Theoretical Foundation of Nursing

WEEK 1: Introduction to Nursing Theory: Its History, Significance,

and Analysis
“The systematic accumulation of knowledge is essential to progress in any
profession . . . however theory and practice must be constantly interactive.
Theory without practice is empty and practice without theory is blind.”
(Cross, 1981, p. 110).
The Evolution of Nursing
A. Intuitive Period C. Educational Period
B. Apprentice Period D. Contemporary Period

History of Nursing
I. Period of Intuitive Nursing (Primitive era – 6th Century)
 Nursing was untaught and instinctive
 Performed out of compassion for others and desire to help others
Beliefs and Practices of Prehistoric Man
 Nursing was a function that belonged to women taking care of the
children, the sick and the aged.
 Believed that illness causes the invasion of evil spirit through the use
of black magic or voodoo.
 Believed that medicine man was called shaman or witch doctor
having the power to heal using white magic.
 They also practiced “trephining” or drilling a hole in the skull with a
rock or stone without anesthesia as a last resort to drive evil spirits
from the body
Contributions to Medicine and Nursing
BABYLONIA
 Code of Hammurabi – provided laws that covered every facet of Babylonian
life including medical practice and recommended specific doctors for each
disease and gave each patient the right to choose between the use of
charms, medications or surgical procedures.

EGYPT
 Introduced the art of embalming
  Developed the ability to make keen observation and left a record of
250 recognized diseases
 Slaves and patient’s families nursed the sick
CHINA
 Believed that in using girl’s clothes for male babies keep evils away
from them
 Prohibited the dissection of dead human body as a worship to
ancestors
 Huangdi neijing - The foundational text of Chinese medicine written as
the basis of traditional Chinese acupuncture
 They gave the world knowledge of material medica (pharmacology)
INDIA
 Men of medicine built hospitals, practiced an intuitive form of asepsis
and were proficient in the practice of medicine and surgery
 Sushurutu made a list of function and qualifications of nurses. This
was the first reference to nurse’s taking care of the patient’s.
ISRAEL
 Moses was recognized as the “Father of Sanitation”
GREECE AND ROMAN EMPIRE
 The Romans attempted to maintain vigorous health, because illness
was a sign of weakness
 Care of the ill was left to the slaves or Greek physicians. Both groups
were looked upon as inferior by Roman society
ANCIENT GREECE
 Nursing was the task of untrained slave
 Introduced caduceus, the insignia of medical profession today
 Hippocrates was given the title of “Father of Scientific Medicine”.
He made major advances in medicine by rejecting the belief that
diseases had supernatural causes. He also developed assessment
standards for clients, established overall medical standards, recognized
a need for nurses.

II. Period of Apprentice Nursing (6th Century- 18th Century)

 (Founding of religious nursing orders to 1836 when Kaiserwerth
Institute for the training of Deaconesses in Germany was established)
 Also called the period of “on the job” training.
  Nursing care was performed without any formal education and by
people who were directed by more experienced nurses
 Religious orders of the Christian church were responsible for the
development of this kind of nursing.
 A religious war or holy war is a war primarily caused or justified by
differences in religion.
 The Crusades - They were Holy Wars waged in an attempt to
recapture Holy Land from the Turks who denied Christ’s pilgrims
permission to visit Holy Sepulcher
CRUSADES
 Military religious orders established hospitals staffed with men
 Knights of Lazarus was founded and primarily for the nursing care
of lepers in Jerusalem after the Christians had conquered the city.
 There was the Rise of Secular Orders
THE RISE OF SECULAR ORDER
 There was the rise of Religious Nursing Orders for women.
 Religious taboos and social restrictions influenced nursing at the
time.
 Older nuns prayed with and took good care of the sick, while
younger nuns washed soiled linens, usually in the rivers.
 In 16th century, hospitals were established for the care of the sick
where hospitals were gloomy, cheerless, airless and unsanitary.
People entered hospitals only under compulsion or as a last resort.
SECULAR ORDERS FOUNDED DURING THE PERIOD OF CRUSADES
 Order of St. Francis of Assisi (1200-Present)
 St. Clare - founder of the second order of St. Francis of Assisi.
 St. Elizabeth of Hungary – known as the “Patroness of Nurses”, she
was the daughter of the Hungarian King.
 St. Catherine of Siena – The first lady with the lamp. She was a
hospital nurse, prophetess, researcher and a reformer of society and
the church
DARK PERIOD OF NURSING 17TH TO 19TH CENTURY
 Also known as the period of reformation and American civil war
 Hospitals were closed
 Nursing was the works of least desirable people
 Nurses were uneducated, filthy and overworked
 Mass exodus of nurses
 Martin Luther destroyed the unity of the Christian faith
  Properties of hospitals and schools were confiscated.
 Theodore Fliedner - established the school of nursing, the
Kaiserswerth Institute for the training of deaconesses in Germany
where Florence Nightingale had her first formal training for 3 months
as a nurse.

III. Period of Educated Nursing (From June 15, 1869 when

Florence Nightingale School of Nursing was opened until
World War II)
1. The development of nursing during this period was strongly influenced by
trends resulting from wars, from an arousal of social consciousness, from the
emancipation of women and from the increased educational opportunities
offered to women
2. Popularization of the philosophy of the Nightingale System
• Importance of nursing education
• Nurses teaching students
• Specialization developed

1st Training School of Nursing

United States of America Bellevue Hospital School of Nursing -
Founded in 1873 in New York.
It was the first school of nursing in the United States to be founded on the
principles of nursing established by Florence Nightingale

Florence Nightingale (1859/1969)

• known as the “lady with the lamp”
• following her wartime service of
organizing and caring the wounded
in Scutari during the Crimean War.
• envisioned nurses as a body of
educated women at a time when
women were neither educated nor employed in public service.
NIGHTINGALE’S VISION OF NURSING
• Her vision and establishment of a School of Nursing at St. Thomas’
Hospital in London marked the birth of “modern nursing” does
recognized her as the “Mother of Modern Nursing”
• She set that care of the sick is based on knowledge of persons and
their surroundings—a different knowledge base than that used by
physicians in their practice.

IV. Period of Contemporary Nursing (Period after World War II up to

present)
 Scientific and technological developments as well as social changes
mark this period
 Establishment of WHO
 Use of atomic/nuclear energy for medical diagnosis and treatment
 Utilization of computers
 Use of sophisticated equipment for diagnosis and therapy
 Health is perceived as a fundamental human right
 Nursing involvement in community health is greatly intensified
 Development of the expanded role of nurses
 Professionalization of nursing

Historical Eras of Nursing’s Search for Specialized Knowledge

1. Curriculum Era: 1900 to 1940s
- Moving nursing education from hospital-based diploma programs into
colleges and universities
- Emphasized course selection and content for nursing programs
- The emerging goal is to develop specialized knowledge and higher
education
• Efforts to understand the nature of the knowledge needed for the
practice of nursing
• The expansion of curricula beyond physiological and
pathophysiological knowledge to social sciences, pharmacology and
nursing procedures
• The differences between the medical view of the patient and the nurse
view are visible in this era.
• Nursing procedures were taught and practiced in the ward- like room
called a “nursing arts laboratory”

2. Research Emphasis Era: 1950 to 1970’s

- Emphasizes on nurses to participate in research, and
Research courses were included in the nursing curricula
- The emerging goal is that, recognition that isolated studies do not
yield unified knowledge

3. Graduate Education Era: 1950 to 1970s

 - The emphasis is caving out an advanced role for urses and basis
for specialized clinical nursing practice.
 - The emerging goal is to focus on graduate education as
master’s degree programs in nursing emerged in this era.
 Development of nursing knowledge was a major force
during this period.

4. Theory Era: 1980 to 1990s

- It was a natural outgrowth of the research and graduate education eras
 - The emerging goal is that theories guide nursing research and practice
- Research without conceptual and theoretical frameworks
produced isolated information rather than research and theory
together were required to produce nursing science

1. Theory Utilization Era: Twenty-first Century

- The emphasis is that, nursing theory guides research,
practice, education and administration.
- The emerging goal for this era is that, nursing frameworks produce
knowledge (evidence for quality care).
- restored a balance between research and practice for knowledge
development in the discipline of nursing.

THEORY
– a coherent
statement or
- a product of
set of ideas
knowledge and
and concept
can predict
that explains
outcomes
observe facts
or phenomena

NURSING
– THEORIES
are organized bodies of knowledge to define what nursing is, what nurses
do, and why do they do it.
- provides way to define nursing as a unique discipline that is separate from
other disciplines (e.g., medicine).
- It is a framework of concepts and purposes intended to guide the practice
of nursing at a more concrete and specific level
- as a profession, is committed to recognizing its own unparalleled body of
knowledge vital to nursing practice
- as a science, nursing is based on the theory of what nursing is, what nurses
do, and why.
- as a unique discipline and is separate from medicine. It has its own body of
knowledge on which delivery of care is based.

First Nursing Theories in the late 1800s

1860
Florence Nightingale “Environmental Theory”
“the act of utilizing the environment of the patient to assist him in his
recovery.”
1952
Hildegard Peplau “Theory of Interpersonal Relations”
“emphasis on the nurse-client relationship as the foundation of nursing
practice.”
1955
Virginia Henderson “Nursing Need Theory”
“assisting sick or healthy individuals to gain independence in meeting 14
fundamental needs”.
1960
Faye Abdellah “Typology of 21 Nursing Problems”
the focus of nursing is “disease-centered approach to a patient-centered
approach”.
1962
Ida Jean Orlando “The Deliberative Nursing Process”
“emphasized the reciprocal relationship between patient and nurse and
viewed nursing as finding out and meeting the patient’s immediate need for
help”.

1968
Dorothy Johnson “Behavioral System Model”
“upheld the fostering of efficient and effective behavioral functioning in the
patient to prevent illness”.
1970
Martha Rogers “The Science of Unitary Human Beings”
“nursing is both science and art as it provides a way to view the unitary
human being as integral with the universe.
1971
Dorothea Orem “Self-Care Deficit Nursing Theory”
“The act of assisting others if the client is unable to fulfill biological,
psychological, developmental, or social needs”.
1971
Imogene King “Theory of Goal attainment”
“nurse is considered part of the patient’s environment and the nurse-patient
relationship is for meeting goals towards good health”.
1972
Betty Neuman “Systems Model of Nursing practice”
“many needs exist, and each may disrupt client balance or stability. Stress
reduction is the goal”.
1979
Sr. Callista Roy “Adaptation Model of Nursing”
“viewed the individual as a set of interrelated systems who strives to
maintain the balance between various stimuli”.

Significance of Nursing Theory

The greatest significance of nursing theory is that, nursing was recognized
as an academic discipline and a profession

Discipline - is specific to academic and refers to a branch of education, a

department of learning, or a domain of knowledge.
Profession - refers to a specialized field of practice, founded upon the
theoretical structure of science or knowledge and accompanying practice
abilities.
Overall, theoretical works have taken nursing to higher level of education
and practice as nurses moved from functional focus with emphasis on what
nurses do, to a patient focus, emphasizing what nurses know for thought,
decision making and action.

WEEK 2: History and Philosophy of Science

History of Nursing in the Philippines

Nursing in the Philippines: Early Beliefs and Practices

• Beliefs about causation of disease (evil spirits, enemy or witch)
• People believed that evil spirits could be driven away by persons
with powers to expel demons
• People believed in special gods of healing, the Herbolarios
• Superstitious beliefs and practices in relation to health and
sickness such as Herbmen or Herbicheros as one who practiced
witchcraft
• Persons suffering from diseases without identified cause were
believed to be bewitched by “mangkukulam”
Earliest Hospitals
• Hospital Real de Manila (1577) – it was established mainly to care
for the Spanish king’s soldiers, but also admitted Spanish civilians;
founded by Gov. Francisco de Sande
• San Lazaro Hospital (1578) – founded by Brother Juan Clemente and
was administered for many years by the Hospitalliers of San Juan de
Dios; built exclusively for patients with leprosy
• San Juan de Dios Hospital (1596) – founded by the Brotherhood of
Misericordia and administered by the Hospitaliers of San Juan de Dios;
support was delivered from alms and rents; rendered general health
service to the public.
 Filipino Nurses during Philippine Revolution
1. Josephine Bracken – installed a first hospital in an estate house in
Tejeros; provided nursing care to the wounded night and day.
2. Rosa Sevilla de Alvero – converted their house into quarters for the
Filipino soldiers, during the Philippine-American War that broke out in
1899
3. Dona Hilaria de Aguinaldo – wife of Emilio Aguinaldo; organized
Filipino Red Cross under the inspiration of Apolinario Mabini
4. Dona Maria Agoncillo de Aguinaldo – second wife of Emilio
Aguinaldo; provided nursing care to Filipino soldiers during revolution.
President of Filipino Red Cross branch in Batangas
5. Melchora Aquino – Nursed the wounded Filipino soldiers and gave
them shelter and food
6. Capitan Salome – a revolutionary leader in Nueva Ecija; provided nursing
care to the wounded when not in combat

7. Agueda Kahabagan – revolutionary leader in Laguna, also provided

nursing services to her troops
8. Trinidad Tecson – “Ina ng Biac na Bato”, stayed in the hospital at Biac na
Bato to care for the wounded soldiers
9. Anastacia Giron-Tupas, the first Filipino nurse to occupy the position of
chief nurse and superintendent in the Philippines

Hospital School of Nursing’s Formal Training (1901 – 1911)

Pensionado Act of 1903 (or Act 854)
- Allowing Filipino nursing student to study in United States.
- Among of the first wave of nurses who went to United States

Saint Paul’s Hospital School of Nursing (Manila, 1907)

- It provided general hospital services.
It opened its training school for nurses in 1908, with Mother Melanie as
superintendent and Miss Chambers as Principal

1st Training School of Nursing in the Philippines

Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)

- It was run by the Baptist Foreign Mission Society of America. In March, 1944, 22
nurses graduated; in April 1944 graduate nurses took the first Nurses Board
Examination at the Iloilo Mission Hospital.
Miss Rose Nicolet, a graduate of New England Hospital for Women and Children in
Boston, Massachusetts was the first superintendent for nurses.
Philippine General Hospital School of Nursing (Manila, 1907)
In 1906, Mary Coleman Masters, an educator advocated for the idea of
training Filipino girls for the profession of nursing with the approval of Government
officials, she first opened a dormitory for Girls enrolled at the Philippine Normal Hall
and the University of the Philippines
St. Luke’s Hospital School of Nursing (Quezon City, 1907)
- In 1907, the school opened with three girls admitted. These three girls had
their first year in combined classes with the PGH School of Nursing and St.
Paul’s Hospital School of Nursing.
- Miss Helen Hicks was the first principal.
- Mrs. Vitaliana Beltran was the first Filipino superintendent of nurses and
- Dr. Jose Fores was the first medical director of the hospital.
Mary Johnston Hospital and School of Nursing (Manila, 1907)
- In 1907, Sister Rebecca Parrish together with registered nurses Rose Dudley
and Gertude Dreisbach, organized the Mary Johnston School of Nursing.
- The nurses’ training course began with three Filipino young girls fresh from
elementary as their first students.

The Start of Nursing Practice

• 1919 - the First True Nursing Law was enacted through Act 2808. During this
period the Board Examiners for Nursing was also created.
 • 1920 - The first nursing board examination was given in.
• 1921 – 1931 - A Much Established Professional Organization:
a. The Filipino Nurses Association now PNA
b. The Philippine Journal of Nursing
• 1931 – 1941 - Public Health Nursing Development:
• The Philippine Nursing Act of 2002 was enacted under the Republic
Act No. 9173

History and Philosophy of Science

 Science is a method for describing, explaining and predicting causes or
outcomes of interventions.
 Scientific activity has helped to establish the evidence we use to guide
practice in the delivery of nursing care.
 We desire to know the unknown, and identify the cause, the effect and the
significant difference that an intervention can make to increase the longevity
of life.
 Early 20th Century Views of Science and Theory

Epistemology – the philosophical study of knowledge

Positivism, a term first used by Comte, emerged as the dominant view of
modern science
Modern logical positivists believed that empirical research and logical
analysis (deductive and inductive) were two approaches that would produce
scientific knowledge

Late 20th Century Views of Science and Theory

One of the major perspectives in the new philosophy emphasized science as
a process of continuing research rather than a product focused on findings.

Brown’s premise that observations are concept laden; that is, an

observation is influenced by values and ideas in the mind of the observer.
Foucault believes that empirical knowledge was arranged in different
patterns at a given time and in a given culture and that human were
emerging as an object of study.

Piaget’s Theory of Human cognitive functioning: “human pattern

recognition progresses through the interaction of both data-driven and
conceptual-driven uses sources of information as well as stimuli from sensory
environment”

According to Kuhn, science progresses from prescience, to a normal science,

to a crisis, to a revolution and then to a normal science – this is the
paradigm shift

WEEK 3: Structure of Nursing Knowledge

1. Structure Level:
a. Analysis of theory d. generality
b. clarity e. accessibility
c. simplicity f. importance
2. Metaparadigm:
a. Person c. Nursing
b. Health d. Environment
3. Philosophy
4. Conceptual models
5. Theory
6. Middle range theory

1. Structure Level
- presents the structure and analysis of specialized nursing knowledge

a. Analysis of theory - the first step in applying nursing

theoretical works to education, research, administration, or
practice
- analysis is an important process for learning, developing
research projects, and for expanding the science associated with
the theoretical works of nursing in the future.

Structure Level
b. Clarity - speaks to the meaning of terms used, and definitional
consistency
- speaks to the consistent structural form of terms in the theory
- word should be defined carefully and specifically according to the
framework within which it is developed.

c. Simplicity - is highly valued in nursing theory development

- A theory should be sufficiently comprehensive, presented at a level
of abstraction to provide guidance, and have as few concepts as
possible with simplistic relations to aid clarity.
- The most useful theory provides the “greatest sense of
understanding” as in “brief but complete”

d. Generality - it speaks to the scope of application and the purpose

within the theory
 - “The broader the scope….the greater the significance of the theory”
e. Accessibility - accessible addresses the extent to which empiric
indicators for the concepts can be identified and to what extent the
purposes of the theory can be attained”
- it is the linkage to facilitate test ability and ultimate use of theory to
practice.

f. Importance - Nursing theory guides research and practice,

generates new ideas, and differentiates the focus of nursing from that
of other professions
- Because research, theory, and practice are closely related, nursing
theory lends itself to research testing and research testing leads itself
to knowledge of practice.

Nursing Theory, Practice, and Research

• They are bound together in a continuous interactive relationship
• Nursing Theory and Nursing Research build the knowledge base for
nursing, which is then applied to Practice

2. Metaparadigm for Nursing

The broad conceptual boundaries of discipline: nursing, human beings,
environment, and health.

a. Person - referred to as a patient

• Nurses performed tasks for the patient and controlled the patient’s
environment to enhance recovery
• respect for persons of various backgrounds and was not judgmental
about social worth.

b. Health
 Health - a dynamic process, is the synthesis of wellness and illness and
is defined by the perception of the client across the life span.
  Health - being well and using every power or resources to the fullest
extent in living life
 Health - the client physical, social, aesthetic, and moral realms.
 Illness is defined as the lived experience of loss or dysfunction that
can be mediated by caring relationships.
 Nightingale envisioned the maintenance of health through prevention
of disease via environmental control and social responsibility.

c. Environment
• Environment is the landscape and
geography of human social experience,
the setting or context of experience as
everyday life and includes variations
in space, time and quality
Environment also includes societal beliefs, values, mores, customs, and
expectations.

d. Nursing
 Nursing - is the art and science of holistic health care guided by the
values of human freedom, choice, and responsibility.
 Nursing - is an academic discipline and a practice profession
 Nursing science - is a body of knowledge arrived at through theory
development, research, and logical analysis.

Nursing
  The art of nursing practice, actualized through therapeutic nursing
interventions
 Nurses use critical thinking and clinical judgment to provide evidence-
based care to individuals, families, aggregates, and communities to
achieve an optimal level of client wellness

WEEK 4: Philosophy, Conceptual Models Theories and Middle Range

Theories

Types of Nursing Theoretical Works

Nursing Philosophies
Nightingale
Watson
Ray
Benner
Martinsen
Eriksson
Nursing Conceptual Models
Levine
Rogers
Orem
King
Neuman
Roy
Johnson

Nursing Theories
 Boykin and Schoenhofer
Meleis
Pender
Leininger
Newman
Parse
Erickson, Tomlin, and Swain
Husted and Husted

Middle-Range Nursing Theories

Mercer Barker
Mishel Kolcaba
Reed Beck
Wiener and Dodd Swanson
Eakes, Burke, and Hainsworth Ruland and Moore

Nursing Philosophy - is the most abstract type and sets forth the meaning of
nursing phenomena through analysis, reasoning and logical presentation of
concepts and ideas.
• Philosophies are broad and address general ideas about nursing
• Philosophies are theoretical works that address one or more metaparadigm
concept (person, environment, health, nursing) and are of a philosophical
nature.
• Philosophies address questions such as:
- What is nursing?
- What is the nature of human caring?
- What is the nature of nursing practice?
- What is the social purpose of nursing practice?

EXAMPLES OF PHILOSOPHIES IN NURSING

1. Florence Nightingale: “Modern Nursing” (1946)
 - Nightingale provides an answer to the
question “What is Nursing?” in her work
“Nursing: What It Is and What It Is Not”.
- Nightingale distinguishes nursing from
household servant and draws a contrast
between nursing and medicine and specifies
the concern of nursing to be healthy rather
than illness.

2. Jean Watson: “Nursing: the Philosophy and Science of Caring”

- Watson sets forth theoretical propositions for the human-to- human
relationships of nursing
- “Transpersonal Caring” is the proposed approach to achieve connectedness
in which the nurse and the patient change together.
- Emphasis is on harmony for unity in mind, body and soul and illness is seen as
disharmony.
- the nurse and the patient participate together in relationship

3. Patricia Benner: “Stages of Expertise” (1984)

- Benner’s provide s a philosophical view of nursing practice that is focused on
how the knowledge of practice is acquired and how it develops overtime.
- Her research led to a description of the progression of nurses from
novice to expert and an awareness of caring in nursing.

Conceptual models - Are sets of concepts that address phenomena central to

nursing in propositions that explain the relationship among them.

Conceptual Model of Nursing

- also called Paradigm or Frameworks
 - a set of concepts and statements that integrate the concepts into a meaningful
configuration.
- composed of abstract and general concepts and propositions that provide a
frame of reference for members of the discipline.
- this frame of reference determines how the world is viewed by the members
of a discipline and guides them.

Example of Conceptual Model:

1. Martha Roger’s “Science of Unitary Human Beings”

- The systematic focus is the life process or patterning of the life of the human
being
- The four concepts are: openness, energy field, pattern and pan-
dimensionality.
- The three homeodynamic principles are: helicy, resonancy, and integrity
which describes the relationship of the concept of science.

Martha Roger’s “Science of Unitary Human Beings”

Integr
ality Open
ness
Reson Unitary
ancy energ
Human y field
Beings
Helicy Patter
Pan- n
dimen
Example of Conceptual Model:sional
ity
2. Sis Callista Roy’s “Adaptation Model”
 - the focus is on a person
as an adaptive system
- occurs through Cognator
and regulator control process
that lead to coping behavior
in four modes: Physiological,
self-concept, role function
and interdependence

Nursing Theory - a conceptualization of some aspects of reality, articulated

for the purpose of describing, explaining, predicting or prescribing nursing
care.
- a body of knowledge that describes or explains nursing and is used to
support nursing practice
- the primary distinction between the theory and conceptual model is the
level of abstraction.
- a conceptual model is highly abstract system and linking statements. A
theory is more specific, concrete concepts and propositions.

Characteristics of a Theory
Theory - a system of ideas intended to explain something, especially one
based on general principles independent of the thing to be explained.
A theory is:
• Interrelating concepts in such a way as to create different way of
looking at a particular phenomenon
• Logical in nature, Generalizable
• Basis for hypothesis that can be tested
• Consistent with other validated theories, laws and principles but will
leave open unanswerable questions that need to be investigated

Components of Nursing Theories

Components of Nursing Theories
1. Concepts:
• Interrelated concepts define a theory.
• Concepts are used to help describe a phenomenon.
• They are words or phrases that identify, define, and establish
structure and boundaries for ideas generated about a particular
phenomenon.
• Concepts may be abstract or concrete/empirical

a) Abstract Concepts - defined as mentally constructed independent of

a specific time or place.
- one that is not observable
b) Concrete or Empirical Concepts - are directly experienced and
related to a particular time or place.
- one that can either be observed or experienced through the senses.

2. Definitions:
• It is about the general meaning of concepts in a manner that fits the
theory.
 • Use to measure the constructions, relationships and variables within a
theory.
• Definitions can be theoretical or operational
a) Theoretical Definitions - define a particular concept based on the
theorist’s perspective.
b) Operational Definitions - states how concepts are measured.

3. Assumptions:
• Assumptions are “the taken for granted” statements that determine
the nature of the concepts.
• It describes concepts or connect two concepts that are factual
• This are accepted as truths and are based on values and beliefs.

• Relational Statements/Proposition - define the relationships

between two or more concepts.
• They are the chains that link concepts to one another.

4. Phenomenon
- A term given to describe an idea or responses about an event, a
situation, a process, a group of events, or a group of situations.
- Phenomena may be temporary or permanent.
 - Nursing theories focus on the phenomena of nursing and nursing care
- Ex: Pandemic, Epidemic

Purposes of Nursing Theories

• to improve practice by positively influence the health and quality of
life of patients.
• developed to define and describe nursing care
• guide nursing practice
• provide a basis for clinical decision making.

1. In Academic Discipline
- to explain the fundamental implications of the profession and to
enhance the status of the profession
- provide a general focus in curriculum design in education
- guide curricular decision making

2. In Research
- To improve the nursing profession’s ability to meet the societal duties
and responsibilities
- to be a continuous reciprocal and cyclical connection with theory,
practice, and research.
- offer a framework for generating knowledge and new ideas
- offer a systematic approach to identify questions for study, interpret
findings and validate nursing interventions.

3. In Profession
- encourages nurses to reflect on, question, and think about what they do
provide an invaluable service.
- help establish criteria to measure the quality of nursing care
- enhance autonomy of nursing by defining its own independent functions.
 Classification of Nursing Theories By Level Abstraction
Middle Range theory - Concepts most specific to practice that propose
precise testable nursing practice questions and include details such as
patient age group, family situation, health condition, location of the patient,
and action of the nurse

Middle-Range Nursing Theories

• More limited in scope (as compared to grand theories) and present
concepts and propositions at a lower level of abstraction.
• Due to the difficulty of testing grand theories, nursing scholars proposed
using this level of theory.
• Address specific phenomena or concepts and reflect practice

Practice-Level Nursing Theories

• are narrow in scope and focuses on a specific patient population at a
specific time.
• this level of nursing theories have a more direct effect on nursing
practice
• provide frameworks for interventions and suggest the effect of nursing
practice.

Grand Nursing Theories

• are abstract, broad in scope, and complex, therefore requiring further
research before they can be fully tested.
• provide a general framework for broad, abstract ideas about nursing.
• Grand nursing theorists develop their works based on their own
experiences
• Address the nursing metaparadigm components of person, nursing,
health, and environment.
WEEK 5: Nursing Philosophies: Nightingale, Watson, Benner,
Eriksson
Environmental Philosophy
“Nursing ought to signify the proper use of fresh air, light, warmth,
cleanliness, quiet and the proper selection and administration of diet – all at
the least expense of vital power to the patient”

Florence Nitingale: 1820-1910

History and Background
- Born : May 12, 1820
- Florence, Italy
- She was the younger of two children
- Her british family belonged to elite social circles
- Her father, WILLIAM SHORE NIGHTINGALE, a wealthy
landowner who had inherited two states – when nightingale
was 5 years old
- Her mother, FRANCES NIGHTINGALE, hailed from a family of
merchants and took pride in socializing with people of
prominent social standing.

EDUCATION:
- As far being home schooled by her parents and tutors nightingale
gained excellence in Math
- Nightingale was active in philanthropy, ministering to the ill and
poor people in the village neighboring her family’s estate
- Nightingale enrolled as a nursing student in 1844 at the Lutheran
Hospital of Pastor Fliednew in Kaiserwerth, Germany
- She studued there for 3 months
- It was another 2 years before she allowed to practice nursing.

WORKS
- She served the wounded soldiers during the crimean war
- At the barrack hospital at Scutari, she observed the disastrous
sanitary conditions.
- Called as “Lady with the lamp”
 - She worked intensely to effect all types
- of reforms in nursing and hospital
- environment
- Because of her works in reforming
- nursing, she was given the title
- “ Founder of Modern Nursing”
- She established school of Nursing
- at St. Thomas Hospital in England.

NIGHTINGALE’S CANONS IN ENVIRONMENTAL THEORY

1. VENTILATION AND WARMING
2. LIGHT AND NOISE
3. CLEANLINESS OF THE AREA
4. HEALTH OF HOUSES
5. BED AND BEDDING
6. PERSONAL CLEANLINESS
7. VARIETY
8. OFFERING HOPE AND ADVICE
9. FOOD
10. OBSERVATION

MAJOR CONCEPTS: NIGHTINGALE’S ENVIRONMENTAL THEORY

PERSON – The one who is receiving care, a dynamic and complex being
comprising physical, intellectual, emotional, social and spiritual components
ENVIRONMENT – anything that can be manipulated to place a patient in the
best possible condition for nature to act.
HEALTH – being well and using every power to the fullest extent in living life.
The prevention of illness and promotion of health.
NURSING – an spiritual calling, to assist nature to repair the patient, the
science of environmental management.
CRITERIA FOR ANALYSIS
CLARITY – NIGHTIANGALE’s work is clear and easily understood.
SIMPLICITY – was simple and focuses on the manipulation of environment
to promote good nursing care.
GENERALITY – applies in all situations that nursing care is provided
ACCESIBILITY – her concept are amenable to studies with both qualitative
and quantitative method
IMPORTANCE – her theory encompass areas of practice, research and
education.

JEAN WATSON “HUMAN CARING” 1940

Philosophy and Theory of Transpersonal Caring
“we are the light in institutional darkness, and in this model we get
to return to the light of our humanity.”

Nursing is concerned with promoting health, preventing illness, caring for

the sick and restoring health.

Historical and Background

- Jean Watson was born Margaret Jean Harmon and grew up in the
small town of welch, west virginia
- She was the youngest of eight children
- Married her husband douglas
- Experiencing and receiving her own theory through the care of her
husband and loving nurse friends and colleages.

Metaparadigm and Major Concepts in Nursing

Human Being – As a valued person to be cared for, respected, nurtured,
understood and assisted.
Health – a high level of overall physical, mental, and social functioning,
adaptive-maintenance level of daily functioning and the absence of illness.
Nursing - as a science of persons and health illness mediated by
professional, personal, scientific, and ethical care interactions
Society – provides the values that determine how one should have
Environment – healing spaces to help others transcend illness, pain, and
suffering
Actual Caring Occasion – involves actions and choices by the nurse and
the indivudal to decide what to do in caring
Transpersonal Concept – is a human to human relationship between the
nurse and the patient, they share a phenomena.

Watson’s 10 Carative Factors

1. FORMING HUMANISTIC – ALTRUISTIC VALUE SYSTEM
2. INSTILLING FAITH HOPE
3. CULTIVATING A SENSITIVITY TO SELF AND OTHERS
4. DEVELOPING A HELPING TRUST RELATIONSHIP
5. PROMOTING AN EXPRESSION OF FEELINGS
6. USING PROBLEM-SOLVING FOR DECISION MAKING
7. PROMOTING TEACHING LEARNING
8. PROMOTING A SUPPORTIVE ENVIRONMENT
9. ASSISTING WITH GRATIFICATION OF HUMAN NEEDS
10. ALLOWING FOR EXISTENTIAL PHENOMENOLOGICAL FORCES

WATSON’S HIERARCHY OF NEEDS

HIGHER ORDER INTRAPERSONAL – INTERPERSONAL
NEED OR GROWTH SEEKING NEED
IS THE NEED FOR SELF ACTUALIZATION
 HIGHER ORDER PSYCHOSOCIAL NEEDS OR INTEGRATIVE NEEDS
IN INCLUDE THE NEED FOR ACHIEVEMENT, AND AFFILIATION

LOWER ORDER PSYCHOPHYSICAL NEEDS OR FUNCTIONAL NEEDS

THESE INCLUDE THE NEED FOR ACTIVITY, INACTIVITY, AND SEXUALITY

LOWER ORDER BIOPHYSICAL NEEDS OR SURVIVAL NEEDS

THE NEED FOR FOOD AND FLUID, ELIMINATION, AND VENTILATION

WATSON’S THEORY AND THE NURSING PROCESS

ASSESMENT – in includes identification, and review of the problem, and
formation of a hypothesis
EVALUATION – examination of the effects of intervention, the results and
degree of positive outcome.
PLAN – includes conceptual approach or design for problem solving
INTERVENTION – it is the direct action and implementation of plan

CRITERIA FOR ANALYSIS

CLARITY – uses nontechnical, sophisticared language to artfully describe her
concepts such as caring love and caritas.
SIMPLICITY – easy to understand and apply due to more about being than
doing
GENERALITY – broad aspects of health and illness phenomena.
ACCESIBILITY – more on qualitative approach and need to be explored
IMPORTANCE – help nurses and their patients find meaning and harmony

Patricia Benner “Stages Of Expertise”

“From Novice to Expert”
-explains that nurses develop skills and an understanding of patient care
over time from a combination of a strong educational foundation and
personal experiences.
Patricia Benner – Works / Books
• From Novice to Expert
• Nursing Pathways for Patient Safety
• The Primacy of Caring

Benner’s 7 - Domain in the Nursing Practice

• 1. The Helping Role – includes competencies related to establishing
a healing relationship and providing comfort measures.
• 2. The Teaching–Coaching Function Domain – includes timing,
readying patient for learning, motivating, assisting with lifestyle
alterations
• 3. The Diagnostic and Patient-Monitoring Function Domain –
competencies in ongoing assessment and anticipation in outcomes
• 4. The Effective Management of Rapidly Changing Situation
Domain – ability to assess and manage care during crisis situations
 • 5. The Administering and Monitoring Therapeutic Interventions
and Regimen Domain – related to preventing complications during
drug therapy, wound management and hospitalization.
• 6. The Monitoring and Ensuring the Quality Care Practice
Domain – related to maintenance of safety continuous quality
improvement, collaboration and consultations with the physician.
• 7. The Organizational and Work – Role Competencies Domain –
competencies in priority setting, team building , coordinating and
providing for continuity.

Benner’s Metaparadigm
 NURSING – a caring practice whose science is guided by the moral art
and ethics of care and responsibility.
 PERSON – a self- interpreting being, that is, the person does not come
into the world predefined but gets defined in the course of living a life.
 HEALTH – is well-being, the human experience of health or wholeness,
the absence of disease and illness.
 SITUATION – social environment. The person’s past, present and
future which include his personal meanings, habits and perspective
influence the current situation.

Criteria for analysis

Clarity –led its use among nurses around the world. Not only contributed to
appreciative understanding but also revealed nursing knowledge’
Simplicity – relatively simple with regard to the 5 stages of skills acquisition
(novice to expert)
Generality – has universal characteristics, it is not restricted by age, illness,
disease or location of nursing practice.
Accessibility – considered hypothesis generating rather than hypothesis
testing.
Importance – influence major changes in nursing practice, research,
teaching and administration.
Katie Eriksson: Caritative Caring [ 1943 – Present ]
Eriksson: Theory of Caritative Caring
 Caritative caring - consists of love and charity, which is also known
as caritas, and respect and reverence for human holiness and dignity.
 Suffering that occurs as a result of a lack of caritative care is a
violation of human dignity.
 Nursing Ethics are the ethical principles that guide a nurse’s decision –
making abilities.

Katie Eriksson – Biography

 Eriksson was born on November 18, 1943, in Jakobstad, Finland.
 She belongs to the Finland-Swedish minority in Finland, and her native
language is Swedish
 Katie Eriksson is one of the pioneers of caring science in the Nordic
countries
 She formulated 11 theory of caritative caring
Eriksson’s Metaparadigm
 THE HUMAN BEING - the human being is an entity of body, soul,
and spirit. Human being is fundamentally a religious being.
 NURSING - love and charity, or caritas, as the basic motive and
principal idea of caring. The natural basic caring is expressed
through tending, playing and learning in a spirit of love, faith and
hope.
 HEALTH - as soundness, freshness, and well-being. The absence of
illness and implies wholeness and holiness
 ENVIRONMENT - uses the concept of ethos
 Ethos originally refers to home, or to the place where a human
being feels at home.