THEORETICAL

FOUNDATION IN NURSING

ROWENA R. TOSOC RN, MAN, PHD

 Objectives
• Explain the components of a theory
• Define the 4 important concepts in
Nursing.
• Differentiate the types of theory.
• Discuss the importance of theory to
nursing practice, nursing education
and nursing research.
What is Nursing
Nursing- is the diagnosis and treatment of human
responses to actual or potential health problems
(ANA)

Nursing encompasses" autonomous and collaborative care of

individuals of all ages, families, groups and communities,
sick or well and in all settings. Nursing includes the
promotion of health, prevention of illness, and the care of
the ill, disabled and dying people. Advocacy, promotion of a
safe environment, research, participation in shaping health
policy and in patient and health systems management and
education are also key nursing roles” (ICN)
• Nursing –is to assist clients in the performance of
activities contributing to health, its recovery or
peaceful death that clients will perform unaided, if
they had the necessary will, strength and
knowledge. (Henderson)
• Nursing- is “a dynamic discipline. It is an art and a
science of caring for individuals, families, groups
and communities geared toward promotion and
restoration of health, prevention of illness,
alleviation of suffering and assisting clients to face
death with dignity and peace. It is focused on
assisting the client as he/she respond to health-
illness situation, utilizing nursing care process and
guided by ethico-legal moral principles.” (ADPCN)
What is a Theory?
Theory- is organized system of accepted
knowledge that is composed of
CONCEPT,PROPOSITION,
DEFINITIONS, and ASSUMPTIONS
intended to explain a set of fact, event or
phenomena.
Theory – is a “creative and rigorous
structuring of ideas that projects a
tentative, purposeful and systematic view
of phenomena(Chinn & Kramer)
Concept- is defined as an idea formulated by the
mind or an experience perceived and observed.
Ex. Disease
Proposition- explains the relationships of different
concepts.
Ex. Children fear of ladies wearing white uniform.
Definition- is composed of various descriptions
which convey a general meaning and reduces the
vagueness in understanding a set of concepts.
Ex Definition of Nursing
Assumption is a statement that
specifies the relationship or
connection of factual concept or
phenomena.
Ex: All patient who are not able to take
care of themselves need nurses.
Diagram of the Relationship of the
Different Components of Theory

Concepts
Systematically
Proposition View Phenomena
Assumption
Organized
THEORY
Definitions
Nursing Theory
Nursing Theory – is a group of interrelated concepts
that are developed from various studies of
disciplines and related experiences.
Meleis(1991) defined nursing theory as" an
articulated and communicated conceptualization
of invented or discovered reality(central
phenomena and relationships) in or pertaining
nursing for the purpose of describing,
explaining, predicting or prescribing
nursing care.”
Components of Nursing Theory
• Acc. To Barnum (1994)
1. Context – environment to which
nursing act takes place.
2.Content – Subject of the theory
3. Process- methods by which the
nurse acts in using nursing theory
Nursing Theory

THEORY
Describes
Explains NURSING
Predicts CARE
Prescribes
Nursing Paradigm
Nursing paradigm –are patterns or
models used to show a clear
relationship among the existing
theoretical works in nursing
Metaparadigm of Nursing
Four Major Concepts of Nursing
1. PERSON- the recipient of nursing
care like individuals, families and
communities.
2. ENVIRONMENT –the external and
internal aspect of life that influence
the person.
3. HEALTH-the holistic level of
wellness that the person experience

4. NURSING-the interventions of the

nurse rendering care in support of or
in cooperation with the client.
These concepts are collectively referred to as
metaparadigm for nursing.
Metaparadigm comes from the word ”meta” a Greek
word which mean with and paradigm which means
"pattern”.
*These four major concepts establish a better
direction and understanding of nursing profession.
Nursing Paradigm embodies the knowledge base
theory, philosophy, research, practice, and
educational experience and literature identified
with the profession.
Characteristics of a Theory
1. Theories can correlate concepts in such a way as
to generate a different way of looking at a certain
fact or phenomenon.
2. Must be logical in nature
3. Should be simple but generally broad in nature.
4. Can be a source of hypotheses that can be tested
for it to be elaborated.
5. Contribute in enriching the general body of
knowledge through the studies implemented to
validate them.
6. Theories can be used by practitioners to direct
and enhance their practice.

7. Theories must be consistent with other validated

theories, laws, and principles but will leave open
unanswered issues that need to be tested.
 Philosophy in Nursing
Philosophy – specifies the definition of
metaparadigm concepts in each of
the conceptual models of nursing
It is the next knowledge level after
paradigm.
It sets the meaning of phenomena
through analysis, reasoning, and
logical argument.
 Concepts
Concepts –are the building blocks of theories.
It can come from an empirical phenomena
or any abstraction of how a person
perceived an object that is not physically
present or observed.
It enhances one’s capacity to understand
phenomena as it define the meaning of the
word
 Two types of Concept
Abstract Concepts – directly observed or
intangible Ex. Care
Concrete Concepts- directly observed or
tangible. Ex pain
Concepts can be used in making or
formulating a conceptual or an operational
definition.
Conceptual definition- meaning of the word
based on how a certain theory or relevant
literature perceives it to be
Operational Definition – are meaning of a
word based on the method of how it was
measured or how the person come up with
that perception.
Conceptual definition-are the meaning of a
word based on how a certain theory or
relevant literature perceives it to be.
Conceptual and Theoretical Models
Theoretical Models or frameworks- are highly
established set of concepts that are
testable.
Conceptual models or frameworks – are
representation of an idea or body of
knowledge based on the own
understanding or perception of the person
or researcher on a certain topic,
phenomena or theory.
Conceptual Model
• Lydia Hall Theory

Person
“The Core”
Body
“The Care”
Disease
“The Cure”
Conceptual Model

PHYSICAL LOWERED
PERSON FITNESS BLOOD
Exercise PRESSURE
Comparison of Conceptual Framework
and Theoretical Framework
CONCEPTUAL THEORETICAL
It is a structure of concepts or It is a structure of concepts which
theories which are pulled together exist or tested in the literature, a
as a map for the study ready-made map for the study
Comparable to definition from a Specifies exactly how the concept
literature such as a dictionary, will be determined and assess it
encyclopedia and journals also identifies procedures and
operations significant to determine
concepts.
Example : Hospital Stay
The time during which a person is The total of days as a patient,
a registered patient in a certain beginning with admission day and
hospital finishing with discharge.
 Science
Science comes from the Latin word”scientia”-
meaning knowledge, it refers to any
systematic knowledge or practice in a
discipline of study.
It is a system of acquiring knowledge based
on the scientific method.
It is also an organized body of knowledge
gained through research.
 Scientific Method/Process
1. Observation- integration of knowledge or phenomena by
rational/sentient being.
2. Gathering Information –recognition and collecting data for a
particular scientific problem or inquiry.
3. Forming Hypothesis- an attempt to explain or suggest a
nature of the phenomena.
4. Experimental Investigation- a set of examination done to
solve the particular query raised through the hypothesis
process.
5. Conclusion/theoretical Explanation- a statement explaining a
set of natural phenomena or scientific query derived from
experimental investigation.
 Knowledge
Information, skills and expertise acquired by a
person through various life experiences or through
formal/informal learning like self-study, attending
formal education or vocational.
The abstract or workable understanding of a subject
or ideas.
Facts and information or awareness or familiarity
gained by experience of a fact or situation.
 Types of Cognitive Process
1. Perception- achieving understanding of sensory
data.
2. Association- combining two or more
concepts/ideas to form new concept.
3. Learning- acquiring experience, skills,
information and values.
4. Reasoning- mental process of seeking
conclusions through reason
5. Communication- transferring data from sender to
receiver using different mediums or tools of
communication.
Sources of Knowledge
1. Traditional knowledge – those that are
passed down from generation to
generation.
2. Authoritative knowledge- an idea by a
person of authority which is perceived as
true because of his expertise.
3. Scientific knowledge- is a type of
knowledge which came from scientific
method trough research.
 Phenomenon
Set of empirical data or experiences that can
be physically observed or tangible.
In Nursing, phenomenon can be:
• Clinical or environmental setting of nursing
• Disease process
• Client’s behavior
• Interventions
• Practices that are utilized in nursing
theories and metaparadigm.
 Classification of Nursing Theories
According to Function
1. Descriptive – also known as factor-
isolating theories, they identify and
describe major concepts of phenomena
but they do not explain the relationship of
the concept
The main purpose is to present
phenomenon based on the five senses
together with their corresponding
meaning
2. Explanatory or Factor Relating Theories- a type of
theory that present relationship among concepts
and proposition
It aims to provide information on how and why
concepts are related
3. Predictive or Situation-Relating theories- are
achieved when the relationships of concepts
under a certain condition are able to describe
future outcomes consistently.
This theory is generated and tested using
experimental research.
4. Prescriptive theories or Situation-
Producing- deals with nursing actions, and
test the validity and certainty of a specific
nursing intervention.
This kind of theory is commonly used in
testing new nursing interventions.
 SCOPE OF THEORIES
Scope- refers to the qualified level of
precision of a certain theory and accuracy
of its concepts and propositions.

Three Categories according to scope of theory

1. Grand theories- a broad range of important
relationship among concepts of a discipline. They
are made up of concepts representing common
and extremely complex phenomena
They represent the summary of development, and
concentrate on the broad phenomena of concern
within the discipline
Example: Orem’s Self-care theory of Nursing and
Neuman’s Theory
They are broad so they are not a perfect guide for
the formation of specific nursing knowledge, but
they provide a general framework for creating and
structuring broad and abstract ideas.
Grand theory are also as broad as nursing models,
because Nursing models provide a view point or
perspective, but they never suggest testable
truths, so grand theories are definitely accepted
because they suggest something that is true or
testable
Example : Roy’s Theory “that the Person as an
Adaptive System”
 Middle- Range theory
They are least abstract in level of theoretical
knowledge, since it include details specific to
practice.
Description, explanations and prediction are made
with purpose of answering questions about
different phenomena
Lie between grand and micro; synthesizes practice
and research.
Emerge at the intersection of research and practice,
when theory guide practice, practice generates
research questions and research informs
understanding of theory and practice
 Example
Hildegard Peplau- Psychodynamic Nursing.
Joyce Travelbee- Human- to-Human
relationship Model
Madeline Leininger- Transcultural Theory in
Nursing
 Micro-Range Theories
These are situation- specific and limited to a
particular population or fields of practice and also
linking of concrete concepts into a statement that
can be observed in practice and research.
Most concrete and narrow in scope.
Two Levels of Micro-range Theories
1. Higher level of abstraction- strongly related to mid-range
theory, they consist of limited number of concepts and
applicable to a narrow issue or events.
2. Low level of abstraction-Example of this is a Hypothesis
which is a tentative statement of relationship between two or
more variables that can be tested.
 Purposes of Nursing Theory
Nursing theory serve as an excellent help in
the development and expansion of
knowledge and as support in different
features of learning like in education,
research and clinical practice.
Education:
1. Nursing theories were primarily used to
develop and guide nursing education in
universities and institutions.
2. They were known to be more strongly
established in the field of academics rather
than clinical practice.
3. Major concepts of some nursing models
were structured into conceptual framework
and built to complete the curriculum
around that framework.
4. The academe were able to come up with
their program objectives, course objective,
course description and clinical
performance criteria. This assist and direct
• This assist and direct the entire education
system to create a comprehensive
curriculum.
5. Theoretical concepts primarily prepare
students for practice as member of the
professional community.
6. To ensure adequate and quality nursing
and to clarify and improve the status of the
Nursing profession.
 Research
Research in nursing was inspired from different
theoretical assumptions or conceptual framework.
Grand theories assist nursing researcher because
they are complex in nature however most of
nursing research are based on middle range
theories since this theory focus on discovery of
concepts. Theoretical concepts from social
science serve as a foundation for qualitative
nursing research
• In nursing critical theory in research
helps elaborate more on how social
structure influence a wide variety of
human experiences from art to social
practice.
 Clinical Practice
1. Nurse’s ability is enriched through help of different nursing
theories.
2. Theories guide critical thinking and decision- making in
clinical practice.
3. Nurses will have a better understanding on the basis and
nature of their work and be able to express it clearly in
collaboration with other professionals.
4. Nursing theories strengthen professional independence
by guiding the most important part of the practice.
5. Nursing theories are always critical in assisting nurses to
facilitate questions, reflections and critical thinking in every
aspect of care for the purpose of safe and effective nursing
practice.
Interdependence of Theory and
Research
• “Practice without theory, like a map without a
route, is a blind; theory without practice, like route
without map, is empty.
• Nursing Practice

• Nursing Theory Nursing Research

• The relationship between nursing theory and
nursing research helps in building nursing
knowledge.
• Nursing theory guides/direct Nursing Practice
utilizing critical thinking, analytical skills in making
a decision.
• Nursing Practice generates nursing research
questions.
• Nursing Research enhances knowledge and thus
enhances the delivery of care/improve nursing
practice.
 Analysis of Theory
• Analysis of theory – is the process that is carried
out to acquire knowledge of the theoretical work.
• It is the first step in in applying nursing theoretical
works to education, research, administration or
practice.
• Analysis and evaluation are methods to study
nursing theoretical works critically.
• We consider the degree of usefulness to guide
practice, research and education.
• It allows the researcher to know the theory’s
strength and weakness
 Ways of Analyzing and Evaluating
Nursing Theory
Five Criteria
1. Clarity- `“Is it clear?”`
As to consistency, semantic( Study of meaning of
language, symbols and logic) and structure.
Identify the major concepts and their sub-concepts,
Words should be defined operationally. The
diagrams should be clear and consistent all
through out.
It should follow a logical sequence that is
understandable.
Assumptions should be consistent with the defined
goals of the theory.
2. Simplicity- How simple is this theory?
Chin & Kramer that advise the use of middle range
theory that serve as a guide to practice.
A theory must be adequately comprehensive at a
level of abstraction to offer direction, it must have
few concepts as possible with simplistic relation
to aid clarity.
2. Simplicity- How simple is the theory?
Simple theory is important to serve as a guide to
practice.
A theory must be adequately comprehensive at the
level of abstraction so it will give direction. It must
have few concepts as possible.
Acc to Walker and Avant there should be
PARSIMONY which means elegant in simplicity
although it may be extensive content.
3. Generality- How general is this theory/
For this criterion we examine the scope of
concepts and goals/objective within the
theory.
As a rule of thumb, the more limited the
concept and goal is, the less general the
theory becomes
Ellis mention that “the broader the scope of
the theory the greater its significance, so
the more abstract the works is, the more
middle range theory can be drawn.
• 4.Empirical Precision- how accessible is
this theory?
• Empirical precision is the degree in which
the defined concepts are observable in
actual setting.
• It is linked with the testability and ultimate
use of the theory.
• It must generate a hypothesis and must
add to a body of knowledge. since one
characteristic of theory is that it is tentative
and subject to change.
 5. Derivable consequences- How important
is this theory?
In research theory and practice are related
meaningfully, so nursing theory should
lead to research testing, and research
testing should lead to knowledge that
guide practice
Theories should reveal what knowledge
should nurses acquire and pursue.
Significance of theory to Nursing
Profession

1. It helps to settle what we know and what we need

to know in the future.
2. It helps to differentiate what should form the basis
of practice by clearly describing what nursing
does and what nursing is all about.
3. It is vital to have a theory to analyze and explain
what nursing do, since nursing is caring and
caring cannot be measured.
4. With the use of nursing theory come the word
evidenced- based practice, which proves that
knowledge is not static it continues to grow.