Theoretical

Foundations of
Nursing:
Overview
Regie P. De Jesus, MAN
 Epistemology
• A branch of inquiry that is concerned
with the theory of knowledge or
how knowledge came to be
• Related to our concept of reality
• Paradigms – general or worldwide
view of reality
• 2 Paradigms
– 1. Empiricism
– 2. Rationalism
 Empiricism
• It is the way of looking at reality
using the five general senses of
sight, touch, hearing, taste, and
smell.
 Rationalism
• It is the use of the rational senses in
ensuring the truthfulness of a
phenomenon
• What is real is in the essence of the
phenomenon being described and
not just on whether it can be tested
by the five general senses
 Concept
• A mental idea of a phenomenon
• An idea that brings diverse elements
into a basic relationship
• A unit of thought
• Something understood or retained in
the mind, from experience, reasoning,
and/or imagination; a generalization or
abstraction of a particular set of
instances or occurrences
• Examples: person, health,
environment, and nursing
 Theory
• A set of statements that tentatively
describe, explain, or predict
relationships among concepts that
have been systematically selected and
organized as an abstract
representation of some phenomenon.
• These organized perspectives serve as
guides for nursing action in
administration, education, research,
and practice.
• A well-substantiated explanation of some
aspect of the natural world
• An explanation of what should happen,
barring unforeseen circumstances
• An explanation for some phenomena
that is based on observation,
experimentation, and reasoning
(repeatedly) but has not been yet
decisively proven.
Characteristics of a Theory
• Interrelating concepts in such a
way as to create a different way of
looking at a particular
phenomenon
• Logical in nature
• Generalizable
• Basis for hypothesis that can be
tested
• Increasing the general body of
knowledge within the discipline
through the research
implemented to validate them
• Used by the practitioners to guide
and improve their practice
• Consistent with other validated
theories, laws, and principles but
will leave open unanswered
questions that need to be
investigated
Conceptual Framework
• A set of interrelated concepts that
symbolically represents and conveys
a mental image of a phenomenon.
• Conceptual models of nursing
identify concepts and describe their
relationships to the phenomena of
central concern to the discipline:
person, environment, health and
nursing
• A set of concepts and the
propositions that integrate them
into a meaningful configuration
(Marriner- Tomey and Alligod, 1998)
 Hypothesis
• It is an educated guess based
upon observation.
• Can be supported or proven
false by experimentation or
continued observation
 Theoretical Model
• It represents an equation that
describes the path or explains the
phenomenon being observed or
experienced.
• Models are typically accompanied by
a pictorial representation of the
variables and their interralationships
Maslow’s Hierarchy of Needs
Components of a Theory
• A. Concepts
• B. Definitions
• C. Assumptions
• D. Phenomenon
 A. Concept
• Concepts help to describe or label
phenomenon.
• Words or phrases that are used to
represent the phenomenon
observed or experienced
• Building blocks of theories
• Examples: conservation,
adaptation, wholeness (Levine’s
Conservation Model)
 B. Definitions
• It conveys the general meaning of
the concepts in a manner that fits
the theory.
Two types
• A. Theoretical Definition
• B. Operational Definition
• Theoretical definition – concepts
that are described according to
how these concepts are defined in
the dictionary.
• Operational Definition – concepts
that are based on how these
concepts are used or will be used
within the context of the
phenomenon being observed or
experienced
• E.g.
• Theoretical definition
– Temperature is the hemothermic range
of a person’s internal environment
maintained by the thermoregulatory
system of the body.
• Operational definition
– Temperature is the degree of
temperature measured by the oral
thermometer taken for one minute
under the tongue.
 C. Assumptions
• These are statements that describe
concepts or connect two concepts
that are factual.
• These are the “taken for granted”
statements that determine the
nature of the concepts, definitions,
purpose, relationships and
structure of the theory
• E.g. In Levine’s Conservation Model
– A. Individuals continuously defend their
wholeness
– B. Adaptation is an ongoing process of
change
 Types of Theories
Depending on the generalisability of their principles
• 1. Metatheories – are theories whose
subject matters are some other
theories
• A.k.a. Nursing Philosophies
– These are theories about theories
– Thus the highest level of theory
– Meta – “beyond,” “on a higher level”
– Limited in terms of being without
boundaries, abstract, and very difficult for
practical application
• 2. Grand Theories
• A.k.a. Nursing Conceptual
Models
– Third level of nursing theory
– Are broad in scope and complex
and therefore requires further
specification through research
before they can be tested.
– These are intended to provide
structural framework for broad,
abstract ideas about nursing
• These theories emphasize a
global viewpoint with a broad
perspective of nursing practice
• It may also provide the
foundation for a middle-range
theories (e.g. Theory of Self-Care
Deficit from Orem’s Grand Theory
of Self-Care)
• 3. Middle Range Theories
– Second level of nursing Theories
– Have more limited scope, less
abstraction, address specific phenomena
or concepts and reflect practice
(Administration, clinical or teaching).
– more precise and only analyses a
particular situation with a limited
number of variables
– “best of both worlds” - Easy applicability
in practice and abstract enough to be
scientifically interesting
• These theories focus on concepts
of interest to nurses and include
quality of life, illness, social
support, incontinence, caring,
pain, grief
• E.g. Roy’s Theory of the Person as
an Adaptive System, King’s
Theory of Goal Attainment
• 4. Descriptive/ Practice Theories
– First level of Nursing theory
– Describe phenomena, speculate on
why phenomena occur, and describe
the consequences of phenomena.
– These include 2 steps:
• A. Factor-Isolating – identify and describe
a phenomena
• B. Factor-Relating – identify and describe
possible explanations or causes of the
phenomenon
• 5. Prescriptive Theories
– Address nursing interventions and
predict the consequence of a
specific nursing interventions
– These are action-oriented, which
test the validity and predictability
of a nursing intervention
– These includes 2 steps:
• 1. Situation-relating
• 2. Situation-Producing
• 1. Situation-Relating – predicts
occurrence of a phenomenon
when the cause is present
– E.g. High salt, high fat diet results to
hypertension
• 2. Situation-Producing – Prevents
occurrence of the phenomenon by
controlling or eliminating possible
causes
– E.g. Frequent turning and positioning
of bed-ridden patients to prevent
pressure ulcers
 Theories can also be
categorised as:
• "Needs "theories.
• "Interaction" theories.
• "Outcome "theories.
• "Humanistic theories"
 "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.
 "Interaction" theories
• 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 needs.
 "Outcome" theories
• These portray the nurse as the
changing force, who enables
individuals to adapt to or cope with ill
health (Roy 1980).
• Outcome theories have been
criticized as too abstract and difficult
to implement in practice (Aggleton
and Chalmers 1988).
 NEED INTERACTION OUTCOME
THEORISTS THEORISTS THEORISTS

 King
 Johnson
 Abdellah  Orlando
 Levine
 Henderson  Peplau
 Rogers
 Orem  Travelbee
 Roy
 Wiedenbach
Nursing Defined
 What is Nursing?
• Nursing comes from the Latin
word “nutrix” which means “to
nourish.”
• Nursing encourages people to live
healthy lives, cultivate a caring
and healthy attitude among them,
and foster mutually beneficial
relationships with each other
 International Council of
Nurses
• Nursing encompasses autonomous and
collaborative care of individuals of all ages,
families, groups and communities, sick or well
and in all settings. Nursing i includes the
promotion of health, prevention of illness,
and the care of ill, disabled and dying people.
Advocacy, promotion of a safe environment,
research, participation in shaping health
policy and in patient and health systems
management, and education are also key
nursing roles.
Royal College of Nursing UK
• The use of clinical judgement in the
provision of care to enable people to
improve, maintain, or recover health,
to cope with health problems, and to
achieve the best possible quality of
life, whatever their disease or
disability, until death."
American Nurses Association
• Nursing is the protection, promotion,
and optimization of health and
abilities; prevention of illness and
injury; alleviation of suffering through
the diagnosis and treatment of human
responses; and advocacy in health
care for individuals, families,
communities, and populations.
 Virginia Avenel Henderson
• The unique function of the nurse is to
assist the individual, sick or well, in the
performance of those activities
contributing to health or its recovery
(or to peaceful death) that he would
perform unaided if he had the
necessary strength, will or knowledge.
Nursing as an Integration
of Science and Art
• Nursing as Art
– Art as it includes clinical practice
– It involves the art of serving, of
nurturing, and of caring for
everyone who needs it.
– It involves the use of
compassionate, caring,
conscientious, competence, and
confidence.
• Nursing as Science
– It is governed by laws and theories that
have been scientifically proven to be
relevant to the performance of nursing

Nursing as both an Art and Science

– The art of nursing is grounded in
scientific principles
 Nursing Theory
• A body of knowledge that describes
or explains nursing and is used to
support nursing practice
• An organized and systematic
articulation of a set of statements
related to questions in the discipline
of nursing
 Importance of Nursing
Theories
• Aims to describe, predict,
and explain the
phenomenon of nursing
• Provide the foundations of
nursing practice, help to
generate further knowledge
and indicate in which
direction nursing should
develop in the future
• Helps provide better patient care,
enhanced professional status for nurses,
improved communication between nurses,
and guidance for research and education
• The main exponent of nursing – caring –
cannot be measured. It is vital to have the
theory to analyze and explain what nurses
do
• Establishes a unique body of knowledge
• Maintain professional boundaries in
nursing
 Purposes of Theories
• A. In Practice
– Assist nurses to describe, explain, and
predict everyday experiences
– Serve to guide assessment, intervention,
and evaluation of nursing care
– Provide rationale for collecting reliable
and valid data above the health status of
clients, which are essential for effective
decision making and implementation
• Help to establish criteria to
measure the quality of nursing care
• Help build a nursing terminology to
use in communicating with other
professional
• Enhance autonomy (independence
and self-governance) of nursing by
defining its own independent
functions
• B. In Education
– Provide a general focus for curriculum design
– Guide curricular decision making
• C. In Research
– Offer framework for generating knowledge
and new ideas
– Assist in discovering knowledge gaps in
specific field of study
– Offer a systematic approach to identify
questions for study, select variables,
interpret findings and validate nursing
interventions
 BASIC PROCESSES IN THE
DEVELOPMENT OF NURSING
THEORIES
1. General Systems Theory
2. Adaptation Theory
3. Developmental Theory
A. General System Theory:
• It describes how to break whole things
into parts and then to learn how the
parts work together in " systems".
• These concepts may be applied to
different kinds of systems, e.g..
Molecules in chemistry , cultures in
sociology, organs in Anatomy and
health in Nursing.
 B. Adaptation Theory
• It defines adaptation as the adjustment of
living matter to other living things and to
environmental conditions.
• Adaptation is a continuously occurring
process that effects change and involves
interaction and response.
• Human adaptation occurs on three levels:
– --- the internal ( self )
– --- the social (others)
– --- and the physical ( biochemical reactions )
 C. Developmental Theory
• It outlines the process of growth and development
of humans as orderly and predictable, beginning
with conception and ending with death.
• The progress and behaviors of an individual within
each stage are unique.
• The growth and development of an individual are
influenced by heredity , temperament, emotional,
and physical environment, life experiences and
health status.
 Nursing Paradigm
• Nursing has a model or paradigm
that explains the linkages of science,
philosophy, and theory that is
accepted by the discipline.
 Four Major Concepts of
Nursing Theories
• 1. Person – refers to all human
being
– People are the recipients of nursing
care
– They include individuals, families,
communities, and groups
• 2. Environment
– Includes factors that affect individuals
internally and externally
– It means not only everyday surroundings
but also settings where nursing care is
provided
• 3. Health
– Addresses the person’s state of well-being
– ....state of complete physical, mental,
emotional, social, and spiritual well-being
and not necessarily the absence of disease
or infirmity – World Health Organization
• 4. Nursing
– It is central to all nursing theories
– Definitions of nursing describe what
nursing is, what nurses do, and how
nurses interact with clients
 NURSING PROCESS
• the nursing process is the method
used to assess and diagnose needs,
plan outcomes and interventions,
implement interventions, and
evaluate the outcomes of the care
provided.
 Nursing Process
• A- ssessment
• D- iagnosis
• P- lanning
• I- mplementation/ Intervention
• E- valuation