Berbagai Tingkatan Teori dalam

Keperawatan

Tim Sains Keperawatan FIK UI 2017

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Tujuan
• Membedakan antara phylosophical theory, conceptual
models & nursing theories (grand theories and middle range
theories)
• Analisis berbagai tingkatan Teori keperawatan:
 Philosophical Theories
 Conceptual Models
 Grand Theories
 Middle Range Theories

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Jadwal Kegiatan
• Sesi 1 (3 Oktober 2017) Ceramah pengantar dan diskusi
kelompok
• Sesi 2 (17 Oktober 2017) Presentasi kelompok (Filosofi &
Conceptual Model)
• Sesi 3 ( 24 Oktober 2017) Presentasi kelompok (Grand
Theory & Middle Range Theory)

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Sasaran Pembelajaran
• Menguraikan berbagai tingkatan teori (Philosophical, conceptual
model, grand theory, dan middle range theory) dalam
keperawatan
• Menganalisis berbagai tingkatan teori keperawatan terpilih dari
setiap tingkatan teori ((Philosophical, conceptual models, grand
theory, dan middle range theory) menggunakan pedoman analisis
teori
• Membandingkan perbedaan dan persamaan antara berbagai teori
tersebut berfokus pada asumsi theorists terhadap konsep-konsep
sentral (metaparadigm) dalam disiplin ilmu keperawatan
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Kegiatan Kelompok
• Mahasiswa bekerja dalam kelompok
• Sebelum menganalisis teori, pelajarilah buku Fawcett (2005) yang
berjudul Contemporary nursing knowledge: Analysis and Evaluation of
Nursing Models and Theories, bab 1 The structure of contemporary
nursing knowledge, halaman 3-25, untuk mendapat gambaran tingkatan
pengetahuan keperawatan kontemporer dari metaparadigma sampai
indikator empiris
• Diskusikan dalam kelompok perbedaan dari metapardigma, filosofi,
model konseptual, dan teori (grand theory, middle range dan practice
theory).
• Pemahaman ini diperlukan sebelum saudara melakukan analisis pada
beragam teori yang berbeda tingkatannya.

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Komponen dan tingkat abstraksi
Contemporary Nursing Knowledge (Fawcett, 2005)

Komponen Tingkat abstraksi

Metaparadigm Most abstract

Philosophies

Conceptual models

Theories

Empirical indicators Most Concrete

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Pengertian Teori
• Teori adalah serangkaian bagian atau variabel, definisi, dan dalil yang
saling berhubungan yang menghadirkan sebuah pandangan sistematis
mengenai fenomena dengan menentukan hubungan antar variabel,
dengan maksud menjelaskan fenomena alamiah.
• Teori dibuat untuk menjelaskan sebuah fenomena seperti self care
(Fawcett, 2005)
• Contoh: perawat menggunakan teori Self Care Deficit Orem untuk
membantu klien mendapatkan perawatan

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• Dalam ilmu pengetahuan, teori berarti atau kerangka pikiran
yang menjelaskan fenomena alami atau fenomena sosial tertentu.
• Teori dirumuskan, dikembangkan, dan dievaluasi menurut
Teori juga merupakan suatu yang telah
terbukti .
• Manusia membangun teori untuk menjelaskan, meramalkan, dan
menguasai fenomena tertentu (misalnya, benda-benda mati,
kejadian-kejadian di atau tingkah laku manusia).
• Sering kali, teori dipandang sebagai suatu atas kenyataan
(misalnya : apabila kucing mengeong berarti minta makan).
• Sebuah teori membentuk generalisasi atas banyak pengamatan dan
terdiri atas kumpulan yang koheren dan saling berkaitan.

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Elemen Teori
• Di dalam sebuah teori terdapat beberapa elemen yang mengikutinya.
Elemen ini berfungsi untuk mempersatukan variabel-variabel yang
terdapat di dalam teori tersebut.
• Elemen teori:
1) konsep,
2) scope (cakupan)
3) hubungan (relationship)

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 Elemen 1: Konsep
• Sebuah ide yang diekspresikan dengan symbol atau kata.
• Konsep dibagi dua yaitu, simbol dan definisi.
• Dalam ilmu alam konsep dapat diekspresikan dengan simbol-simbol seperti,
”∞” = tak terhingga, ”m”= Massa, dan lainya.
• Mempelajari konsep dan teori seperti mempelajari bahasa. Konsep selalu
ada di mana pun dan selalu kita gunakan.
• Misalnya kita membicarakan tentang self care. Self care merupakan suatu
konsep, ia merupakan ide abstrak yang hanya di dalam pikiran kita saja.

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Elemen (1) Konsep
• DEFINISI KONSEP
• Dalam sebuah teori berhubungan dengan arti umum konsep
• Definisi konsep menggambarkan aktivitas penting untuk mengukur
konsep, hubungan atau variabel dalam sebuah teori (Tomey & Alligood,
2010)
• Contoh: definisi self care menurut Orem “the practice of activities that
maturing and mature persons initiate and perform, on their own behalf
in the interest of maintaining life, healthful functioning, continuing
persona ldevelopment, and well being through meeting known requisites
for functional and developmental regulations”

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Elemen 2: SCOPE
• Dalam teori seperti yang dijelaskan di atas memiliki konsep.
Konsep ini ada yang bersifat abstrak dan ada juga yang bersifat
konkrit. Teori dengan konsep-konsep yang abstrak dapat
diaplikasikan terhadap fenomena sosial yang lebih luas, dibanding
dengan teori yang memiliki konsep-konsep yang konkrit.
• Contohnya: Teori Self care deficit Orem (grand theory) yang lebih
abstrak dibandingkan dengan teori Comfort Kolcaba (mid-range
theory)

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Elemen 3: RELATIONSHIP
• Teori merupakan sebuah relasi dari konsep-konsep atau secara
lebih jelasnya teori merupakan bagaimana konsep-konsep
berhubungan. Hubungan ini seperti pernyataan sebab-akibat
(causal statement) atau proposisi.
• Proposisi adalah sebuah pernyataan teoritis yang memperincikan
hubungan antara dua atau lebih variabel, memberitahu kita
bagaimana variasi dalam satu konsep dipertangggung jawabkan
oleh variasi dalam konsep yang lain.
• Proposisi dalam suatu teori merupakan asumsi yang menjelaskan
sifat konsep, definisi, tujuan dan hubungan serta strutur teori.

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Analisis Teori
• Fawcett (2005) membedakan langkah2 untuk menganalisis model
konseptual dan teori
• Analisis model konseptual
Step 1 Origins of the nursing model
Step 2 Unique focus of the nursing model
Step 3 Content of the nursing model
• Analisis teori: memeriksa secara detail
1)Theory scope
2)Theory context
3)Theory content

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 Analysis of Nursing Models
• 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, rather than relying
on inferences about what might have been meant or by referring to
other authors’ interpretations of the nursing model.
• 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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Analysis of the Nursing Models

• Step 1 Origins of the nursing model

• Step 2 Unique focus of the nursing model
• Step 3 Content of the nursing model

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.

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 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?

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 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).
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 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?
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 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
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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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Analysis of Nursing Theories
According to Fawcett (2005), analysis of theory involves a
nonjudgmental, detailed examination of:
1) Theory scope
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:
 What are the concepts of the theory?
 What are the propositions of the theory?
 Which propositions are non relational?
 Which propositions are relational?

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 Theorists based on textbooks

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Based on Tomey & Alligood (2010; 2014)
• Nursing theorists of historical significance
• Philosophies
• Nursing Models (conceptual models)
• Nursing Theories
• Middle range theories

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Nursing theorists of historical significance
• Hildegard E. Peplau
• Virginia Henderson
• Faye Glenn Abdellah
• Ernestine Wiedenbach
• Lydia Hall
• Joyce Travelbee
• Kathryn E. Barnard
• Evelyn Adam
• Ida jean Orlando Pelletier

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Philosophies
• Florence Nightingale (Modern Nursing)
• 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)
• Karl 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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Penugasan Kelompok
• Mahasiswa akan mengerjakan tugas dalam kelompok
• Setiap kelompok akan menganalisis 2 teori yaitu 1 teori dari kategori
filosofi/model konseptual dan 1 teori dari kategori grand theory
/middle range theory
• Penetapan teori berdasarkan musyawarah/undian
• Kelompok menganalisis teori berdasarkan panduan Fawcett (2005)
untuk analisis model konsptual dan analisis teori
• Tuliskan hasil diskusi kelompok dalam bentuk makalah dan slides ppt
• Makalah dikumpulkan paling lambat sehari sebelum jadwal presentasi
• Tiap teori disajikan dalam 1 makalah yang terpisah ( 2 makalah/klp)
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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.
• Sumber internet lainnya yang relevan

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