THEORETICAL FOUNDATION OF NURSING

CHAPTER 1
What is theory?
A theory is an organized system to accepted knowledge that is composed of concepts, propositions,
definitions and assumptions intended to explain a set of fact, event or phenomena. As defined by Chinn and Kramer
(1991), a theory is “a creative and rigorous structuring of ideas that projects a tentative, purposeful and systemic view of
phenomena”. This definition tries to explain the tentativeness of a theory.
Specifically, concept is defined as an idea formulated by the mind or an experience perceived and
observed such as justice, love, war, and disease. Proposition, on the other hand, explains the relationships of different
concepts. A definition is composed of various descriptions which convey a general meaning and reduces the vagueness
in understanding a set of concepts.

Assumption is a statement that specifies the relationship or connection of factual concepts or phenomena.
The following diagram explains the relationships of concepts propositions, assumptions and definitions with
theory and phenomena.

Concepts
Propositions SYSTEMATICALLY VIEW PHENOMENA
THEORY
Assumptions ORGANIZED
Definitions

Components of a theory
 Concepts – ideas and mental images that help to describe phenomena (Alligood and Marriner-Tomey, 2002)
 Definitions – convey the general meaning of the concepts
 Assumptions – statements that describe concepts
 Phenomenon – aspect of reality that can be consciously sensed or experienced (Meleis,1997)

How Other Authors Define Theory:

Parker (2001) “ A theory, by traditional definition, is an organized, coherent set of concepts and their relationship to
each other that offers descriptions, explanations and predictions about phenomena”.

Potter (2004) “ A theory is a set of concepts, definitions, relationships and assumptions that project a systematic view
phenomena”.

Blackwell (2005) “[It is] a reasoned proposed explanation of an occurrence, or of something that will occur or be
produced, for which absolute proof is lacking”.

Delaune and Ladner (2006) “A theory is a set concepts and propositions that provide an early way to view phenomena”.

Mosby (2006) “[It is] an abstract statement formulated to predict, explain or describe the relationships among concept,
constructs or event. It is tested by observation and research using factual data”.

Kozier (2008) “A theory is a supposition or system of ideas that is proposed to explain a given phenomenon”.

What about a Nursing Theory?

Nursing theory is a group of interrelated concepts that are developed from various studies of disciplines and related experiences. This
aims to view the essence of nursing care. Theories are specifically contributed by different nursing theorists from different times and ages. For an
instance, in the 19th century, Florence Nightingale projected a valuable relationship between health and environmental factors like fresh air,
sunlight and ventilation.
T Describes
H Explains
E Nursing
Predicts Care
O
Prescribes
R
Y
Meleis (1991) defined nursing theory as “an articulated and communicated conceptualization of invented or discovered reality (central
phenomena and relationships) in or pertaining to nursing for the purpose of describing, explaining, predicting, or prescribing nursing care”. Another
theorist, Barnum (1994), stated that a complete nursing theory is one that has context, content and process.

Components of a Theory by Barnum (1994)

Context Resembles environment to which nursing act takes place

Content Subject of the theory

Process Method by which nurse acts in using theory

What is Nursing?

 According to American Nursing Association (ANA), Nursing is the “diagnosis and treatment of human responses to actual or potential
health problems”.

 As defined by the International Council of Nurses (ICN), 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 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 .”

 Henderson’s definition of 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 or knowledge”.

 According to Association of Deans of Philippine Colleges of Nursing (ADPCN) 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.

 Focused in supporting communities, families and individuals i9n maintaining, restoring or achieving a state of optimum health and
functioning.

What are Nursing Paradigms?

Nursing Paradigm are patterns or models used to show a clear relationship among the existing theoretical works in nursing.

The Metaparadigm of Nursing

1. Person – the recipient of nursing care like individuals, families and communities.
2. Environment – the external and internal aspects of life that influence the person.
3. Health – the holistic level of wellness that the person experiences.
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. The word metaparadigm came from the word “meta”, a Greek word
which means “with” and paradigm which means “pattern”.
What are the different types of theories?

Descriptive Theories also known as Factor-Isolating Theories are known to be the primary level of theory development. they identify and describe major concepts of
phenomena.
Explanatory Theories or Factor-Relating Theories are the type of theory that present relationship among concepts and propositions.
Predictive Theories, otherwise known as Situation-Relating Theories, are achieved when the relationships of concepts under a certain condition are able to describe
future outcomes consistently.
Prescriptive Theories also called Situation-Producing Theories deal with nursing actions, and test the validity and certainty of a specific nursing intervention.

Types of Nursing Theories

1. Grand Theories – broad and complex
2. Middle-Range Theories- address specific phenomena and reflect practice
3. Descriptive theories- first level of theory development
4. Prescriptive theories- address nursing interventions and predict their consequences.

Characteristics of a Theory
 Theories can correlate concepts in such a way as to generate a different way of looking at a certain fact or phenomenon.
 Theories must be logical in nature.
 Theories should be simple but generally broad in nature.
 Theories can be the source of hypothesis that can be tested for it to be elaborated.
 Theories contribute in enriching the general body of knowledge through the studies implemented to validate them.
 Theories can be used by practitioners to direct and enhance their practice.
 Theories must be consistent with other validated theories, laws, and principles but will leave open unanswered issues that need to be tested.

Concepts
Basically, 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 like charity, caring, patience.

Two Types of Concepts

 Abstract concepts are indirectly observed or intangible. It is independent of time and place.
 Concrete concepts are directly observed or tangible.

Concepts can be used in making or formulating a conceptual or an operational definition.

Conceptual definitions are the meaning of a word based on how a certain theory or relevant literature perceives it to be.
Operational definitions are meaning of a word based on the method of how it was measured or how the person come up with the perception.

Conceptual Models and Theoretical Models

Theoretical models or frameworks are highly established set of concepts that are testable. The following is a theoretical framework as proposed by Lydia Hall, a
nurse theorist.
Conceptual models or frameworks are representations of an idea or body of knowledge based on the own understanding or perception of a person or researcher on
a certain topic, phenomena or theory.

Conceptual Framework vs. Theoretical Framework

CONCEPTUAL THEORETICAL

It is a structure of concepts or theories which It is a structure of concepts which exist or tested in

are pulled together as a map for the study. the literature, a ready-made map for the study.

Types of Definition of Concepts

CONCEPTUAL OPERATIONAL

Comparable to definition from a literature Specifies exactly how the concept will be determined and
such as a dictionary, encyclopedia, and assess it also identifies procedures and operations
journals. significant to determine concepts.

Science
In its broadest sense, science, from the Latin scientia, meaning “knowledge”, refers to any systematic knowledge or practice in a discipline of study.

The scientific method includes several steps:

Scientific Method

Observation Integration of knowledge and/or phenomenon by a rational/sentient being

Gathering Information/ data Recognition and collecting data for a particular scientific problem or inquiry.

Forming Hypothesis An attempt to explain or suggest a nature of a phenomenon.

Experimental Investigation A set of examinations done to solve the particular query raised through the
hypothesis process.

Conclusion or Theoretical Explanation A statement explaining a set of natural phenomena or a scientific query derived from
Experimental Investigation

What is Knowledge?
 Information, skills and expertise acquired by a person through various life experiences, or through formal/informal learning such as formal education, self-
study, vocational.
 The abstract or workable understanding of a subject or idea.
 What is known in a particular field of discipline or study
 Facts and information or awareness or familiarity gained by experience of a fact or situation.
 There is however no single agreed classification of knowledge.

Knowledge acquirement involves several cognitive processes.

 Types of Cognitive Process

Perception Achieving understanding of sensory data

Association Combining two or more concepts/ideas to form a new concept, or for comparison.

Learning Acquiring experience, skills, information and values

Reasoning Mental process of seeking conclusions through reason

Communication Transferring data from sender to receiver using different mediums or tools of
communication.

What are the sources?

Knowledge emerges from a range of sources which can be categorized into three namely traditional, authoritative and scientific sources.
 Traditional knowledge is a nursing practice which is passed down fro generation to generation. When asked about the basis of the nursing practice the
answer would be as simple as “It’s always been practiced this way”.
 Authoritative knowledge is an idea by a person of authority which is perceived as true because of his or her expertise.
 Scientific knowledge is a type of knowledge which came from a scientific method through research. These new ideas are tested and measured
systematically using objective criteria.

Phenomenon
A phenomenon can be defined as sets of empirical data or experiences that can be physically observed or tangible such as crying or grimacing when in pain.
In Nursing, phenomena can be:
 Clinical or environmental setting of nursing – health center
 Disease process – stomach ulcer
 Client’s behavior – guarding behavior at the pain site
 Interventions – care of the client in pain
Practices that are utilized in nursing theories and metaparadigms (person, nursing, health and environment)

Key Points

Phenomenon An empirical data that can be observed

Concepts Building blocks of theories which can either be an empirical or abstract data

Conceptual models Derived from a person own point of view

Paradigms Another term for conceptual framework or model

Assumptions Statements that the theorists hold as factual

Propositions Statements that imply the relationships of concepts

Hypothesis A testable relationship statement

Research Use of systematic methods to study a phenomenon and create a general

knowledge

Induction A type of reasoning that uses specific details to forms a general conclusion

Deduction A type of reasoning wherein general conclusions are made based from
specific concepts.