COMPONENTS OF THE THEORETICAL FOUNDATION

The basic elements that structure a nursing theory are concepts and propositions. In a theory,
propositions represent how concepts affect each other.
What Is a Concept?
A concept is the basic building block of a theory. A con- cept is a vehicle of thought. According
to Chinn and Kramer (1995, p. 78), the term concept refers to a “com- plex mental formulation
of . . . [our] perceptions of the world.” A concept labels or names a phenomenon, an observable
fact that can be perceived through the senses and explained. A concept assists us in formulating a
mental image about an object or situation. Concepts help us to name things and occurrences in
the world around us and assist us in communicating with each other about the world.
Independence, self-care, and car- ing are just a few examples of concepts frequently encountered
in health care. Theories are formulated by linking concepts together. A conceptual framework is
a structure that links global concepts together and repre- sents the unified whole of a larger
reality. The specifics about phenomena within the global whole are better explained by theory.
By its nature, a concept is a socially constructed label that may represent more than a single
phenomenon. For example, when you hear the word chair, a mental image that probably comes
to mind is an item of furni- ture used for sitting. The word chair could represent many different
kinds of furniture for sitting, such as a desk chair, a high chair, or an easy chair. Further, the
word chair could also represent the leader of a commit- tee or the head of a corporation. The
meaning of the word chair depends on the context in which it is used. In health care, the concept
of wandering may be rep- resented by words such as aimless and random move- ment,
disorganized thought processes, and conversation that is difficult to follow. To be useful, the
multiple meanings that often underlie a concept must be thor- oughly understood and clearly
defined within the con- text in which it is used.
It is important to remember that the same concept may be used differently in various theories.
For exam- ple, one nursing theory may use the concept of environ- ment to mean all that
surrounds a human being (the external environment), whereas another theory may use this
concept to mean the external environment and all the biological and psychological components
of the per- son (the internal environment).
What Is a Proposition?
A proposition (another structural element of a theory) is a statement that proposes a relationship
between con- cepts. An example of a nonnursing proposition might be the statement “people
seem to be happier in the spring- time.” This proposition establishes a relationship between the
concept of happiness and the time of the year. A nursing propositional statement linking the con-
cept of helplessness and the concept of loss might be stated as “multiple and rapid losses
predispose one to feelings of helplessness.” Propositional statements in a theory represent the
theorist’s particular view of which concepts fit together and, in most theories, establish how
concepts affect one another.
What Is a Theory?
 A theory is a set of concepts and propositions that pro- vide an orderly way to view phenomena.
In the scientific literature, theory may be defined in many different ways, with subtle nuances
specific to the particular author’s viewpoint. These various explanations share a common notion
of the purpose of the theory, that being descrip- tion, explanation, and prediction. “The purpose
of a theory in scientific disciplines is to guide research to enhance the science by supporting
existing knowledge or generating new knowledge” (Parse, 1987 p. 3). A the- ory not only helps
us to organize our thoughts and ideas, but it may also help direct us in what to do and when and
how to do it. The use of the term theory is not restricted to the sci- entific world, however. It is
often used in daily life and conversation. For example, when telling a friend about a mystery
novel you are reading, you may have said, “I have a theory about who committed the crime.” Or
you may have heard a Little League coach saying to his players, “I have a theory about how to
improve our performance.” The way in which this term is used in these statements is a useful
way to think about the meaning of theory.
USE OF THEORIES FROM OTHER DISCIPLINES
In addition to using theories specifically constructed to describe, explain, and predict the
phenomena of concern to nursing, the nursing profession has long used theories from other
disciplines. A discipline is a field of study. Theories from biological, physical, and behavioral
sci- ences are commonly used in the practice of nursing. For example, nonnursing theories such
as Maslow’s Hierarchy of Basic Human Needs, Erikson’s Theory of Human Development, and
Selye’s General Adaptation Syndrome have been and continue to be useful in nursing practice.
These nonnursing theories are often incorporated into nursing practice together with specific
nursing theories. When used in conjunction with a nursing theory, a non- nursing theory is
transformed by the unique approach of the nursing perspective. This perspective provides the
spe- cific framework or viewpoint within which to use theories and knowledge from other
disciplines.
IMPORTANCE OF NURSING THEORIES
Why do we have nursing theories? In the early part of nursing’s history, knowledge was
extremely limited and almost entirely task oriented. The knowledge explosion that occurred in
health care in the 1950s produced the need to systematically organize the tremendous volume of
new information being generated. From the very beginnings of nursing education, there was a
need to cat- egorize knowledge and to analyze client care situations in order to communicate in
coherent and meaningful ways. The literature about the relationship between theory and nursing
care yields many interpretations in terms of the role each component plays in the health care
envi- ronment. According to Barnum (1994, p. 1), “a theory is a construct that accounts for or
organizes some phenom- enon.” Chinn and Kramer (1995, p. 20) viewed theory as a “systematic
abstraction of reality that serves some pur- pose.” Meleis (1991, p. 13) stated that a theory is “a
sym- bolic depiction of aspects of reality that are discovered or invented for the purpose of
describing, explaining, pre- dicting, or prescribing responses, events, situations, con- ditions, or
relationships.” Similarly, Parse (1987, p. 2) defined a theory as a “set of interrelated concepts at
the same level of discourse that explains, describes, or makes predictions about the phenomena
of the discipline.” Nursing theories provide a framework for thought in which to examine
situations. As new situations are encountered, this framework provides a structure for
organization, analysis, and decision making. In addition, nursing theories provide a structure for
communicating with other nurses and with other members of the health care team. Nursing
theories assist the discipline of nurs- ing in clarifying beliefs, values, and goals, and they help to
define the unique contribution of nursing in the care of clients. When the focus of nursing’s
contribution is clear, then greater professional autonomy and, ultimately, control of certain
aspects of practice are achieved. In the broadest sense, nursing theory is necessary for the
continued development and evolution of the disci- pline of nursing. Because the world of health
care changes virtually on a daily basis, nursing needs to con- tinue to expand its knowledge base
to proactively respond to changes in societal needs. Knowledge for nursing practice is developed
through nursing research that, in turn, is used to either test existing theories or gen- erate new
theories. Nursing research is the systematic application of formalized methods for generating
valid and dependable information about the phenomena of concern to the discipline of nursing
(Chinn & Kramer, 1995).
The relationship between nursing practice, theory, and research is depicted in Figure 2-1. These
processes are so closely related that to consider one aspect without Nursing practice, theory, and
research are interdependent. Nursing theory develop- ment and nursing research activities are
directed toward developing nursing practice standards.
considering the other two aspects would be the same as seeing only a part of the whole. Nursing
practice is the focal point of the relationship between practice, theory, and research. It provides
the raw material for the ideas that are systematically developed and organized in the form of
nursing theory. The ideas proposed by nursing theory must be tested and validated through
nursing research. In turn, new knowledge that results from nursing research is used to transform
and inform nursing practice. Alternatively, nursing practice generates questions that serve as the
basis for nursing research. Nursing research, then, influences the development of nursing theory
that, in turn, transforms nursing practice. Levine stated that “exploring a variety of nursing the-
ories ought to provide nurses with new insights into patient care, opening nursing options
otherwise hid- den, and stimulating innovative interventions” (1995, p. 13). Theoretical thinking
enhances and strengthens the nurse’s role and helps one to actually think nursing. As nurses learn
more about specific nursing theories, it may be discovered that they can relate more to one the-
ory than another or that they can appreciate the ideas contained in several different theories.
Nurses may use a specific nursing theory to help guide their practice or may choose a more
eclectic approach and adopt ideas from several theories. Both of these approaches are valid.
Furthermore, nurses may find some theories more appropriate for certain situations. In that case,
one the- ory can be used with a client in a home health care set- ting, whereas another theory
may be more applicable to a client in an acute care environment. Regardless of the approach
chosen, nurses will recognize the value and usefulness of nursing theory as a tool for effective
nurs- ing practice.
SCOPE OF THEORIES
“Although theories address relatively specific and con- crete phenomena, they vary in scope.
Scope refers to the relative level of substantive specificity of a theory and the concreteness of its
concepts and propositions” (Fawcett, 1993, p. 19). Essentially, three different categories relate to
the scope of theories: grand theories, middle-range theories, and micro-range theories. This
classification is applicable to both nursing and non- nursing theories.