_____________THEORETICAL FOUNDATIONS OF NURSING______________

THEORETICAL FOUNDATIONS OF NURSING

• refer to the core principles, concepts, and theories that underpin the practice of
nursing.

• These foundations guide nursing actions, provide a basis for clinical

decision-making, and shape the understanding of patient care.

• It further deals with health as a multifactorial phenomenon and the necessary core
competencies that the nurse needs to develop.

• The students are expected to demonstrate the knowledge and principles gained
from the course and apply it in formulating appropriate patient care plans.

HISTORY OF NURSING THEORY

• Began with the writings "Notes on Nursing" and continues to the present.
- the founder of modern nursing and author of "Notes on Nursing"

• In the second half of the 20th century, nurses saw the need to develop nursing
knowledge through theory development from vocation to profession

ERAS OF NURSING KNOWLEDGE

1. Curriculum Era (1900-1940s)
• Emphasizes on courses included in nursing programs

2. Research Era (1950s-1970s)

• Emphasizes role of nurses and what to research

3. Graduate Education Era (1950s-1970s)

• Emphasizes on caving out an advanced role and basis for nursing practice
4. Theory Era (1980-1990s)
• Emphasizes on the many concepts about nursing

5. Theory Utilization Era (21st Century)

• Emphasizes on using the theories into practice.

SIGNIFICANCE OF NURSING THEORY

• Nursing was recognized as an academic discipline and a profession

DISCIPLINE - refers to branch of education, department of learning, and domain of

knowledge.

PROFESSION - refers to a specialized field of practice founded on the theoretical

structure of the science or knowledge of the discipline
"NURSING THEORY IS THE BACKBONE OF CLINICAL CARE"

NURSING SCIENCE
SCIENCE - method for describing, explaining, and predicting causes or outcomes of
interventions.

NURSING SCIENCE - method for describing, explaining, and predicting causes or

outcomes of nursing interventions.

RATIONALISM
• Reason and logic
• The mind contains innate ideas
• About intuition
• Deductive method - general to specific

EMPIRICISM
• Experience, evidence and experimentation
• The senses are the source of all knowledge
• About sensory perception
• Inductive method - specific to general
 THEORY
• A belief, policy, or procedure proposed or followed as the basis of action.
• An organized system of accepted knowledge that applies in a variety of situations.
• An expectation of what should happen, barring unforeseen circumstances.
• Set of statements that attempts to explain observed phenomena.
• An explanation for some phenomena that is based on observation,
experimentation, and reasoning.

CONCEPT
• an idea or generalization
• often called the building blocks of theories.
• Unit of thought; general idea formed in the mind
• Something that came from experience, reasoning, and/or imagination
• Helps describe/label a phenomenon.

ABSTRACT CONCEPT - cannot be observed; intangible (e.g. hope, caring)

EMPIRICAL CONCEPT - can be either observed or experienced through senses;

concrete concepts.
DEFINITIONS
• Convey the general meaning of the concepts in a manner that fits the theory.
• Describe the activity necessary to measure the constructs, relationships, or
variables within a theory.
THEORETICAL DEFINITIONS - Define a particular concept based on the theorist's
perspective.
OPERATIONAL DEFINITIONS - States how concepts are measured.

ASSUMPTIONS
• are statements that are accepted as truth; "taken for granted" statements
• Represent the values and beliefs of the theory
PROPOSITIONS
• is a statement that asserts a factual claim or a premise which can be either true or
false, but not both.
PHENOMENON
• An aspect of reality that can be consciously sensed or experienced.
• A term given to describe an idea or response about an event, a situation, a
process, a group of events, or a group of situations.
• Phenomena may be temporary or permanent.
• The nursing theories focus on the phenomenon of nursing and nursing care.
Example: Nurse's care and management, client responses to stress, evaluation of
nursing management, self-care

PHILOSOPHY
These are beliefs and values that define a way of thinking and are generally known
and understood by a group or discipline.

PRINCIPLE
A basic generalization that is accepted as true and that can be used as a basis for
reasoning or conduct.
CONCEPTUAL FRAMEWORK/MODEL
• a set of interrelated concepts that symbolically represents and conveys a mental
image of a phenomenon.
• A set of concepts that integrate them into a meaningful configuration.
• illustrates the expected relationship between your variables.

PARADIGM
• a typical example or pattern of something; a model.

NURSING THEORY
•organized bodies of knowledge to define what nursing is, what nurses do, and why
they do it.
•a framework of concepts and purposes intended to guide nursing practice at a more
concrete and specific level.
•Guide on how to function as a nurse

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CLASSIFICATION OF THEORIES
BY ABSTRACTION
1. METATHEORIES- these are theories about theories. Theories that
study other theories
2. GRAND THEORIES - theories that are broad in scope, and complex, therefore
requiring further research for clarification before they can be fully tested; structural
framework; provide a general framework and nursing ideas.
3. MIDDLE-RANGE THEORIES - theories that have more limited scope, less
abstraction, address specific phenomena or concept
4. PRACTICE-LEVEL THEORIES - are more specific to a patient's needs or goals;
provide frameworks for nursing interventions and suggest outcomes or the effect
of nursing practice.

BY GOAL ORIENTATION

5. DESCRIPTIVE THEORIES - describe the phenomena and identify its properties,

consequences and components in which it occurs.
They have the ability to explain, relate, and in some situations predict nursing
phenomena

Factor-Isolating Theory
• Also known as category-formulating or labeling theory.
• Theories under this category describe the properties and dimensions of
phenomena.

Explanatory Theory
• Explanatory theories describe and explain the nature of relationships of certain
phenomena to other phenomena.
BY GOAL ORIENTATION
6. PRESCRIPTIVE THEORIES - address the nursing interventions
for a phenomenon, guide practice change, and predict
Includes propositions that call for change.
• In nursing, prescriptive theories are used to anticipate the outcomes of nursing
interventions.
• An action oriented which test the validity and predictability of the nursing
intervention
IMPORTANCE OF NURSING THEORIES
• Aim to describe, predict and explain the phenomenon of nursing.
• Provide the foundations of nursing practice, help to generate further knowledge
and indicate in which direction nursing should develop in the future,
• Help to distinguish what should form the basis of practice by explicitly describing
nursing.
• Help provide better patient care, enhanced professional status for nurses,
improved communication between nurses, and guidance for research and education.
• The main exponent of nursing - caring - cannot be measured. It is vital to have the
theory to analyze and explain what nurses do.
• Establish a unique body of knowledge.

PURPOSES OF THEORIES
IN EDUCATION
• Provide a general focus for curriculum design
• Guide in curricular decision-making of program objectives, course objectives,
course descriptions, and clinical performance criteria.
• The purpose was to explain the fundamental implications of the profession and
enhance the profession's status.

IN RESEARCH
• Offer a framework for generating knowledge and new ideas.
• Assist in discovering knowledge gaps in specific field of study
• Offer a systematic approach to identify questions for study, select variables,
interpret findings and validate nursing interventions.

IN PROFESSION OR PRACTICE
• Assist nurses to describe, explain, and predict everyday experiences.
• Serve to guide assessment, intervention, and evaluation of nursing care.
• Provide a rationale for collecting reliable and valid data about the health status of
clients, which are essential for effective decision-making and implementation.
• Help to establish criteria to measure the quality of nursing care.
• Help build a common nursing terminology to use in communicating with other
health professionals. Ideas are developed and words defined.
• Enhance autonomy (independence and self-governance) of nursing by defining its
own independent functions

IN PROFESSION OR PRACTICE
• Assist nurses to describe, explain, and predict everyday experiences.
• Serve to guide assessment, intervention, and evaluation of nursing care.
• Provide a rationale for collecting reliable and valid data about the health status of
clients, which are essential for effective decision-making and implementation.
• Help to establish criteria to measure the quality of nursing care.
• Help build a common nursing terminology to use in communicating with other
health professionals. Ideas are developed and words defined.
• Enhance autonomy (independence and self-governance) of nursing by defining its
own independent functions

NURSE PARADIGM
- Is a model or paradigm that explains the linkages of science, philosophy, and
theory that is accepted and applied by the discipline.
4 MAJOR CONCEPTS OF NURSING PARADIGM
1. Person - refers to all human beings. The "person" are the recipients of nursing
care; they include individuals, families, communities and groups.

2. Environment - (or situation) is defined as the internal and external factors such as
surroundings that affect the client. It includes all positive or negative conditions that
affect the patient, the physical environment, such as families, friends, and significant
others, and the setting for where they go for their healthcare (e.g. hospital).

3. Health - addresses the person's state of well-being

4. Nursing - is central to all nursing theories. Definitions of nursing describe what

nursing is, what nurses do, and how nurses interact with clients.
It is the "diagnosis and treatment of human responses to actual or potential health
problems"

DIFFERENT VIEWS ON NON-NURSING THEORIES USED IN NURSING

1. GENERAL SYSTEMS THEORY

•Includes purpose, content, and process, breaking down the “whole” and analyzing
the parts.
*The relationships between the parts of the whole are examined to learn now they
work together
•a system is made up of separate components. The parts rely on one another, are
interrelated, share a common purpose and together form a whole

Input - the information that enters the system.

Output - the end products of a system.
Feedback - the process through which the output is returned to the system.

1. GENERAL SYSTEMS THEORY

• Von Bertalanffy developed general systems theory, which has the following
assumptions:
A, all systems must be goal directed.
B. A system is more than the sum of its parts.
C. A system is ever changing and any change in one part affects the whole.
D. boundaries are implicit and human systems are open and dynamic.

• Nursing Models based on systems theory

- Imogene King's Systems Interaction Model
- Betty Neuman's Health Care Systems Model
- Dorothy Johnsons's Behavioral System Model
2. CHANGE THEORY
• People grow and change throughout their lives. This growth and change are
evident in the dynamic nature of basic human needs and how they are met.
• Change happens daily. It is subtle, continuous and manifested in both everyday
occurrences and more disruptive life events.
• Reactions to change are grounded in the basic human needs for self-esteem,
safety, and security.
• Change involves modification or alteration. It may be planned or unplanned.

Kurt Lewin developed the change theory, which identifies the following 6
components:
1. Recognition of the area where change is needed.
2. Analysis of a situation to determine what forces exist to maintain the situation
and what forces are working to change it.
3. Identification of methods by which change can occur.
4. Recognition of the influence of group mores or customs on change.
5. Identification of the methods that the reference group uses to bring about
change.
6. The actual process of change.

Lewin identified 3 states of change:

UNFREEZING
- is the recognition of the need for change and the dissolution of previously held
patterns of behavior.
MOVEMENT
toward a new and more healthful pattern.
REFREEZING
- is the shift of behavior
- is the long-term
solidification of the new pattern of behavior.

3. DEVELOPMENTAL THEORY
Human growth and development is an orderly predictive process that begins with
conception and continues through death
FOUR MAIN AREAS OF DEVELOPMENTAL THEORY
I. Biophysical development
II. Psychoanalytic/ psychosocial development
III. Cognitive development
IV. Adaptation theory

3. DEVELOPMENTAL THEORY
I. Biophysical development
Attempts to describe the way our physical bodies grow and change.
Example: Developmental milestones of a baby
II. Psychoanalytical/Psychosocial development

Attempts to describe the development of the human personality, behavior and

emotions. This development is thought to occur with varying degrees of influence
from internal biological forces and external societal/cultural forces.

• Sigmund Freud's Psychosexual model - associated with different pleasurable

zones for gratification.

• Erik Erikson's Psychosocial model - individuals need to accomplish a particular

task before successfully completing the stage.
3. DEVELOPMENTAL THEORY
III. COGNITIVE DEVELOPMENT
Focused on reasoning and thinking processes, including intellectual operations
• Jean Piaget's theory of cognitive development
4. ADAPTATION THEORY
• Defines adaptation as the adjustment of living matter to other living things and to
the environmental conditions.
• Adaptation is a continuously occurring process that effects change and involves
interaction and response.
3 LEVELS OF HUMAN ADAPTATION
1. The internal (self)
2. The social
3. The physical (biochemical reaction)
SAFETY NEEDS
Once physiological needs are met, one's attention turns to safety and security in
order to be free from the threat of physical and emotional harm. Such needs might
be fulfilled
• Living in a safe area
• Medical insurance
• Job security
• Financial reserves

SOCIAL NEEDS
- Are those related to interaction with others and may include:
- Family
- Friendship
- Belonging to a group
- Relationship

ESTEEM NEEDS
Once a person feels a sense of
belongingness, the need to feel important arises.

Internal Esteem needs - those related to self-esteem such as self respect and
achievement.

External esteem needs - those such as social status and recognition, reputation.

SELF-ACTUALIZATION NEEDS
Self-actualization is the summit og Maslow's
Hierarchy of needs. It is the quest of reaching one's full potential as a person.
- Truth
- Justice
- Wisdom
- Meaning
A nurse in the emergency room (ER) is assessing four patients who arrived
simultaneously. Based on Maslow's Hierarchy of Needs, which patient should the
nurse prioritize first?

A. A 45-year-old woman experiencing severe chest pain and shortness of breath.

B. A 22-year-old man with a deep laceration on his leg, bleeding moderately but
controlled with a pressure dressing.

C. A 30-year-old woman crying and hyperventilating after a minor car accident,

appearing highly anxious but with no visible injuries.

D. A 60-year-old man with a broken arm, in pain but with stable vital signs.

1. A,B,C,D 3. A,D,B,C

2. B,C,D,A 4. C,D,B,A

ADVANCE READING
Please study about the following nursing theorists and their theories/models:
1. Florence Nightingale
2. Virginia Henderson
3. Faye Glenn Abdellah