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INTRODUCTION TO NURSING THEORY

L.ANAND,
Lecturer, College of Nursing,
NEIGRIHMS, SHILLONG
The systematic accumulation of knowledge is essential to progress in any
profession . . . however theory and practice must be constantly interactive.
Theory without practice is empty and practice without theory is blind.
( Cross, 1981 , p. 110).

I. INTRODUCTION

A. The foundation of any profession is the development of a specialized body of


knowledge
1. In the past, the nursing profession relied on theories from other disciplines,
such as medicine, psychology, and sociology, as a basis for practice.
2. For nursing to define its activities and develop its research, it must have its
own body of knowledge.
3. This knowledge can be expressed as conceptual MODELS and
THEORIES.
B. Nursing theories and models provide information about:
1. Definitions of nursing and nursing practice
2. Principles that form the basis for practice.
3. Goals and functions of nursing
4. Clarifies the scope of nursing practice.
C. Nursing theories and models are derived from concepts
(i) Concept is an idea of an object, property, or event.
(ii) Concepts are basically vehicles of thought involving mental images.
(iii) In Nursing, concepts have been borrowed from other discipline (adaption,
culture, homeostasis) as well as developed directly from nursing practice
and research (maternal-infant boding, health-promoting behaviours).
(iv) Concepts are building blocks of theory.

Types of concepts:
1. Empirical or concrete concepts: These are directly observable objects,
events, or properties, which can be seen, felt or heard e.g color of the skin,
communication skill, presence of lesion, wound status etc., These are limited
by time and space (it can be viewed/measured only specific period & specific
setting and variable).
2. Inferential concepts: These are indirectly observable concepts, e.g pain,
Dyspnea and temperature.
3. Abstract Concepts: These concepts are not clearly observable directly or
indirectly (known as Non -observable concepts directly).E.g. social support,
Personal Role, Self-esteem etc.
Most of the theories use abstract concepts and it should be defined as
observable (concrete) concepts when applied in research, education
and practice. In simple terms, we transform the abstract concepts to
concrete concepts based on local need.
Abstract concepts not affected by time and space. It can be applied and used
wider settings and populations.
D. Propositions:
Propositions are statements that explain the relationship between the
concepts.

II. THEORIES
A. General information
1. Are a set of logically interrelated concepts that provide a systematic
explanatory and predictive view of phenomena
2. Can begin as an untested premise (hypothesis) that becomes a theory
when tested and supported or can progress in a more inductive manner
3. Are tested and validated through research and provide direction for this
research
4. Nursing theory is a framework designed to organize knowledge and explain
phenomena in nursing.

B. Characteristics
1. Must be logical, relatively simple, and generalizable.
2. Are composed of concepts and prepositions.
3. Interrelate concepts to create a specific way of looking at a particular
phenomenon.
4. Provide the bases for testable hypotheses.
5. Must be consistent with other validated theories, laws, and principles but
have open unanswered questions for investigation.
6. Can consist of separate theories about the same phenomenon that
interrelate the same concepts but describe and explain them differently.
7. Can describe a particular phenomenon (descriptive or factor-isolating
theories) explain relationships among phenomena (explanatory or
factor-relating theories); predict the effects of one phenomenon on
another (predictive or situation-relating theories); or be used to
produce or control a desired phenomenon (prescriptive or situationproducing theories)
8. Contribute to and assist in increasing the general body of knowledge within
a profession through research implemented to validate them.
9. Can be used by nurses to guide and improve their practice.
10. Differ from conceptual models; both can describe, explain, or predict a
phenomenon.

But only theories provide specific direction to guide

practice; conceptual models are more abstract and less specific than
theories but can provide direction for practice.
11. Facilitate communication and systematic thinking among nurses regarding
professional convictions, moral/ethical structure to guide nurses actions,
12. It facilitates coordinated and less fragment care.
13. The main exponent of nursing caring cannot be measured, it is vital to
have the theory to analyze and explain what nurses do.

II. MODELS
Conceptual Model is a set of interrelated concepts that symbolically
represents of mental image or phenomenon. Model deals with highly abstract
concepts than theory.

A. General information
1. Describe a set of ideas that are connected to illustrate a larger, more
general concept
2. Are a symbolic depiction of reality
3. Provide a schematic representation of some relationships among
PHENOMENA
4. Use symbols or diagrams to represent an idea

B. Characteristics
1. Attempt to describe, explain, and sometimes predict the relationships
among phenomena.
2. Are composed of empirical, inferential, and abstract concepts.
3. Provide an organized framework for nursing assessment, planning,
intervention, and evaluation.
4. Facilitate communication among nurses and encourage a unified approach
to practice, teaching, administration, and research.

Conceptual models and theories in nursing are based on the nursing


metaparadigm

III METAPARADIGM
Conceptual models and theories in nursing are based on the nursing
metaparadigm. Metaparadigm is the most global conceptual or philosophical
framework of a discipline or profession
1. It defines and describes relationships among major ideas and values.
2. It guides the organization of theories and models for a profession.

A. The nursing metaparadigm comprises four concepts : person, environment,


health, and nursing.
1. Person refers to the recipient of nursing care, including physical. mental
and social.
2. Environment refers to all the internal and external conditions,
circumstances, and influences affecting the person
3. Health refers to the degree of wellness or illness experienced by the
person
4. Nursing refers to the actions, characteristics, and attributes of the
individual providing the nursing care.

IV. CLASSIFICATION OF NURSING THEORIES


Nursing theories can be classified based on range/scope or abstractness,
purpose of the theory, and philosophical underpinnings.
A. Based on range/scope/generalization and level of abstractness:
1. Metatheory :
It refers to theory of theories.
Characteristics of Metatheory:
(i) Focus on generating Knowledge and theory development.
(ii) Focus on philosophical issues and methodological issues of nursing
theory.
(iii) Focus on developing criteria for analysis and evaluating nursing theory.
Example of Metatheory- J.Dickoffs and P.Jamess Theory of Theories
2. Grand Theories:
Grand theories are the most complex and broadest in scope.
Characteristics of Grand theories:
(i) Focus on broad and general areas and concepts.
(ii) It deals with nonspecific and relatively abstract concepts.
(iii) Concepts mentioned in grand theories lack operational definitions.
(iv) Grand theories are not directly amenable to testing.
(v) These can be used in variety of setting and populations.
Example of Grand theories- Orem, Roy, Rogers

3. Middle RangeTheories:
Middle-range theories target specific phenomena or concepts, such as
pain and stress; they are limited in scope yet general enough to encourage
research. It deals with concrete and relatively operational concepts and
amenable to empirical testing. These theories are highly specific to nursing.
These theories are relatively simple to understand and apply.
Characteristics of Middle Range theories:
These are characteristics of good mid-range theory as described by Whall(1996):
(i)

Its concepts and propositions are specific to nursing;

(ii)

it is readily operationalized;

(iii) it can be applied to many situations;


(iv) propositions can range from causal to associative, depending on their
application; and
(v)

Assumptions fit the theory.

(vi) It should be relevant for potential users of the theory, i.e. nurses; and
(vii) It should be oriented to outcomes that are important for patients, not merely
describe what nurses do.
(viii) It should describe nursing-sensitive phenomena that are readily associated
with the deliberate actions of nurses.
Example: Benner Model of skill acquisition in Nursing.Corbin and strauss
Chronic illness trajectory framework
4. Practice Theories/Micro theories/prescriptive theories:
Practice theories are narrowly defined; they address a desired goal and
the specific actions needed to achieve it.
Characteristics of Practice theories:
(i)

Least complex in nature.

(ii)

More specific than middle range.

(iii)

Provides specific directions.

(iv)

Limited to specific populations.

(v)

Often use of knowledge of other discipline.

(vi)

Specific to population and setting (oncology,obg).

(vii)

Cannot be applied in all setting.

Comparison of Grand, Middle Range And Practice Theories

Characteristic

Grand Theories

Middle-Range
Theories

Practice Theories

Complexity/
abstractness,
scope

Comprehensive, global
view point (all aspects
of human experience)

Less comprehensive
than grand theories,
middle view of reality

Focused on a narrow
view of reality, simple
and straightforward

Generalizibility/
specificity

Nonspecific, general
application to the
discipline irrespective
of setting or specialty
area

Some generalizablity
across settings and
specialities, but more
specific than grand
theories

Linked to special
populations or an
identified field of
practice

Characteristics
of concepts

Concepts abstract and


not operationally
defined

Limited number of
concepts that are fairly
concrete and may be
operationally defined

Single, concrete
concept that is
operationalized

Propositions not always


explicit

Propositions are
clearly stated

Propositions defined

Not generally testable

May generate testable


hypotheses

Goals or outcomes
defined and testable

Developed through
thoughtful appraisal
and careful
consideration over
many years

Evolve from grand


theories, clinical
practice, literature
review, practice
guidelines

Derived from practice


or deduced from
middle-range or
grand theory

Characteristics
of propositions
Testability

Source of
development

B. Based on Philosophical Underpinnings:


I. Developmental theories and models emphasize growth, development, and
maturation
1. The primary focus is change in a particular direction.
2. This change is orderly and predictable, occurring in specific stages, levels,
or phases.
3. The goal is to maximize growth.

II. Systems theories and models view persons as open systems


1. Each open system can receive input from the environment, process it,
provide output to the environment, and receive feedback while maintaining
a dynamic tension of forces
2. Each system strives for a steady state (balance between internal and
external forces)
3. The goal is to view the whole rather than the sum of the parts.
III. Interaction theories and models are based on the relationships among
persons
1. The primary focus is on the person as an active participant.
2. Emphasis is on the persons self-concept, and ability to communicate and
perform roles.
3. The goal is achievement through reciprocal interaction.
C. Based on Purposes of theory:
I. Descriptive Theories
II. Explanatory Theories
III. Predictive Theories
IV. Prescriptive Theories

V. HISTORICAL PERSPECTIVE
A. 1860 to 1959
1. In 1860, Florence Nightingale developed her Environmental Theory.
2. In 1952, the journal Nursing Research was established, encouraging
nurses to become involved in scientific inquiry.
3. In the same year, Hildegard Peplau published Interpersonal Relations in
Nursing; her ideas have influenced later nursing theorists.
4. In 1955, Virgina Henderson published Definition of Nursing.
5. In the mid-1950s, Teachers College, Columbia University, New York City,
began offering masters and doctoral programs in nursing education and
administration, resulting in student participation in theory development and
testing.

B. 1960 to 1969
1. During the 1960s, Yale University School of Nursing, New Haven, Conn.,
defined nursing as a process, interaction, and relationship.
2. Also during the 1960s, the U.S. government began funding masters
doctoral education in nursing.
3. In 1960, Faye Abdellah published Twenty-One Nursing Problems.
4. In 1961, Ida Orlando published her theory in The Dynamic Nurse-Patient
Relationship: Function, Process, and Principles of Professional
Nursing.
5. In 1962, Lydia Hall published Core, Care, and Cure model.
6. In 1964, Ernestine Wiedenbach published her theory in Clinical Nursing:
A Helping Art
7. In 1965, the American Nurses Association published a position paper
stating that theory development was an important goal for nursing.
8. In 1966, Myra Levine published Four Conservation Principles.
9. In 1969, Dorothy Johnson published Behavioral Systems Model.

C. 1970 to 1979
1. During the 1970s, Case Western Reserve University, Cleveland,
sponsored symposia to stimulate theory development.
2. During the mid 1970s, the National League for Nursing established an
accreditation requirement that nursing schools base their curricula on a
nursing conceptual framework.
3. In 1970, Martha Rogers published her model in An Introduction to the
Theoretical Basis of Nursing.
4. In 1971, Dorothea Orem published Self-Care Deficit Therory of Nursing,
Imogene King published Theory of Goal Attainment, and Joyce
Travelbee published Interpersonal Aspects of Nursing.
5. In 1972, Betty Neuman published Health Care Systems Model.
6. In 1976, Sister Callista Roy published Adaptation Model.
7. In 1976, J.G.Paterson and L.T.Zderad published Humanistic Nursing.

8. In 1978, Madeleine Leininger published Humanistic Nursing.


9. In 1979, Jean Watson published Nursing: Human Services and Human
Care - A Theory of Nursing.

D. 1980 to the present


1. In 1980, Evelyn Adam published To be a Nurse and Joan Riehl-Sisca
published Symbolic Interactionism
2. In 1982, Joyce Fitzpatrick published Life Perspective Model.
3. In 1983, Kathryn Barnard published Parent-Child Interaction Model and
Helen Erickson, Evelyn Tomlin, and Mary Ann Swain published Modeling
and Role Modeling.
4. In 1984, Patricia Benner published from Novice to Expert: Excellence
and Power in Clinical Nursing Practice.
5. In 1985, Ramona Mercer published Maternal Role Attainment.
6. In 1986, Margaret Newman published Model of Health.
7. In 1994, Parish Nursing Model:proposed by Bergquist and King.
8. In 1994,Rogers proposed Occupational Health Nursing Model
9. In 1997, Barbara Artinian and Margarnet Conger published The
intersystem Model: Integrating Theory and Practice

Conclusion:
The development of nursing theories and models is a relatively recent
occurrence. The nursing profession has not reached a consensus on the
meaning and interpretation of concepts, theories, and models. A lack of
consensus also exists whether a single model or theory should be selected or
whether multiple models and theories are more useful to nursing practice.
Areas of agreement among theorists include the importance of the four
concepts of person, environment, health, and nursing; the goal of enhancing
client comfort; a holistic approach of nursing; and a set of distinct values of
nursing. Nursing should have knowledge base like other discipline.