EVIDENCE - BASED

THEORETICAL
NURSING
Basis for Professional
Nursing
OBJECTIVES:
n to show the relationship and
importance of evidenced-based
theoretical nursing in developing
the curriculum and activities
of nursing schools here in the
Philippines.
n To discussthe application of
nursing theories in academic
and clinical management .
 JOURNEY TO NURSING
THEORIES (Activity)
By Pairs: Interview Method
Ask your partner these questions:

1.As an undergraduate student, can you easily

recall 5 nursing theorists and their theories?
2.Choose 1, describe the concepts.
3.Were you able to use this theory either
personally or professionally?
4.If yes, please describe the occasion.

NURSING THEORIES THAT CAN
BE APPLIED IN THE ACADEME
n Background:
n First reaction to Theoretical Foundations in
Nursing:

UGH!
Why? The Journey is Long and
Winding
n STAGES IN NURSING PROGRESS

THEORY
Stage 1: PRACTICE
What DEVELOPMENT THEORIST ho?
 Aimed to define nursing and FLORENCE NIGHTINGALE
identify (WESTERN WORLD)
goals
 Organization of women to take

care
of wounded soldiers RUFAIDA SAAD AL-
ASLAMIYA
 establishment of formal (EASTERN WORLD)
education
and training for nurses, code of
ethics, advocated for
alleviation of
suffering and promotion of
 Stage 2: EDUCATION AND
ADMINISTRATION

What ? Who?
 Aimed to IMPROVE definition of VIRIGINIA HENDERSON
nursing and added HOW TO
practice nursing (1966)
 Definition of the different levels of 14 Nursing Needs
nursing education
 different from medical profession
Stage 3: RESEARCH
What ? Who?
 Overlapped with the first two 1948: Division of Nursing
stages Research
 started as case studies (1920) 1952: First Nursing Research
 Objectives of research were Journal
focused on: 1970: Commission and Council
a. Improving nursing of
education Nurse Researchers
b. Embracing research 1977: Research on how to teach,
productivity administer, and lead
c. Raising quality of schools
graduates Gortner and Nahon, 1977)
1980: Focus on scientific syntax
(influenced by Kuhn)
Stage 4: THEORY
What ? Who?
 Aimed at finding essence and Theory Think Tank

mission of nursing in an
organized Overwhelming and too abstract

way Example: Martha Rogers

Acceptance of the following: “Science of Unitary Human
1. nursing is complex that Being”
requires body of knowledge
(theories)  Simplistic and reductionist

2. Nursing is an Dorothea Orem (1971)

autonomous “Nursing Care Deficit Nursing
profession. Concepts/ Theory”
theories needed to
support
 Why? Milestones in Theory
Development in Nursing
PERIOD DESCRIPTION
BEFORE 1955 From FN to Research Stages
1955 – 1960 Birth of Nursing Theory
Columbia University Teachers College
Abdellah, Peplau, Rogers, Henderson, Hall, Wiedenbach
1961 - 1965 Theory: A National Goal for Nursing
1966 - 1970 Theory Development: A Tangible Goal for
1971 - 1975 Academics
Theory Syntax: Metaparadigm of Nursing
1976 - 1980 A Time to Reflect
1981 - 1985 Nursing Theories Revival : Emergence of
Domain
1986 - 1990 From meta theory to concept development
Concepts
1991 – 1995 Mid-Range and Situational Theories
1996 - 2000 Evidence Based Research
2001 – 2005 Diversity in thought: Linking Theory and
Practice
Furthermore, the Journey is
Complicated.
n Survey of McEwen (2000) :
 1. books were dated
 2. too focused on Grand Theories
 3. too theoretical

In Practice, many questions remain
unanswered. Uncomfortable.
In the academe, the noise competes with
acquisition of knowledge.
How will they relate?
McEwen (2006) Recommendations:
n 1. emphasis on Middle Range Theories
 and more modern ones. Grand Nursing
 Theories as knowledge foundation
 2. teach and practice evidence –based
 nursing linked to research
 3. organize text according to Nursing
 language
 4. complement nursing theories with
 borrowed theories used in Nursing
1. FOCUS ON MRT AND
MODERN THEORIES
n Use the classification as guide
COMPARISON DIAGRAM
THEORY
 Level of Abstraction


Meta theory MOST

Grand Theories

Mid-range theories

Practice theories LEAST

CLASSIFICATION OF
THEORIES IN NURSING
n Tomey and Alligood (2002)
 Scope of THEORETICAL WORKS:
 1. Philosophies: based on analysis,
 reasoning, and logical arguments
 Nightingale, Wiedenbach, Henderson,
 Abdellah, Hall, Watson, Benner

CLASSIFICATION OF
THEORIES IN NURSING
n Tomey and Alligood (2002)
 Scope of THEORETICAL WORKS
2.Grand Theory – comprehensive and
include their perspectives, usually
developing from their own model
 Example: Person as An Adaptive
System Theory from Adaptation Model by
Roy
2.
GRAND NURSING THEORIES
n Historical Background
n Focus on greatest contribution to nursing
n Just enough knowledge to whet readers’
 appetite, unless the students’ will
 pursue studies
FOCUS: THEORIES IN
NURSING
n Tomey and Alligood (2002)
 Scope of THEORETICAL WORKS:
 3. Middle –Range Theories focus on
 specific phenomena in the middle
 of a continuum between GNT and
 SITUATION BASED THEORIES
 Example: Kolcaba
 CLASSIFICATION OF THEORIES
BASED ON RANGE, SCOPE AND
ABSTRACTNESS
n
n Peterson (2004)
 1. Meta theory, Philosophy, or Worldview
 2. Grand Theory or Macro theory
 3. Middle Range or Mid-range*
 4. Micro theory, situation-specific theory or
 practice theory*
 5. Partial Theory or in the development
stage
RELATIONSHIP AMONG
LEVELS OF THEORY
SUPPORTS

REFINES

TESTS
IN
PRACTICE

Walker and Avant (2005) Strategies for Theory Construction

 CLASSIFICATION OF
THEORIES IN NURSING
n 3 Major Groups:
 1. human needs
 Nightingale, Henderson, Abdellah,
 Orem, Johnson, Neuman
 2. interactive process
 Levine, Artinian, Erickson, Tomlin, Swain
 King, Roper, Logan, Tierney, Roy,
Watson
 3. unitary process
 Rogers, Newman, Parse
CLASSIFICATION BASED ON
PURPOSE
n Dickoff and James (1968)
 1. descriptive (factor –isolating)
 2. explanatory (factor-relating)
 3. predictive (situation relating )
 4. prescriptive (situation producing)
Note: level of development is progressive.
CLASSIFICATION BASED ON
PURPOSE
DESCRIPTIVE –Factor Isolating
PURPOSE: DESCRIPTION AND
OBSERVE, DESCRIBE, EXAMPLES:
IT DOES NOT EXPLAIN HOW
NAME OR WHY THE CONCEPTS
CONCEPTS, PROPERTIES, ARE RELATED
AND
DESCRIPTIONS Examples:
KIDNER, FLANDERS-
PURPOSE: TO PROVIDE STEPANS
MEANING (2004)
AND OBSERVATIONS Descriptive model of mothers
whose pregnancies were
GENERATED AND TESTED complicated with HELLP
BY DESCRIPTIVE syndrome (hemolysis, elevated
RESEARCH TECHNIQUES liver enzymes, low platelets)
INCLUDING:
EXPLANATORY
(FACTOR RELATING )
It does DESCRIPTION AND
EXAMPLES
Relates concepts with one Examples:
another
Mc Carley(1999) Chronic
Describe interrelationships Dyspnea

Cause and Effect and Haight, Barba, Tesh, Courts

correlations (2002) Thriving Model (Failure
Developed by Correlational to Thrive in elderly)
Research
Fawcett(1999) These models need additional
research and developments
PREDICTIVE OR SITUATION
RELATING
It does: Description and examples
Conditions under which Dirksen (2000) Prediction of
concepts are related, and the Well being among Breast Cancer
relational statements are able to Survivors
describe future outcomes (Reosurcefulness, Social Support,
consistently Self
Esteem)
Prediction of precise
relationships between concepts Smith et al (2002) Caregiving
Effectiveness Model
Relatively difficult to find in (Characteristic of caregiver,
nursing literatures interpersonal interactions
between patient and caregiver,
educational preparenedness, and
adaptive factors such as economic
PRESCRIPTIVE OR SITUATION
PRODUCING
It does:
Precribe activities necessary THE MOST DIFFICULT TO
to reach defined goals
Address nursing therapeutics
and consequences of
interventions
They describe the type of
client, the conditions, the
prescription and the
consequences
Meleis ( 2005)
Description and Examples
IDENTIFY INNURSING
LITERATURES.
Novak (1997). Middle Range
Theory on
CHRONOTHERAPEUTICINTE
RVENTION FOR POST
SURGICAL PAIN. It used a
time dependent approach to pain
assessment and provides directed
nursing interventions to address
post op pain.
CATEGORIZATION BASED ON
NURSING DOMAINS
n Meleis(2004)
1. Nursing clients: Johnson, Roy, Newman

2. Human being-environment interactions

 Rogers
3. Interactions : King, Orlando, Travelbee

4. Nursing therapeutics: Levin , Orem

 .
II. Teach and practice according to
evidence –based research
PRINCIPLES:
1.Clinical experience
2.Experiences
3.Conceptualization about KNOWLEDGE
 patients’ responses and
 experiences
4. KNOWLEDGE is existing and needs to be

discovered.
THE EVIDENCE BASED JOURNEY IS
DAUNTING… BUT WORTHWHILE
1.HUMAN BARRIERS
“Nurses as Nurses”

n Service orientation vs professionalization

n Today, financial potential and career growth
overshadows the goals of nurses to
make a difference in nursing profession
n
THE EVIDENCE BASED JOURNEY IS
DAUNTING… BUT WORTHWHILE
Cont. 1. HUMAN BARRIERS
 “Nurses are Nurses”
n Attitudes of students are changing as
changes occur in the spheres of life
n More nurses seeking Graduate Degrees
n More male joining nursing



THEORIES AND NURSING
EDUCATION
n Before: Nurses are trained to be passive
handmaidens of physicians, executors of
 Doctor’s orders, implementers of
hospital
 policy
n Today: Nurses plays a major role in
training the mind to think beyond
immediate action, to question situations,
to link events, to generalize and
conceptualize.
 THEORIES AND NURSING
EDUCATION
Before
Nurses are dependent on hospital Autonomous, uses own problem
and medical system
Nurses do procedures and train
as “socialized intellectual
subordinates” in the hospital
setting. Hospitals improve
patient care and increase
savings.
Present
solving, critical thinking, uses
own theory, debate on nursing
issues
Nurses are trained in universities
using its own standards, base of
knowledge, competencies and
skills

HOWEVER: However:
REWARDS are given in clinical No standards of rewards which
practice and teaching, but not in may be due to lack of
THE EVIDENCE BASED JOURNEY IS
DAUNTING… BUT WORTHWHILE
2. KNOWLEDGE BARRIER
Our discipline status is based on scientific

foundations. THE THEORIES! (Meleis, 2005)

However, discipline cannot be installed only

academically with the use of theories in

curricula (Fawcett, 1999)
Theories must be developed through asking and

answering significant questions of profession

and discipline (Tomey and Alligood, 2006)

2. KNOWLEDGE BARRIER
n What is the central goal of nursing related
to the use of the theories?
KNOWLEDGE BARRIERS
n CONCLUSION:
 There is a need for nursing theories to drive
development of knowledge in daily
responses, activities, lives of patients such
as eating, sleeping, mobility, relating etc.
 This can be supplemented by borrowed
theories.
THE EVIDENCE BASED JOURNEY IS
DAUNTING… BUT WORTHWHILE
3.CONCEPTUAL BARRIERS
 In the past, there seems to be a close
gate
 that prevent nurses from developing and
 perceiving nursing phenomena. This is
referred to as PERCEPTUAL BLOCKS
(Adams 1974)
FORMS OF
CONCEPTUAL BARRIERS
1.Difficulty delineating a phenomenon that is
worthy of pursuance theoretically
 a. Unable to perceive meaningful clues
 b. Focus on tangential issues
2.Use of comfortable boundaries on a
phenomenon
 a. Societal expectations
 b. Non-compliance/ Lack of diagnostics
3. Lack of experience. Seeing the world in

medical models.
III. Organize text according
to Nursing language
CATEGORIZATION BASED ON
PARADIGMS
n PARADIGM is a worldview or an over all
way of looking at a discipline and its
science
n PARADIGM is a view of life and not just a
principle or theory
n
Sources of Knowledge
n Traditional — passed down from generation
to generation
n Authoritative — comes from an expert
n Scientific — arrived at through the scientific
method
Types of Knowledge
n Science — knowledge in and of nursing
n Philosophy — the study of wisdom
n Process — conceptual frameworks and
theories
n Historical influences — Florence
Nightingale, societal changes
n Societal influences — schools of nursing
Framework of Nursing Theory
n Theory — group of concepts that describe
a pattern of reality
n Can be tested, changed, or used to guide
research
n Concepts — abstract impressions
organized into symbols of reality
n Conceptual framework or model
Types of Reasoning
n Deductive reasoning — examines general
ideas and considers specific actions or
ideas
n Inductive reasoning — builds from specific
ideas or action to conclusions about
general ideas
n Retroductive reasoning
Interdisciplinary Base for Nursing
Theories
n General systems theory — theory for
universal application
n Adaptation theory — adjustment of living
matter to other living things and
environment
n Developmental theory — orderly and
predictable growth and development
Benefits of Nursing Theory

n Directs nurses toward common goal

n Leads to improved patient care
n Provides rational and knowledgeable
reasons for nursing actions
Benefits of Nursing Theory

n Gives nurses knowledge base necessary

for appropriate actions
n Helps resolve current nursing issues
n Prepares nurses to question assumptions
and values
n Serves research, education, and practice
Goal of Theoretical Frameworks
n Holistic patient care
n Individualized care to meet needs of
patients
n Promotion of health
n Prevention or treatment of illness
METAPARADIGM OF Nursing
Theories
n Person (patient)
n Environment
n Health
n Nursing
IV. Complement nursing theories with
borrowed theories used in Nursing

Kuhn (1970)
Science of Scientific revolution

 a. Paradigm
 b. Paradigm shift
Nursing developed its own paradigm and

meta paradigm
Four Principles of Learning
n Prior Knowledge :
 What we know affects what we learn
n Social Interaction:
 Learning is enhanced when learners talk
to each other
n Use of Strategies:
 Successful learning involves use of
numerous strategies
n Particular Situations:
n Learning is situational and not readily
transferred to other situations
 Learner-centered
teaching in Education

 Piaget : Knowledge constructed through

 assimilation/accommodation
Dewey : Active learning
Bruner : Developing thinking
Ausubel : Rote and discovery learning
Learner-centered
teaching in Education
Vygotsky :
 Metacognition/Zone of
Proximal
 Development
Sternberg : Learning styles
Gardener : Multiple Intelligences
Wiggins : Performance based
Assessment

Learning and Psychology
n Affective
n Cognitive
n Psycho-motor
PSYCHOMOTOR (Dave 1975)

Juxtaposition with Benner’s “From Novice to Expert” will be

useful development of Nursing Curriculum
AFFECTIVE LEARNING (Kratwohl, Bloom and M

Affective domain has received less attention, and is less intuitive than the
Cognitive. It is concerned with values, or perception of value issues, and ranges
from mere awareness (Receiving), through to analyzing values.
Bloom’s Taxonomy (1956)

Knowledge

Cognitive: the most-used of the domains, refers to knowledge structures

(although sheer “knowing the facts” is its bottom level). It can be viewed as a
sequence of progressive contextualisation of the material.
Anderson and Krathwohl (2001)

Later version
 Side by Side: Bloom’s and Schultz

Caption: Terminology changes "The graphic is a representation of the NEW verbage associated with the long familiar
Bloom's Taxonomy. Note the change from Nouns to Verbs [e.g., Application to Applying] to describe the different levels of
the taxonomy. Note that the top two levels are essentially exchanged from the Old to the New version." (Schultz, 2005)
(Evaluation moved from the top to Evaluating in the second from the top, Synthesis moved from second on top to the top
as Creating.) Source: http://www.odu.edu/educ/llschult/blooms_taxonomy.htm
Journey :Year 2010 onwards!
n Nurses are now on the land of the “CAN “
and not anymore in the land of the
“CAN’T”
n
n Knowledge depends on experience; experience
on observation; but observation by
themselves do not form experience.
Observations have to be organized as
prioritized by the mind to develop into
knowledge (Kant, 1800).
ASSIGNMENT
n Week 4: Thursday
Reporting by Pair: MANAGEMENT THEORIES

Scientific Management (Frederick Taylor)

Management Functions (Henri Fayol)

Participative Management ( Follet)

Weber (Bureaucratic Organizations)

Hawthorne Effect (Mayo)

Theory Y and X (McGregor

Employee Participation (Argyris)

Activities of Management (Gulick)


 ASSIGNMENT
n Week 5: Thursday
n Reporting by Pair: LEADERSHIP THEORIES
The Great Man/ Trait Theory

Leadership Styles

Organizational Structure

Integrated Leader –Manager

Behavioral Theories

Situational and Contingency Leadership

Interactional Leadership

Transactional and Transformational Leadership

Quantum Leadership and Thought Leadership

Servant Leadership

Emotional Intelligence

Cultural Bridging


References:


Meleis, A.I. (2007). Theoretical Nursing Development and Progress. 4th ed. Lippincott Williams and
Wilkins. Philadelphia, PA.



McEwen, M., Wills, E. (2007). Theoretical Basis for Nursing. 2nd ed. Lippincott Williams and
Wilkins. Philippine Edition.



Fawcett, J. (1995). Analysis and Evaluation of Conceptual Models of Nursing. 3rd ed. Philadelphia.
F.A. Davis Company.



Peterson , S., Bredow, T. (2009). Middle Range Theory. Application to Research . 2nd ed.
Lippincott, williams, and Wilkins. Philadelphia, PA.



Tomey, A., Alligood, M. (2008). Nursing Theories and their Works. 6th ed. El Sevier Singapore Pte
Ltd. Singpaore.
