has provided direction for
the structure of professional nursing practice, education, and
The introduction of nursing theory historically begins with
Florence Nightingale
Conceptual and theoretical nursing models generate
knowledge that will:
improve nursing practice
guide nursing approach
facilitate the organization of curricula for all levels of
nursing education
Development . . .
From nursing science, conceptual models and nursing theories
As the profession continues to expand, its own body of
knowledge, concepts and theories continue to develop to
support nursing practice component.
Major nursing theories
Nightingale's environmental theory
Hendersons Human Needs Theory
Orems self care theory
Roys Adaptation Model
Rogers theory of Science of Unitary Human Beings
Roper, Logan and Tierneys activities of daily living theory
Faye Abdullah: patient centered approach
Newman systems theory
Lidya E. Hall: Care, core and cure
Kings theory of goal attainment
The prescriptive theory of Nursing
Nightingale's environmental theory
It is one of Nightingale's nursing theories
Incorporated the restoration of the usual health status of the
nurse's clients into the delivery of health care
Disease - reparative process
Nurses role - manipulating the environment to facilitate this
Her intent was to describe nursing and provide guidelines for
nursing practice and education

Factors present in the patient's environment
Pure or fresh air
Pure water
Sufficient food supplies
Efficient drainage
Light (especially direct
Ventilation and warming -
Building sickness
Observation of the sick
Social considerations

Major concepts defined by Nightingale
Patient an individual who is responsible, creative, in control
of their lives and health, and desiring good health.
Health a state of wellbeing; using ones power to the fullest.
Illness - the reaction of the nature against the conditions in
which we have placed ourselves.
Environment is external to the person, but affecting the
health of both sick and well persons.

The environment, one of the chief sources of infection, must
include fresh air, fresh water, efficient drainage, cleanliness,
and light.
Nursing - a service to people intended to relief pain and
The goal of nursing is to promote the reparative process by
manipulating the environment.

Applies in all situation that nursing care is provided.
Allows clients to change/ adapt in relation to their diseased
It is used by managers and leaders to influence the positions
about the nursing care today.

The practice of environment configuration according to
patient's health or disease condition is still applied today
E.g. in cases as patients infected with Clostridium tetani
(suffering from tetanus), who need minimal noise to calm
them and a quiet environment to prevent seizure-causing
Theory critique
Nightingales nursing principles remain relevant today, as
ventilation, warmth, quit, diet, and cleanliness are integral
parts of nursing care.
She emphasized nurses should wash frequently and maintain
the personal hygiene of their patients.
For nightingale, patients are passive and have no say in their
did not put the relationship between concepts clearly

Hendersons Human Needs Theory
Virginia Henderson viewed nursing as an art and a discipline
separated from medicine.
She believed that 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 a peaceful
death) that he/she would perform unaided if he/she had the
necessary strength, will or knowledge.
Identified 14 components of Basic Nursing Care (basic needs
of the patient) :
Hendersons . . .
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body waste
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes dress and undress
7. Maintain body temperature within normal range by
adjusting clothing and modifying the environment
8. Keep the body clean and well groomed and protects the
14 basic needs . . .
9. Avoid changes in the environment and avoid injuring others.
10. Communicate with others expressing emotions, needs, fears,
or opinions.
11. Worship according to ones faith.
12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation.
14. Learn, discover, or satisfy the curiosity that leads to normal
development and health and use of the available health

Major concepts defined by Henderson
Patient individual; requires assistance to achieve health and
independence or a peaceful death.
Individual will achieve or maintain health if they have the
necessary strength, will or knowledge.
Health is a quality of life basic to human functioning.
Health is equated with independence, while illness is
associated with a lack of independence.

Major concepts . . .
Environment all external conditions and influences that affect
life and development.
Nursing a unique function of assisting sick or well individuals
in a complementary role.
The goal of nursing is to help the individual gain independence
as rapidly as possible.

Theory critique
Hendersons theory closely corresponds to Maslows hierarchy
of needs
However, she omitted self- actualization from the remit of the
Henderson viewed the nurses role as that of a substitute for
the patient, helper to the patient, and a partner with the patient.
She listed 14 basic needs that nurses should assist patients with
if the patients are unable to perform them unaided.
Theory critique
These basic needs compose Hendersons component of
nursing care, which mainly focuses on nursing is an art.
Hendersons 14 basic needs are the basis for activities of daily
living theory.
Hendersons theory is useful in nursing as the nurse can use
the fourteen basic needs as a basis for their nursing

Orems self care deficit theory
Dorothea Orem first published her concepts of nursing in
sustaining in 1959, refining them in 1980 and 1985.
Originally, she designed her theory for nursing school
curricula to help students differentiate among nursing actions.
She worked on three theories, self care deficits, theory of self
care and theory of nursing systems.
This theory focuses on identifying the patients self-care needs
and nursing actions designed to meet the patients needs.
Orems .
Orem contends that the term care describes nursing in a
most general way.
Nursing is distinguished from other human services and other
forms of care by the way in which it focuses on human beings.
Nursing is commonly viewed as a human health service.
Orems General Theory of Nursing
Three Interrelated Theories:
1. Theory of Self-Care = why and how people care for themselves
2. Theory of Self-Care Deficit = why people can be helped
through nursing
3. Theory of Nursing Systems = describes and explains
relationships that must be made and maintained for nursing to
be produced
Self-Care Theory
Based on the concepts of:
Self-care agency
Self-care requisites
Therapeutic self-care demand
Self Care Theory Concepts
Self Care
The performance of
activities that individuals
initiate and perform on
their behalf to maintain
life, health, and well-
Self Care Theory Concepts
Self-Care Agency
The individuals ability to perform self-care activities
Consists of TWO agents:
Self-care Agent - person who provides the self-care
Dependent Care Agent - person other than the individual
who provides the care (such as a parent)

Self Care Theory Concepts
Self-Care Requisites
Reasons for which self-care is done; these express the intended or
desired results
Consists of THREE categories:
Universal - requisites/needs that are common to all individuals
(e.g. air, water, food, elimination, rest, activity, etc.)
Developmental - needs resulting from maturation or develop
due to a condition or event (e.g. adjustment to new job,
Health Deviation - needs resulting from illness, injury &
disease or its treatment (e.g. learning to walk with crutches
after a leg fracture)

Self Care Theory Concepts
Therapeutic Self-Care Demand
The totality of care measures necessary at specific times or
over a duration of time for meeting an individuals self-care
requisites by using appropriate methods and related sets and

Self Care
Self-Care Deficit Nursing Theory
The condition that validates the existence of a
requirement for nursing in an adult is the health
associated absence of the ability to maintain
continuously the amount and quality of therapeutic
self-care in sustaining life and health, in recovering
from disease or injury, or in coping with their effects.
Self-Care Deficit Nursing Theory
Is the central focus of Orems grand theory of nursing
Nursing is required when adults (parent/guardian) are
incapable of or limited in their ability to provide continuous
effective self-care.
Describes and explains how people can be helped through
Nursing meets these self-care needs through five methods
of help.

Five Methods of Nursing Help
1. Acting or doing for another
2. Guiding and directing
3. Providing physical or psychological support
4. Providing and maintaining an environment that supports
personal development
5. Teaching
Theory of Nursing Systems
This describes:
How the patients self care needs will be met by the nurse , the
patient, or both
Nursing responsibilities.
Roles of the nurse and patient
Rationales for the nurse-patient relationship
Types of actions needed to meet the patients demands
Designed by the nurse
Based on the assessment of patients ability to perform self-care

Three Classifications of Nursing Systems
1. Wholly Compensatory: a patients self-care agency is so
limited that s/he depends on others for well-being.
a. Unable to engage in any form of action (e.g. coma)
b. Aware and who may be able to make observations or
judgments, and decisions about self-care but cannot/should
not perform actions requiring ambulation and manipulative
movements (e.g. patients with vertebral fractures)

a. Unable to attend to themselves and make reasonable
judgments about self-care but who can be ambulatory and
able to perform some self-care with guidance (e.g. severely
mentally incompetent)
Wholly Compensatory Nursing System
Nurse Action
patients therapeutic
Patient action
Compensates for
patients inability to
engage in self-care
Supports and
protects patient
Three Classifications of Nursing Systems
2. Partly Compensatory: A patient can meet some self-care
requisites but needs a nurse to help meet others; either the nurse
or the patient have the major role in the performance of self-
E.g. a patient with recent abdominal surgery

Partly Compensatory Nursing System
Nurse action
Performs some self-care
measures for patient
Compensates for self-care
limitations of patient
Assists patient as required
Regulates self-care agency
Patient Action
Performs some self-care
Accepts care and
assistance from nurse
Three Classifications of Nursing Systems
3. Supportive-educative: a patient can meet self-care requisites
but needs help in decision-making, behavior control, or
knowledge acquisition; the nurses role is to promote the patient
as a self-care agent (teacher/consultant)
Supportive-Educative Nursing System
Patient action
Accomplishes self-
Regulates the exercise
and development of
self-care agency
Nurse action
Major concepts defined by Orem (general)
Patient - is an individual unable to continuously maintain self-
care in sustaining life and health, in recovering from disease or
injury, or in coping with their effects.
Health ability to meet self care demands that contribute to
the maintenance and promotion of structural integrity,
functioning and development.
Illness occurs when an individual is incapable of
maintaining self-care as a result of health related limitations.
Concepts .
Environment Any setting in which a patient has un-meet
self care needs.
Nursing A service of deliberately selected and performed
actions to assist individuals to maintain self care, including
structural integrity, functioning, and development.
Theory critique
Orems theory is useful for comprehensive assessment and
analysis of individuals.
The theory is very useful for nurses working with chronically
ill patients in the hospital or other settings.
It is also used in health maintenance and illness prevention.
The term self-care is used by so many premises which may
create confusion.
Individuals emotional needs are neglected.

Roys Adaptation Model
Developed by Dr. callista Roy.
wrote and spoke on the need to define the goal of nursing as a
way of focusing the development of knowledge for practice.

Dr. Roy had read a little about the concept of adaptation and
was impressed with the resiliency of children she had cared for
in paediatrics.
Roys Adaptation Model
She focused the individual as a bio-psychosocial adaptive
Described nursing as a humanistic (values others opinions and
viewpoints) discipline that places emphasis on persons coping
According to Roy, the individual and environment are sources
of stimuli that require modification for adaptation.

Roys Adaptation Model
When the demands of environmental stimuli are too great, or
the persons adaptive mechanisms are too low, the persons
behavioural response are ineffective for coping.

Effective adaptive responses promote the integrity of the
individual by conserving energy and promoting the survival,
growth and reproduction, and mastery of human system, which
seeks equilibrium.
Major concepts defined by Roy
Patient a person or family with unusual stressors or ineffective
coping mechanisms.
Health- a step and process of being and becoming adapted and
Illness- a lack of integration
Environment all conditions, circumstances, and influences
surrounding and affecting the development and behaviour of persons
or families.
Nursing promotion of patients effective coping and progress
toward adaptation.
Theory critique
Roys theory is useful in guiding the nurse in nursing
observation and interviewing skills to make an individualized
assessment of each person
Serves as a guide in planning and carrying out nursing care
Some concepts remain ambiguous e.g. how does adaptation
takes place.
Also the theory only includes assessment and interventions
and not the full nursing process.

Neumanns health care system model
Developed by Betty Neumann
This is a complex system theory, with a focus on stress
reaction and stress reduction.
This comprehensive theory depicts the patient as the core of a
circle (genetics, organ strength or weakness, normal
temperature range) with several protective layers.

Neumanns health care system model
The patient is continuously exposed to internal and external
loss, change, grief, sensory deprivation, and cultural
which requires line of defence (nutrition, rest, hydration,
oxygen, financial circumstances, employment, and lifestyle)
and reactions (role expectations, and copping patterns).

Nursing interventions can occur before or after stressors and
at three levels of prevention: primary, secondary, and tertiary.

Major concepts defined by Neumann
Patient- is an open system seeking balance and harmony,
composite of physiological, psychological, socio-cultural, and
developmental variables and viewed as a whole.
It may refer individuals, families, and communities.
Health- A dynamic equilibrium of the normal line of defence.
Neumanns health care system model
Illness- illness is due to reaction to stressors with lines of
resistance (immune and inflammatory response systems).
Environment- comprises internal and external stressors and
resistance factors.
Nursing reduction of stressors through prevention activities
at three levels.
Neumanns theory is applicable to all phases of nursing
It can be applied across all clinical areas and is especially
useful for individuals and families.
It uses a holistic approach because each system or subsystem
cannot be isolated; rather, the influence of each system on the
whole must be considered.
The three levels of prevention are useful guides for planning
Theory critique
Particularly useful to nurses working in the community setting,
but can also be used in the hospital or clinical environment.
It specially shows how to use the nursing process in both
However, it is wellness oriented, and she uses the terms health
and wellness interchangeably as if they mean the same thing.
Also, it is prevention rather than treatment oriented.

Roper, Logan and Tierneys activities of daily living
Roper, Logan and Tierney describe nursing s aim as meeting
the needs of society.
They depict 12 basic activities of daily living and describe five
sources of potential or actual problems.

Basic activities of living
Maintaining a safe
Eating and Drinking
Personal cleansing and
Maintaining body
Working and playing
Expressing sexuality
The five sources of problems
1. Disability
2. Pathologic and degenerative tissue change
3. Accident
4. Infection
5. Environmental changes in the physical, psychological and
social sector of the clients life.
Major concepts defined by Roper, Logan and Tierney
Patient- any individual needing help to perform activities of
daily livings.
Health- can only be defined in relation to the individual and
his expectations, and in relation to his optimal level of
functioning in everyday living.
Environment - houses, factories, and offices, sports grounds
and playgrounds and rounds are all environments.
There is also the broader view of environment e.g. climate and
geographical location.
Concepts . . .
Nursing helping patients to prevent, solve, alleviate or cope
with problems (actual or potential) with activities of daily
livings and exists to meet the needs of society.

Theory critique
Concepts, especially metaparadigm concepts, are not
well defined.
The theory follows the biomedical model.
The focus of the theory is on nursing as a helping art.

Non nursing theories used in nursing
Like nursing theories, there are also non-nursing theories
which are used in nursing practice.
Among non-nursing theories used in nursing:
General system theory
Maslows hierarchy of human needs
Change theory
General system theory
Provides another approach for studying individuals in their
environment and is used by many disciplines.
General system theory includes content, purpose and process,
breaking down the whole and analyzing the parts.
The relationships between the parts of the whole are examined
to learn how they work together.
General system theory . . . .
Von Bertalanffy (1969 - 1976) developed general system theory
which assumes the following:
All systems must be goal directed.
A system is more than the sum of its parts.
A system is ever-changing, and any change in one parts affects
the whole.
Bounders are implicit, and human systems are open and

General ..
Examples of nursing theories that have used the systems
approach to client care:
Roy's adaptation model (1980)
Halls philosophy of nursing (1964)
Newmans health care system model (1972)
Johnson's behavioural model (1968)
Parses theory for Nursing (1981)

Human needs theory
Maslows hierarchy of humans needs is any physiological or
psychological factors necessary for a healthy existence.
The most prominent theorist to focus on human needs has been
Abram Maslow (1970).
Human needs theory
It states that all humans are born with instinctive needs.
These needs grouped into 5 categories; are arranged in the
order of importance from those essential for physical survival
to those necessary to develop a persons fullest potential.
provides a framework for recognizing and prioritizing basic
human needs.
This hierarchy is constructed as a pyramid.
Human needs theory
It is often depicted as a pyramid consisting of five levels:
the four lower levels are grouped together as being
associated with Physiological needs/deficiency needs
while the top level is termed growth needs/Being needs
associated with psychological needs.
Human needs theory
Deficiency needs must be met first.
Once these are met, seeking to satisfy growth needs drives
personal growth.
The higher needs in this hierarchy only come into focus when
the lower needs in the pyramid are satisfied.
Once an individual has moved upwards to the next level, needs
in the lower level will no longer be prioritized.
Deficiency and being needs
The deficiency needs are: physiologic, safety and security,
love and belonging, and esteem needs.
B-needs = self actualization and transcendence ( be greater,
better) needs

1. Physiological needs
These are the basic human needs for such things as air, food,
warmth, water, excretion, sexual and other bodily needs.
If some needs are not fulfilled, a person's physiological needs
take the highest priority.
Physiological needs can control thoughts and behaviors.
can cause people to feel sickness, pain, and discomfort.

2. Safety needs
With their physical needs relatively satisfied, the individual's
safety needs take over and dominate their behavior.
manifest themselves in such things as a preference for job
security, grievance procedures for protecting the individual
from unilateral authority, savings accounts . . . .
Safety and Security needs
Personal security from crime
Financial security
Health and well-being
Safety net against accidents/illness and the adverse impacts

3. Social needs/belongingness
After physiological and safety needs are fulfilled, the third
layer of human needs is social.
This psychological aspect of Maslow's hierarchy involves
emotionally-based relationships in general, such as:
having a supportive and communicative family
Social needs . . .
Humans need to feel a sense of belonging and acceptance.
They need to love and be loved (sexually and non-sexually) by
In the absence of these elements, many people become
susceptible to loneliness, social anxiety, and Clinical
4. Esteem needs
All humans have a need to be respected, to have self-esteem,
self-respect, and to respect others.
People need to engage themselves to gain recognition and have
an activity that give the person a sense of contribution, to feel
accepted and self-valued.
Imbalances at this level can result in low self-esteem or
inferiority complexes.
5. Self-actualization
Self-actualization and transcendence are "being" or "growth"
needs (also termed "B-needs")
they are enduring motivations or drivers of behavior.
Change theory
People grow and change throughout their lives.
Change happens daily.
This changes and growth affects human kinds.
Change is continuous.
Reactions to changes are grounded in the basic human needs
for self-esteem, safety, and security.
Change may be planned or unplanned.
Kurt Lewin (1962) developed the theory of change.
Change theory . . .
Lewin identified three states of change: unfreezing,
movement, and refreezing.
Unfreezing is the recognition of the need for change and the
dissolution of previously held patterns of behaviour.
Movement is the shift of behaviour towards a new and more
healthful pattern.
Refreezing is the long term solidification of the new pattern
of behaviour.