Theoretical Foundations of Nursing

Prof. Dawn Capaque MIT, San Lorenzo Ruiz School of Health Sciences

Objectives
Define theory and list characteristics of a theory Describe the components of a theory and its use Trace the development of a nursing theory Describe the different types of theories and examples of each.

Introduction to Theory
Nursing as a profession There has been questions about whether nursing is a profession or an occupation. An occupation is a job a career. A profession is a learned vocation or occupation that has status of superiority and precedence within a division of work. It needs widely varying levels of training or education, skills and variable knowledge base. All professions are occupations but not all occupations are professions (Logan,Franzen, Butcher,2004;Schwiran , 1998)

Characteristics of a profession
1. Utilizes in its practice a well-defined and well organized body of specialized knowledge on the intellectual level of the higher learning. 2. Constantly enlarges the body of knowledge it uses and improves its techniques of education and service by the use of scientific method.

Characteristic of a profession
3) Entrusts the education of its practitioners to institutions of higher education. 4) Applies its body of knowledge in practical services that are vital to human and social welfare. 5) Functions autonomously in the formulation of professional policy and in the control of professional activity.

Characteristics of a profession
6. Attracts individuals of intellectual and personal qualities who exalt service above personal gain and who recognize their chosen occupation as a life work. 7. Strives to compensate its practitioners by providing freedom of action, opportunity for continuous professional growth and economic security.

Definitions of theory
1. Pinnel and Menesis (1986) Systematic set of interrelated concepts, definitions and deductions that describe, explain or predict interrelationships

Definitions of a theory
2. 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

Definition of a theory
3. Chinn and Krammer creative and vigorous structuring of ideas that project a tentative, purposeful and systematic view of phenomena

Definitions of a theory
Ellis coherent set of hypothetical, conceptual and pragmatic principles forming a general frame of reference for a field of inquiry

Some commonalities
Purpose Concepts Definitions Propositions Structured ideas Tentative Describe a phenomenon or occurrence

Components/Elements of theory
1.Purpose Why is the theory formulated 2.Concepts are building blocks of theory ideas, mental images of a phenomenon, an event or object that is derived from an individuals experience and perception

Components/Elements of theory
3.Has a major concept like nursing, person, health or environment. 4. Definitions give meaning to concepts which can either be descriptive or procedural (stipulate-use of term within the theory)

Components/Elements of theory
Propositions are expressions of relational statements between and among the concepts. It can be expressed as statements, paradigms or figures . AKA as theoretical assertions Assumptions- accepted truths that are basic and fundamental to the theory. Or value assumptions where what is good or right or ought to be.

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)

Theory Development

Prof. Dawn M. Capaque MIT, School of Health Sciences

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.

TERMINOLOGY
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

TERMINOLOGY
Philosophy - Knowledge level which specifies the definitions of the metaparadigm concepts in each of the conceptual models of nursing. - Nightingale is considered philosophical approach - Out of these philosophies theory maybe formalized

Conceptual models
Frameworks or paradigms that provide a broad frame of reference for the systematic approaches to the phenomena with which the discipline is concerned. -different views nursing like Roy focuses on adaptation, King on interaction and Abdellah on interventions

theory
Group of related concepts that propose actions that guide practice

Nursing theory
Group of related concepts that derive tfrom the nursing models. Some derive from other nursing discipline like LEininger which comes from anthropology

Uses of theory
1. Theory guides and improve nursing practice Theory provides goal for nursing care and with goals, nursing practice is rendered more effective and efficient. theories help to focus the goals, making nurses more confident about the practice.

Uses of theory
2. Theory guides research according to Meleis, primary use of theory is to guide research. It validates and modifies the theory. 3. Theory contributes to the development of the disciplines body of knowledge

Uses of theory

4. Theory enhances communication

Theory Development in Nursing: Historical Overview

DMCAPAQUE

Where do I begin?
Florence Nightingale - Considered first modern nursing theorist - First one to delineate what is considered the nursing goal and practice domain. - 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 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.

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 selfknowledge) Nursing theory based on empirical studies theoretical literature client reports, clinical experiences and nurses scholar intuition.

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

` environment

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,Or em,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 ENVIRONMENTfocus 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.