NURSING THEORIES

Theory Originated from the Greek word Theorema (Speculation) Formulation of underlying principles of certain observed phenomena which have been verified to some degree. Explanation of a phenomenon. It explains why an event or situation is associated with another event or situation or what causes an event to happen. Has true foundation and factual truth Nursing Theory Underlying principles, an explanation of a phenomenon, which has true foundation and factual truth related to nursing practice. Nursing Paradigms or Models World view of a certain phenomenon; how the world / people see a certain situation in nursing practice. Metaparadigm for nursing (4 Major Concepts of Theories which are Central to Nursing) 1. Person or Client Recipient of nursing care and the focus of nursing practice Individuals, Families, Groups, and Communities (All Mankind) 2. Environment Internal and External surroundings that affect the client. People in physical environment such as Family, Friends, and Significant Others 3. Health Degree of wellness or well being the client experiences. 4. Nursing The practice of the science and art of the discipline. Nurses characteristics and actions providing nursing care on behalf of, or in conjunction with the client. Philosophy Originated from the Greek Word, Philosophia (love of knowledge; love of wisdom) A belief or system of systems of belief to define nursing phenomena and basis for later theoretical formulation. Question of how one lives, what sort of things exist, and why its important. Concepts An idea, a thought, a general notion, an abstract or concrete item conceived in the mind that needs to be understood Building blocks of theory

Concrete or Empirical Physically observable; tangible (touchable) The Human Brain The Human Heart A Nurse A Caregiver A Professional

Abstract Not physically observable Intelligence Care, Love Nursing Care giving Professionalism

Conceptual Model Symbolic presentation of concepts which is structural or diagrammatic, showing the relationship between concepts. Phenomena Sets of empirical data or experiences that can be physically observed; tangible Phenomenon All natural events that the senses can perceive (recognize) Any fact, circumstance, or experience that is apparent (obvious) to the senses and can be physically observed. Science Originated from the Latin Word, Scientia (organized body of knowledge) According to Webster Science is knowledge attained through study or practice covering general truths of general law obtained and tested through scientific method and concerned with physical world. Knowledge Information, skills, and expertise acquired by a person through life experiences or through formal or informal learning such as formal education, self study, and vocational. Knowledge Acquirement Involves Cognitive Processes (PALRC) 1. Perception achieving and understanding of sensory data 2. Association combining 2 or more concepts to form a new concept. 3. Learning acquiring information, skills, expertise. 4. Reasoning mental process of seeking conclusions through reason. 5. Communication transferring of data from sender to receiver using different tools of communication. Sources of Knowledge 1. Traditional Knowledge Nursing practice that is passed from generation to generation. Ex. Ways on how to get Vital Signs is the same. 2. Authoritative Knowledge An idea by a person of authority which is recognized as true on the basis of his expertise. As long as the authority maintains expertise, this is generally accepted.

3. Scientific Knowledge Came from scientific method through research. These new ideas are tested and measured using objective criteria. Ex. Tepid Sponge Bath (TSB) The student must know the rationale behind the procedure before rendering it to the patient. The 4 Ways of Knowing 1. Empirical Knowing The science of Nursing that ranges from factual, observable phenomena (ex. Anatomy, Physiology, Chemistry) to Theoretical Analysis (ex. Developmental Theory, Adaptation Theory) Systematically organized into laws and theories for the purpose of describing, explaining, and predicting phenomena of special concern to the nursing discipline. Any scientific research based on theoretical and factual information that the nurse use (Ex. Knowledge acquired from text books, lectures, journals, website) How to develop: Study scientific models, theories, and make objective observations. 2. Aesthetic Knowing (Art of Knowing) The art of nursing expressed through creativity and style to meet clients needs. Understanding what is significant to patient such as feelings, attitudes, and opinion; understanding uniqueness of patient, thus emphasizing use of creative and practical styles of care. Focuses on empathy (ability to share and understand ones feelings) How to develop: Appreciation of individuals uniqueness.

4. Personal Knowing (Self Awareness, Knowing oneself) Therapeutic use of self Understanding ones own beliefs, values, thoughts, feelings, attitudes, strengths, and
limitations and how these qualities affect others.

Promotes wholeness and integrity in personal encounter How to develop: Clinical reflection on ones own actions and feelings. 5. Ethical Knowing (Moral Component) The goal is to promote health, alleviate suffering, and conservation of life. Focuses on matters of obligations and following ethical codes. Involves judgment of right & wrong related to intentions, reasons, & attributes of
individuals and situations. Code of Ethics leads the conduct of Nurses is the main basis for ethical knowing. How to develop: Resolve conflicts on values and beliefs.

Functions of Theories 1. Serve both as a tool and a goal. 2. Help direct empirical investigations. 3. Rational basis for mans action 4. Basis for individuals rationalizing their actions in specific situations. 5. Continues the development of Nursing Basic Characteristics of Theory

1. It can interrelate concepts to create a different way of viewing a certain phenomena.

2. Logical in nature means must involve orderly reasoning. 3. Simple yet can be generalized. 4. Increases the general body of knowledge. 5. Consistent with other validated theories, laws, & principles 6. Consistent with previous established knowledge. 7. Can be used by practitioners to guide and improve their practice. 8. Reliable and tested with research. 9. Can be the basis for hypothesis when concepts of theory can be measured, observed or demonstrated. Purposes of Nursing Theory 1. in Education To establish the professions place in a University of Institution of Learning. To improve the status of the profession and clarify the central meaning of the profession In 1970s and 80s, nursing programs identified the major concepts in nursing models, organized these major concepts into a conceptual framework (theoretical framework) and built the entire curriculum (program objectives, course objectives, course descriptions, competencies, and clinical performance criteria). 2. in Research

Identifies parameters for the study.

Identifies conceptual frameworks from which it proceeds. Guides data collection Provides perspective in data interpretation Enable researcher to organize facts into orderly system

3. in Clinical Practice Provide EFFECTIVE EVIDENCE BASED PRACTICE in a specific clinical situation. Practice is the basic purpose of the discipline as a profession; Nursing has a responsibility to preserve the health of client. To assume such responsibility, Nursing must have a foundation of theoretical knowledge based on research. The more research in a particular theory, the more useful the theory is to practice. History of Theory Development 1. Florence Knightingale Presents her 1st nursing theory that focuses on the manipulation of the environment for the benefit of the patient. Although she didnt present her work as a nursing theory, it has directed nursing practice for over 140 years.

2. The Columbia School (1950s; Columbia Universitys Teachers College) Recognized the need to prepare nurses at the graduate level for administrative and
faculty positions and developed nursing graduate programs to meet these needs. Focused primarily in mechanistic point of view in what nurses do (functional roles; patient problems and needs). Because of this, the art of nursing such as value of caring, relationship aspects, and aesthetics was diminished.

3. The Yale School, 1960s

 The focus of theoretical thinking in nursing moved from a problem or need and functional
role focus to the relationship between the nurse and the patient. nurses do and how the patient perceives his or her situation.

Nursing is viewed as a process rather than an end it itself. Their theories look at how
In 1970s Many nursing theories were first presented. Most have been revised since their original presentations. In 1980s Many nursing theories were revised based on the research findings that expanded them. In 1990s Research studies that tested and expanded nursing theory were numerous. In 1992, Parse changed her Man Living Health to Human Becoming. She explained that the reason is that contemporary dictionarys definition of man tends to be gender based as opposed to the meaning of mankind.

3. In the late 20th Century Current Theorists are continuously expanding and refining the work of Theorists before
them and developing new ways of looking at the 4 Major Concepts of Theory. Nurses strive to preserve the idea of caring, for the world of health care changes on a daily basis because of scientific advancements.

Categories of Theory 1. Grand Theory Broadest scope which is composed of concepts presenting global and complex phenomena. Provides guidance to overall framework in structuring broad, abstract ideas. Ex. Orems Self Care Deficit Theory, Betty Neumans Behavioral System Model 2. Middle Range or Mid Level Theory More concrete and narrowly defined than Grand Level Theory. Provides a perspective from which to view complex situations and direction for intervention. Includes descriptions, explanations, and predictions answers questions about nursing phenomena Ex. Peplaus Theory of Interpersonal Relationships between the Nurse and The Client. 3. Micro Range Theory Most concrete and narrow in scope that explains a specific phenomenon. Situation specific and limited to particular populations. Ex. Effects of social supports on grieving Components of the Theoretical Foundations A. Basic Elements of Nursing theory or Distinct Features of Theory 1. Concept 2. Construct

3. Proposition Statement or Assumption Relationship between concepts; what concepts fit together and how concepts affect
one another. B. Components 1. Simplicity 2. Clarity Easy to understand; Clear in appearance, thought, or style 3. Generality Flexible; widespread; can apply theory in bigger population. C. How are Theories Generated and Developed? 1. Deductive Process General (Theory) Specific (Empirical Data) Starts from general abstract explanation to a specific event or situation.

Combination of two or more concepts Ex. concept of health & illness; love & care

Ex. multiple and rapid losses affects to the feeling of helplessness

Theory Propositional Statement (Assumption) Hypothesis Empirical Data 2. Inductive Process Specific (Empirical Data) General (Theory) Data from specific event or situations to General abstract explanation of the event or situations. Theory Propositional Statement (Assumption) Hypothesis Empirical Data

Sources of Nursing Theories 1. Theories from Nursing 2. Theories from Other Discipline Biology, Anthropology, Sociology, Logic, Psychology and Philosophy are physiological, psychological, psychosocial, and sociological in nature. Explain phenomena that are significant in Nursing. Kinds of Theories 1. Adaptation Theories How individuals cope and adapt stress & problems holistically. 2. Stress Theories How individuals deal physiologically & psychologically with stress. Assists the nurse to understand how people react on stress. 3. Change Theories Expected behaviors of individuals when major change occurs within an environment. 4. Interactive Theories Deals with Interactions Ex. Nurse Patient Interaction, Persons ability to interact.

5. Developmental Theories Specific developmental levels and tasks of individual. 6. Family Theories Family structure, functions, and interrelations of Family Group Assists the nurse in Health Teaching and Nursing Diagnosis Interdependence of Theory to Research and Practice in Nursing Profession The main responsibility of a nurse is to preserve the health of the client. To assume such responsibility, Nursing must have a foundation of theoretical knowledge based on research and not based on intuitions, habits, or traditions for decision making. The more research in a relation to a particular theory, the more useful the theory is to practice. Practice is based on theories which are validated through research. Significance of Theory for Nursing as a Profession 1. Used in practice as a well defined body of knowledge. 2. Increases the body of knowledge to improve education and practice. 3. Applies body of knowledge for human and social welfare. 4. Push Education of practitioners to institutions of higher learning. 5. Provides structure for organization, analysis and decision making. 6. Provide structure to communicate with other nurses and health care members for the continued growth and development of the profession. 7. Clarifies beliefs, values, goals, and help define unique contribution of nursing in the care of clients. 8. Knowledge for Nursing is developed through research, research is used to test existing theories, or generate new theories