INTRODUCTION TO

NURSING THEORIES
Unit -1-2-3
BSN 4 years Program
Zafar Iqbal Baloch
Chief Nursing Superintendent /Senior
Lecturer
Jinnah Medical College Hospital
Karachi Pakistan

Objective

Define the theoretical framework and explain how

to develop and what is its importance and
contribution to research
Define the nursing theory, list its component/
element, how to develop / stages, List the
characteristics and explain the scope/ uses of
nursing theory
Define the terminology used in theory development
Explain the different types / categories and discuss
the framework to Analyze the Nursing theory
What is Importance of nursing theories in clinical
practice and overview of nursing process
Describe the historical development different types
of theories and examples of each.

Conceptual or
Theoretical Framework
A brief explanation of a theory
or those portions of a
theory to be tested in a study

Theoretical Framework
It provides a context for examining a problem
i.e. theoretical rationale for:
Developing hypotheses
A frame of reference/base for
Observations
Definitions of concepts
Research designs
Interpretations
Generalizations
Serves as a guide to systematically identify
logical, precisely defined relationships among
variables

Conceptual Frameworks
Common in Nursing

Health Locus of Control

Health Belief Model
Coping (Lazarus)
Stress (Selye)

Conceptual
Models/Frameworks
Figure 1. Conceptual Framework of Outcomes of ICU Working Conditions

Xj

Xi

Patient Safety

Working Conditions
Staffing Ratios
Organizational
Turnover
Climate
Wages

Costs

HCW Safety

Xi =Patient Characteristics, Xj =Setting Characteristics, L=Nurse Labor Market

How to Develop a
Theoretical Framework

1. Select concepts

a concept is an image or symbolic representation of

an abstract idea. e.g. health, pain, intelligence

2. Identify the interrelationships among

concepts
A relationship may be:
a. rigid = scientific law e.g. laws of motion
No known contradiction has been observed
b. tentative or questionable = relationship that
does not convey truth or falsity
Laws and hypotheses are types of
propositions

How to Develop a
Theoretical Framework
3.Formulating definitions: to develop a theoretical
framework that can generate and test hypotheses,
concepts must be clearly defined
A.Conceptual definition conveys the general
meaning of the concept
B.Operational definition adds another dimension to
the conceptual definition by delineating the
procedures or operations required to measure the
concept
Some concepts are easily defined in operational terms,
e.g. pulse, other concepts are more difficult to define
operationally, e.g. coping

4. Formulating the theoretical

rationale
Through the literature review, an investigator
becomes aware of or confirms identified
theoretical connections between variables
In evaluating the formulation of the theoretical
rationale, the internal structures, such as
concepts and their definitions, should have
clarity and continuity, and the approach to
understanding phenomena, whether
inductive or deductive, should be logical

Importance and
Contribution of
Frameworks
toplays
Research
The
theoretical framework
an important
role in guiding the entire process of the
research study
If the framework is logically sound and
substantiated by previous research studies,
there is a strong possibility that the
predictions or hypotheses developing from
that framework will be supported.

In some cases, a theoretical rationale in

inappropriately used. e.g. a theory is designed to
explain a particular behavior in infants may not be
appropriate for the study of those behaviors in
adults

Importance and
Contribution of
Frameworks
to
Research
When developing a theoretical
framework for nursing research
studies, knowledge is acquired
through:
Disciplines other than nursing and
rented for the purpose of answering
nursing questions
Identifying and asking questions about
phenomena that are unique to nursing

Importance and
Contribution of
Frameworks to Research
Theories unique to nursing help nursing
define how it is different from other
disciplines
The central phenomena of interest to
nursing are persons, environment,
health & nursing

What is a theory?
Group of related concepts that propose
actions that guide practice
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

What is a theory?
A set of concepts, definitions,
propositions relationships, and
assumptions that project a systematic
view of a phenomena by creating a
interrelationship among the concepts
for explaining, describing and predicting
It is system of idea to explain the
phenomena

Components/Elements of
theory

Components/Elements of
theory

Components/Elements of
theory

Process of Knowledge
Development

Theory Development
Nursing theory isa framework designed to
organize knowledge and explain phenomena
in nursing, at a more concrete and specific
level.
Theory-guided, evidence-based practice . It
is the hallmark of any professional discipline
Each discipline has a unique focus for
knowledge development that directs its
inquiry and distinguishes it from other fields
of study.(Smith & Liehr, 2008).

Theory Development
Induction form of
reasoning that move
from specific to general
a series of particulars is
combined into larger
whole
The logical process of
establishing a general
proposition on the basis
of observation of
particular facts.
Read chapter 4 logical
Reasoning

Deduction Is a
form logical reasoning
that progress from
general to specific
The logical process of
deriving a conclusion
from a known premise
or something known
to be true
Retroduction
combine induction
and deduction

How does a theory

develop?

Four strategies of theory

development
1. Theory
practice theory ( theory
developed in other discipline and
used in nursing situations)
2. Practice theory
evolved from clinical practice

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.

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

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.

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.

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

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.

Characteristics of a
Theory

1. Systematic, logical and coherent

(orderly reasoning, no contradictions)
2. Creative structuring of ideas
mental images of ones 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)

Uses of theory
Theory guides and provide knowledge
to improve nursing practice by
describing ,explaining , predicting and
controlling the phenomena
Theoretical knowledge increased the
chance of success of nurses
Theory provides goal for nursing care
and with goals, nursing practice is
rendered more effective and efficient.

Uses of theory
Theories help to focus the goals,
making nurses more confident about
the practice.
Theory guides research. It validates
and modifies the theory.
Theory contributes to the
development of the disciplines body
of knowledge
Theory enhances communication

Commonly used nonnursing theories

Systems theory
Basic Human Needs theory
Health and Wellness Models
Stress and Adaptation
Developmental Theories
Psychosocial Theories

Purposes of nursing
theory

What are the purposes

of nursing theory?

1.Education -Nursing theory was used

primarily to establish the professions place
in the university.
2. Research-Nursing research identifies the
philosophical assumptionsor theoretical
frameworks from which it proceeds.
-new theoreticalperspectives provide an
essential service by identifying gasps in the
way we approach specific fields of study
such as symptom management or quality
of life

Why on earth do we
study nursing theory?

3. Practice theprimary contribution of

nursing theory when employed in a
clinical setting is the facilitation
ofreflection, questioning, and thinking
about what nurses do.-nursing theory is a
useful tool for reasoning, critical thinking,
and decision making in nursing practice.
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

Terms/ Concepts in
nursing theory
development

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

Terms/ Concepts in
nursing theory
PARADIGMdevelopment
A model that explains the linkages of
science, philosophy, and theory accepted
and applied by the discipline (Alligood and
Marriner Tomey, 2002)
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

Terms/ Concepts in
nursing theory
development

Nursing has identified its domain

in a paradigm that includes four
linkages:
1) person/client
2) health
3) environment
4) nursing

Terms/ Concepts in
nursing theory
development
Person- Recipient of care, including
physical, spiritual, psychological, and
sociocultural components.
Individual, family, or community
Environment- All internal and external
conditions, circumstances, and
influences affecting the person
Health- Degree of wellness or illness
experienced by the person
Nursing- Actions, characteristics and
attributes of person giving care

Terms/ Concepts in
nursing theory
development
PhilosophyKnowledge level which specifies the
definitions of the Metaparadigm concepts in each
of the conceptual models of nursing.
Metatheory - Theory of theories Focus on
generating knowledge and theory development
Philosophical issues and methodological issues
Model Graphically shows the interrelationships
of the concepts and relational statements
A model is an idea that explain by using
systematic and physical visualization it may be
verbal ( word statements) ,schematics (diagram )
and quantities (mathematical symbols)
Conceptual models - Are made up of abstract
and generalized ideas (concepts)and propositions
that specify their relationship. It is systematic
approaches to the phenomena with which the
discipline is concerned.

Terms/ Concepts in
nursing theory
Theoreticaldevelopment
statements Describe the relationship

between two or more concepts for example

hypothesis is the relationship statement to be tested
Nightingale is considered philosophical approach
Phenomenon aspect of reality that can be
consciously sensed or experienced (Meleis, 1997).
Any occurrence or fact that is directly perceptible
by the senses . Is reality on what is exist in the real
world
Construct- a phenomena that cannot be observed
and must be inferred. Constructs are concepts
developed or adopted for use in a particular theory.
The key concepts of a given theory are its constructs.
Fact- fact- is something known with certainty

Terms/ Concepts in
nursing theory
Researchdevelopment
- Research is the application of

systematic methods to obtain reliable

knowledge and valid knowledge about
empirical reality research may generate
theory with an inductive approach or test
by deductive approach
Science is observation identification
,description , experimental investigation
and theoretical explanation of the
phenomena. it is body of knowledge
Knowledge knowledge is awareness or
perception of reality acquired through
learning or investigations

Terms/ Concepts in
nursing theory
development
Variables- Variables are the

operational forms of constructs. They

define the way a construct is to be
measured in a specific situation. Match
variables to constructs when identifying
what needs to be assessed during
evaluation of a theory-driven program.
A hypothesis is a proposition that is
empirically testable. It is an empirical
statement concerned with the
relationship among variables

Types of theories

According to range
- Grand theory
Middle range theory
Micro theory

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.
Hendersons The Nature of Nursing ;
Levines The Four Conservation Principles
of Nursing, Roys Adaptation Model, and
Orems Self-Care (Marriner-Tomey)

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.

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.
Peplaus Psychodynamic Nursing and
Orlandos Nursing Process Theory

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

According to Orientation or focus

of the theory
1. Client centered: Nightingale,
Henderson
2. Client-nurse dynamics: Watson
3. Client-nurse environment :
Leininger

Categories of nursing
theories

client

nurse

`
environme
nt

Client centered theory

1. 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,Ore
m,Pender, Roy, Levine, Hall.

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

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.

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

Framework to Analyze
the Nursing theory
III. Key concepts unique to the theory.
Some theories have several key
concepts and it may have subconcepts.

The study and use of nursing

theory in nursing practice must have
roots in the everyday practice of
nurses (Gordon, Parker, and Jester,
2001).

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

Importance of nursing
theories in clinical
Nursing theories provide
a framework for thought in which
practice
to examine situations. As new situations are encountered,

this framework provides a structure for organization,

analysis, and decision making.
Nursing theories provide a structure for communicating with
other nurses and with other members of the health care
team.
Nursing theories assist the discipline of nursing in clarifying
beliefs, values, and goals, and they help to define the
unique contribution of nursing in the care of clients.
Ultimately we get control over our profession
Professional nurses use theories from nursing and from the
behavioral sciences to collect, organize, and classify patient
data and to understand, analyze, and interpret patients'
health situations.

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)

How do student nurses

begin to use nursing
theory?
By asking yourself two very
important questions..

Student Nurse Questions

What is the nature
of knowledge
needed for the
practice of nursing?

What does it
mean to me to
practice
nursing?

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

Current trends that

influence nursing theory
Medical science
Nursing education
Professional nursing organizations
Evolving research approaches
Global concerns
Consumer demands
Technologies

Overview of Nursing
Process

Theory Development in
Nursing: Historical
Overview
Descriptive theories first level of
theory development
Prescriptive theories address nursing
interventions and predict their
consequences

Where do I begin?
Florence Nightingale
- Considered first modern nursing theorist
Her philosophy of health, illness, and the
nurses role in caring for patients
Focused on the relationship of patients to
their surroundings.

- 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

Historical Development
of Nursing Theories:
Significant Events

Nightingale until the 50s

Florence Nightingale Notes on Nursing
((1969, originally published in 1859)
control of the environment to care for the
individual (ventilation, light, warm , noise
absence or reduction, cleanliness & diet )
1952 Nursing Research Journal publication
1960s nature of nursing practice was
debated, defined nursing practice, or
develop nursing theory, and created a
substantive body of knowledge

Historical development
1960-1970 proliferation of
conceptual models and frameworks,
and philosophy of nursing.
Examples: Abdellah 21 nursing
problems and Halls Core, care and
cure (person,body,disease)
1969 first conference on nursing
theory

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

First Conference in Nursing

theory
Brought leading scholars and
theorists to discuss and debate
on issues regarding nursing
science ad theory development.

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

Historical Development
1980s 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.

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.

Maslows Hierarchy of
Needs

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

Dorothea Orem
Self-Care Deficit Theory of Nursing
Theory of Self-Care
Theory of Self-Care Deficit
Theory of Nursing Systems

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.

Roy Adaptation Model

The goal of nursing is the promotion
of adaptation in each of four
adaptive modes.
Physiologic
Self-concept
Role function
Interdependence

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

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.

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.

Gordons Functional
Health Patterns
Influenced by Maslows Hierarchy of
Basic Human Needs and Von
Bartlaffnys 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.

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.

3-84

Copyright 2004 by Delmar Learning, a

division of Thomson Learning, Inc.

Acknowledgement
Prof. Dawn Capaque
MIT, San Lorenzo Ruiz School of Health Sciences
Delmar Learning, a division of Thomson Learning, Inc2004
Faculty.mercer.edu/stewart_dj/Web