Theoretical Foundation in Nursing

Introduction to Nursing Theory, History and Philosophical Science

Description Purpose
Notion / idea Understand and find meaning
Mental patterns / constructs Articulate our knowing
Organized / coherent set of concepts and Explains experience
their relationships to each other
Creative and rigorous structuring of idea Interprets observation
Describes relationships
Projects outcomes / Predicts Phenomena
Ask questions leading to new insights
Projects a tentative, purposeful, and
systematic view of phenomena

Theory vs Hypothesis
Theory Hypothesis
A theory explains a natural phenomenon A hypothesis is an educated guess based on
that is validated through observation and certain data that acts as a foundation for
experimentation. further investiagation.
It is based on extensive data. It is based on limited data.
A theory is proven and tested scientifically. A hypothesis is not proven scientifically.
The results are certain. The results are uncertain.
It relies on evidence and verification. It relies on the possibility.
Nursing Theory
• set of concepts,
definitions, and propositions
that projects a systematic
view of phenomena
by designating specific

interrelationships among concepts for purposes of describing, explaining, predicting, and/or

controlling phenomena.
• a conceptualization of some aspect of reality (invented or discovered) that pertains to
nursing.. The conceptualization is articulated for the purpose of describing, explaining,
predicting, or prescribing nursing care.
• an inductively and/or deductively derived collage of coherent, creative, and focused nursing
phenomena that frame, give meaning to, and help explain specific and selective aspects of
nursing research and practice.
 Nursing Theory Historical Perspective
Curriculum Era: The 1900s to the 1940s
 emphasis on curricular content and progression toward standardizing curricula
 this emphasis on what nurses needed to know to practice nursing led to an expansion of
curricula beyond physiological and pathophysiological knowledge to include social
sciences, pharmacology, and formal classes on nursing procedures
 courses to teach content were called fundamentals, a term that means “basic essentials,”
and that the term is still used in nursing education today
 rooms came to be referred to as “skills or simulation labs”
 nursing’s movement into colleges and universities and the transition from vocational
nurse training to professional nursing education with emphasis on science
 those nurses introduced to research process began to recognize and write about its value
as an essential process for the progression toward a body of substantive knowledge

Research Era: The 1950s and the 1970s

 encouraged to learn how to conduct research
 led to an emphasis on statistics and research methods introduced as new curriculum areas
in baccalaureate programs
 the body of knowledge would be formed as a basis for practice
 development of scholarship and the dissemination of early research findings
 1952 - first nursing research journal
 developments in research influenced nursing education, emphasizing graduate education
with nursing research courses
 Master’s programs were being introduced in universities across the country
 curricula for master’s-level preparation were becoming standardized through
accreditation that most schools were seeking by the National League for Nursing (NLN)
 nurse educators came together at national meetings where accreditation criteria were
approved
 by the end of the 1970s, most accredited master’s programs included courses in nursing
research, clinical specialty practice, leadership, and concept development or nursing
theory in a core curriculum organized with a nursing philosophy and conceptual or
organizing framework

Graduate Education Era: The 1950s and the 1970s

 three nursing doctoral programs existed at the beginning of this era, and the federally
funded programs established in the 1950s as a result of the post– World War II shortage
of nurses
 nurses were being prepared for research and teaching roles in nursing with doctorates in
education and a range of related science disciplines
 conferences centered on nursing science and theory development and facilitated
discussion of the application of knowledge from the various disciplines in nursing
 Nurse Scientist Training Program - addressed the question of the nature of the body of
nursing knowledge — will nursing be based on applied knowledge from other disciplines
or nursing science
 Doctoral education in nursing began to flourish
 early versions of nursing frameworks began to be published
 Nursing Research celebrated its twenty-fifth anniversary in 1977
 these reviews presented recommendations for development in five practice areas of
nursing: medical-surgical, community, maternal- child, psychiatric, and gerontological
 research focused on nurses or student nurses rather than patients
 Batey (1977) conducted a comprehensive review of those first 25 years of published
nursing research and identified conceptualization as the greatest limitation of the projects
 emphasized the importance of the conceptual phase of research to provide a content basis
as well as connection with other studies in order to develop nursing science
 reference to concepts and conceptualization was common in that era and a forerunner to
the theory era
 growing awareness that the nature of knowledge needed for nursing practice was
theoretical knowledge
 scholarly works of nurse scholars from across the country began to be recognized as
theoretical frameworks for research and practice
 nursing publications began to proliferate

Theory Era: The 1980s and 1990s

 strong emphasis on knowledge development
 proliferation of nursing literature; new nursing journals; regional, national, and
international nursing conferences; and new nursing doctoral programs were evidence of
exponential growth in this era
 growth in nursing scholarship
 nursing theory linked to conceptual models which then led to an understanding of
conceptual-theoretical- empirical linkages for nursing knowledge development and the
development of nursing science
 presenting a collective view of nursing’s theoretical works using criteria to clarify their
conception as a metaparadigm (person, environment, health, and nursing) in a uniform
structure of knowledge.

Theory Utilization Era: The Twenty-First Century

 nurses using philosophies, models, and theories for theory-based nursing practice
 continued theory development is essential for our progress as a profession, and as a
discipline this is especially important
 focus on the application of theory in nursing practice
 experiences of nursing practice with holistic nursing frameworks led to in-depth
understanding of the theories and their utility for practice
 theory is not just to know but is to use
Importance of Nursing Theories
 basis of nursing practice
 guides knowledge development and directs education, research, and practice
 help recognize what should set the foundation of practice by explicitly describing nursing
 helps nurses understand their purpose and role in the healthcare setting
 rationale or scientific reasons for nursing interventions
 give nurses the knowledge base necessary for acting and responding appropriately in
nursing care situations
 provide the foundations of nursing practice, generate further knowledge, and indicate
which direction nursing should develop in the future
 providing nurses a sense of identity
 help patients, managers, and other healthcare professionals to acknowledge and
understand the unique contribution that nurses make to the healthcare service
 prepare the nurses to reflect on the assumptions and question the nursing values, thus
further defining nursing and increasing the knowledge base
 aim to define, predict, and demonstrate nursing phenomenon
 maintain and preserve its professional limits and boundaries
 guide knowledge development and directs education, research, and practice, although
each influences the others

Purposes of Nursing Theories

In Academic Discipline
 nursing programs identified the major concepts in one or two nursing models, organized
the concepts, and build an entire nursing curriculum around the created framework
 program objectives, course objectives, course descriptions, and clinical performance
criteria
 explain the fundamental implications of the profession and enhance the profession’s
status

In Research
 theory as a framework to provide perspective and guidance to the research study
 guide the research process by creating and testing phenomena of interest
 continuous reciprocal and cyclical connection with theory, practice, and research à help
connect the perceived “gap” between theory and practice and promote the theory-guided
practice

In Profession
 clinical practice generates research questions and knowledge for theory
 facilitation of reflecting, questioning, and thinking about what nurses do

Nursing as a Profession
Early Definitions of Nursing
 Latin word nutrix, which means “nursing mother”
 nurse is a person who nourishes, fosters, and protects—a person who is prepared to care
for the sick, injured, and aged
 Florence Nightingale, in her Notes on Nursing: What It Is and What It Is Not, described
the nurse’s role as one that would “put the patient in the best condition for nature to act
upon him”

Role of the Professional Nurse

1. Care Provider

2. Communicator / Helper

3. Teacher / Educator

4. Counselor

5. Client Advocate

6. Change Agent

7. Leader

8. Manager

9. Researcher

10. Case Manager

11. Collaborator

Philosophy of Knowledge
Epistemology
 branch of inquiry that is concerned with the theory of knowledge or how knowledge came
to be
 related to our concept of what is real for us because what is considered real is also what is
considered knowledge
 the theory of knowledge can be explained either of two paradigms
 Empiricism
 Rationalism

Empiricism
 way of looking at the reality using the five general senses of sight, touch, hearing, taste,
and smell
 In establishing knowledge, empiricists will most likely conduct experiment directly
measurable any of the five senses
 In terms of theories, empiricists will gather as much information and observable facts
they can before finally that a particular theory exists to explain the many phenomena
observed.

Rationalism
 use of the rational senses in ensuring the truthfulness of a phenomenon
 an enhanced way of looking at things from the point of view of the empiricists
 what is real is in the essence of the phenomenon being described and not just on whether
it can be tested by the five general senses
 a form of deductive reasoning where you understand the whole first before you can
appreciate the lesser parts
 subjected to experimentation to support or confirm the theory

Concepts
 are words or phrases that are used to represent the phenomenon observed or experienced
 building blocks of theories
 Theoretical / Operational
 Theoretical - how these concepts are defined in the dictionary
 Operational - how these concepts are used or will be used within the context of the
phenomenon being observed or experienced

Example:
  Theoretical Definition of Temperature: It is the homoeothermic range of a person’s
internal environment maintained by the thermoregulatory system of the human body.
 Operational Definition of Temperature: It is the degree of temperature measured by
the oral thermometer taken for one minute under the tongue.

Assumptions
 part of an argument which people think is true, but they never explicitly prove to be true
 the way we claim to know something

Theoretical Model
 represents an equation that describes the path or explains the phenomenon being observed
or experienced
 characterized by the organization of the organization of the concepts and definitions into
their primitive and derived terms and the organization of the statements and linkages into
the premises and hypotheses and equations
 Reynolds (1971) proposed three forms of organizing the conceptual system that constitute
the theory. These are set-of-laws, axiomatic, and causal processes.

Set-of-Laws Model
 the organization of finding from empirical research
 identifying empirical findings from available research
 these empirical findings are then evaluated and classified as laws, empirical
generalizations, or hypotheses
 law contains overwhelming empirical support
 empirical organizations are not as conclusive as laws because these contain only some
empirical
support
 hypotheses
have no
empirical
support
Axiomatic Model
 axiomatic forms of theory organization is composed of explicit definitions, set of
concepts, set of existence statements, and a set of relationship statements arranged in a
hierarchical order
 Set-of-existence statements describe situations where the theory is applicable
 Relational statements are axioms and propositions
 An axiom is a
highly abstract
theoretical
statement from
which logical
deductions
arise to bring about
propositions or
theorems.
 Advantages
 cap
acity for highly
abstract
concepts
 allo
ws less extensive research
 supportive statement structures for the theory as a whole

Causal Process Model

  development of theoretical statements that identify and specify cause-effect mechanisms
between the independent (cause) and dependent (effect) variable
 composed of a set of concepts, set of definitions, set of existence statements, and a set of
theoretical statements that specify cause- effect, or causal process
 concepts in the causal process model are arranged in such a way thatmone variable is
able to cause an effect on another variable
 Advantage
 use of highly abstract theoretical concepts
 more efficient research testing
 provides a sense of understanding in the phenomenon of interest

Analyzing a Theory / Theory Analysis

 process or acquiring knowledge of the theory
 test, expand, or extend the theory
 Purpose
 understand its implications
 identify its usefulness
 how it will be translated into action in the practice of a profession
 nursing theories à nursing practice
 areas needing further development can be identified

Criteria for Theory Analysis

 Clarity - understanding of meaning
 Generality - scope of the concepts and goals within the theory
 The more limited the concepts and goals, the less general is the theory.
  The broader the scope of the concepts, the greater is the significance of the theory.
 Simplicity – easy to understand (provides the greatest sense of understanding)
 few concepts as possible with simple relationships
 higher chance of using a theory if it is simple and clear enough for them to
understand and find practical applications with

Criteria for Theory Analysis

 Empirical Precision – accessibility
 testability and the operational use of the theory
 Derivable Consequences – importance
 lead to more knowledge that will guide practice
 guide research and practice
 generate new ideas
 differentiate the focus of the profession from other professions.

Nursing Paradigms
 Used to unify many theoretical works in nursing into a systematic view
 Person - direct receivers of care
 Hospital
 Community
 Environment - anything and everything outside the person
 quality of air he breathes
 the amount and value of food he eats
 the kind of shelter he goes home to
 Health - state of being
 WHO - state of complete physical, mental, emotional, social, and spiritual wellbeing
and not necessarily the absence of disease or infirmity
 for a person to be considered healthy, he should be in complete physical fitness, with
a sound mind, attuned with his feelings, is able to socialize and relate to others, and
has a distinct relationship with a higher being
 Nursing – both an art and a science
 use of compassionate caring, conscientious competence, and confidence
 art of serving, of nurturing, and of caring for everyone who needs it
 governed by laws and theories that have been scientifically proven to be relevant to
the performance of nursing roles
 knowledge of human body parts and how these function as a whole in order to easily
identify the abnormal from the normal.
  knowledge of disease processes, pharmacology and therapeutics, nutrition,
microbiology, and specific nursing interventions.

Nursing Paradigms
 Nursing – KSA
 Knowledge - information – concepts, theories, principles, guidelines – that will be
relevant and significant in carrying out nursing responsibilities
 Skills - acquisition of technical know-how on the different processes and procedures
related to the delivery of nursing care
 Attitude - “art” in nursing
 caring, compassionate, committed, confident, and competent nurse is always said
to be the one with a real nurse attitude
 cannot be taught nor learned

Nursing Theory Development

• Metatheory
 Highest level (4th level)
 Meta - “changed in position”, “beyond”, “on a higher level”, or “transcending”
 referred to as nursing philosophies
 provides the meanings, sentences, and structures interconnecting situations and events
observed by nurses
 may contain grand theories, middle range theories, or practice theories

 Grand Theory
 3rd level
 nursing conceptual models
 broad perspective of nursing practice, and a distinct nursing perspective of nursing
phenomenon
 provide the foundation for a middle range theory

 Middle Range Theory

 2nd level
 moderately abstract, comprehensive, organized within a limited scope and have a
limited number of variables, which are testable in a direct manner
 stronger relationship with research and practice
 Focus: pain, empathy, grief, self-esteem, hope, comfort, dignity, and quality of life

 Practice Theory
 1st level
  describe prescriptions or modalities for practice
 4 steps involved in determining practice theories
1. Factor isolating is to identify and describe a phenomenon;
2. Factor relating means to identify and describe possible explanations or causes of
the phenomenon;
3. Situation relating is to predict occurrence of a phenomenon when the cause is
present. For example, the post open-heart surgery patient will experience cardiac
arrhythmias if the blood potassium level goes below 2.5 meq; and
4. Situation producing control is to prevent occurrence of the phenomenon by
controlling or eliminating possible causes. Examples includes: pregnant women
receive RHO-gram to prevent possible hemolysis in their infants; and the
frequent turning and positioning of bed-ridden patients to prevent pressure
ulcers.

Nursing as both Profession and Discipline

 Profession - specialized field of practice founded upon the theoretical structure of the
science or knowledge of a given discipline and the accompanying practice abilities
 Discipline - related to a branch of education, a department of learning, or a domain of
knowledge

Florence Nightingale
“Nursing is the art of utilizing one’s environment for his or her own recovery.”
Background
• Mother of Modern Nursing
• lady with the lamp
• born in Florence, Italy on May 12, 1820
• daughter of the wealthy landowner, William Nightingale of Embly Park, Hampshire
• Education: Greek, Latin, French, German, and Italian, history, philosophy and mathematics
• 25 y/o: wanted to become a nurse
• Her parents were totally opposed to the idea of Florence because they viewed nursing as
associated with working class women.
• Florence’s motivation to pursue a career in medicine was further strengthened when she met
Elizabeth Blackwell at St. Bartholomew’s Hospital in London
• Blackwell was the first woman to qualify as a doctor in the United States, encouraged
Florence to keep trying to achieve her ambitions
• 31 y/o: Florence’s father gave her permission to train as a nurse
• Nightingale went to Kaiserwerth, Germany where she studied to become a nurse at the
Institute of Protestant Deaconesses.
• Two years later she was appointed resident lady superintendent of a hospital for invalid
women in Harley Street, London.

Crimean War
• In March 1853, the Crimean War broke out between Russia and Turkey, with British and
French forces aiding Turkish armies in repelling the advance of the Russians.
• Shortly after British soldiers arrived in Turkey, they began going down with cholera and
malaria.
• Within a few weeks an estimated 8,000 men were suffering from these two diseases.
• Several nurses in London heard about the cholera epidemic and offered their services to the
British Army but were rejected.
• There was considerable prejudice against women’s involvement in medicine at the time.
• When a national newspaper published the information that many British soldiers were dying
of cholera in the military camps, there was a public protest.
• This prompted the government to change its mind. Nightingale volunteered her services and
was eventually given permission to take a group of thirty-eight nurses to Turkey.
• Nightingale found the conditions in the army hospital in Scutari awful. She found out that
the reports that reached London had been understated.
• Wounded and ill soldiers lay in crowded hallways.
• Rats and insects crawled the floors and walls, and the hospitals lacked basic supplies, such
as cots, mattresses, bandages, washbasins, soap, towels.
• Water was rationed, and available in totally inadequate amounts.
• The men were placed in rooms without blankets or decent food.
• Unwashed, they were still wearing their army uniforms that were “stiff with dirt and gore”.
• In these conditions, it was not surprising that in army hospitals, war wounds only accounted
for one death in every six patients.
• Diseases such as typhus, cholera, and dysentery (bloody diarrhea) were the primary reasons
why the death-rate was so high among the wounded soldiers.
• While Nightingale did not understand basic “germ theory,” she still recognized that
overcrowding, filth, and poor ventilation all contributed to the illness she saw before her.
• She immediately requisitioned 200 scrub brushes, and, enlisting the most well of the
soldiers, set a team to work cleaning the filthy building.
• Nightingale worked tirelessly caring for the soldiers, day and night.
• By night, “she carried a lamp through the corridors, stopping to help the suffering. For this,
she was nicknamed “the lady of the lamp.”
• Nightingale also began improvements in the quality of the sanitation wherein she was able
to dramatically reduce the death-rate of her patients.

Post-War Contributions
• Florence Nightingale returned to England as a national heroine 1856.
• Nightingale decided to begin a campaign to improve the quality of nursing in military
hospitals.
• In 1857, Nightingale year gave evidence to the 1857 Sanitary Commission which eventually
resulted in the formation of the Army Medical College.
• To communicate her opinions on reform to the larger public, Nightingale published two
books, Notes on Hospital (1859) and Notes on Nursing (1859).
• In 1860, she establish the Nightingale School and Home for Nurse at St. Thomas’s Hospital.

Later Life
• In later life Florence Nightingale suffered from poor health.
• She went blind in 1895.
• She lived another fifteen years before her death in London on the 13th day of August 1910.

Theory of Nursing
“Nursing is the art of utilizing the patient’s environment for his or her recovery.”

Focus of the Theory

• Nightingale’s theory emphasized greatly the role of the environment in the care of the
patient.
• Environment is defined as the external conditions and influences affecting the life and
development of an organism and capable of preventing, suppressing, or contributing to
disease, accidents, or deaths.
• Nightingale defined and described the concepts of ventilation, warmth, light, diet,
cleanliness, and noise, all of which are important components of the environment.

Healthy Environment
• Nightingale’s concern for a healthy environment stemmed from her experience during the
Crimean war where more than 80% of soldier deaths were not due to wounds inflicted in the
war but rather because of the dismal setup of the hospitals in the battlegrounds.
• Characterized by pure air, pure water, efficient drainage, cleanliness, and light

Proper Ventilation
• Nightingale believed that nurses have the responsibility to keep the air that the patient
breathes pure as the external air without necessarily chilling him.
• Nightingale recognized the possibility that inadequate ventilation may be the source of
disease.

Adequate Light
• Direct sunlight has “...quite as real and tangible effects on the human body... who has not
observed the purifying effect of light, and especially of direct sunlight, upon the air of a
room?”

Cleanliness
• Nightingale specifically focused on the patient, the nurse, and the environment.
• A well-ventilated environment is nothing if the environment itself is dirty.
• She recognizes the presence of organic matter in a dirty environment which can contribute
to the development of diseases.
• For this, she advocated taking a bath daily and that nurses should also bathe daily while
keeping their duty uniforms clean and their hands washed clean.

Warmth
• Nightingale outlined a procedure for measuring the patient’s body temperature through
palpation of, or feeling for, the extremities in order to assess for heat loss.
• One of the nurse’s roles is to manipulate the environment so that there is a healthy balance
of ventilation and normal body warmth.
• Positioning the patient, opening the windows, and regulating the room temperature are ways
of maintaining this balance.

Quietness
• Nightingale described unnecessary noise can actually be harmful to the patient who is ill.
Diet
• Nightingale maintained that one of the nurse’s roles is to assess both the meal schedule and
its effects on the patient, in addition to assessing the patient’s dietary intake.

Management
• The nurses is actually in control of the environment, physically and administratively.
• The nurse is responsible for controlling the environment so that the patient is protected from
physical and psychological harm.
• Nightingale believe that the nurse continuously controlled the environment even if she is
physically absent from caring for the patient because she is still responsible for supervising
the other members of the health team who worked on her patient during her absence
Theory Assertions
Theory and Nursing
• Nightingale’s view of nursing was comparable to that of motherly instincts.
• She believed that every woman will be a nurse because nursing is having the responsibility
for someone else’s health – a characteristics shared by women, especially mothers.
• Her “Notes on Nursing” provided guidelines to women who wanted to become nurses and
gave advice on how to “think like a nurse.”
• Nursing, however, is a vocation that needs formal learning and application of scientific
principles in the care of patients.
• Nursing personnel were thus more skill in terms of assessment and reporting of the patient’s
health status.
• At the same time, the nurse is also able to perform nursing interventions that will allow the
patient to heal and recover.

Theory and Person

• The person is the patient himself.
• A passive patient is a patient who depends wholly on the nurse for tasks and control of his
environment.
• The Nurse is totally in control of the patient and his environment. Except for a few activities
that entailed choice or preferences, the nurse was in full control, including some personal
choices and behaviors.
• Nightingale viewed the patient as a person who needed nursing care regardless of the
patient’s social worth.
Theory and Health
• Nightingale viewed health as being well.
• Health is also living up to one’s potential to the fullest extent.
• Disease and illness are viewed as reparative processes that are instituted by Mother Nature
herself when the person did not attend to his personal health concerns.
• Nightingale emphasized the promotion and maintenance of health and prevention of
diseases through prudent control of the environment and social responsibility.
• This lay the foundations for health nursing, or that field of nursing that is aimed at health
promotion and disease prevention. This is the early form of what we call primary health care
today.

Theory and Environment

• The environment was viewed as “those elements external to and which affect the health of
the sick and healthy person” and included “everything from the patient’s food and flowers to
the patient’s verbal and nonverbal interactions.
• Central to Nightingale’s theory is the concepts of a therapeutic environment that will
enhance the comfort and recovery of the patient.

Application to Nursing
Nursing Practice
• The Principles of nursing practice by Nightingale are continuously used to this very day.
Ventilation, warmth, quiet, diet, and cleanliness are still important aspects of nursing care.
• With the advent of technology, and with it, globalization come threat from the environment.
Global warming, industrial noise, air pollution, fad diets, and vanity continue to pose
challenges to the nurse practitioner of today.

Nursing Education
• By establishing the St. Thomas Hospital and King’s College Hospital in London,
Nightingale was able to provide a framework for the establishment of nursing training
schools through a universal template that contains principles of nursing training.
• These principles included instruction in scientific principles and practical experience for the
mastery of skills.
• Nightingale also advocated the separation of nursing training from the hospital to a more
appropriate learning environment in the school or university setting.
• This was advocated because Nightingale believed the nursing student’s role is to learn the
art and science of nursing before being employed in the nursing service.
• She addressed the concern that hospitals might take advantage of the presence of nursing
students in their service areas in the form of assigning patients to these students instead of
their regular employed nursing personnel.
• Nightingale is also a strong proponent of practice nursing in education. She believed that
good nursing can only come from good education.
• Although she did not believe in licensure examinations, she used other methods of
evaluation like case studies to monitor the progress of nursing students.

Nursing Research
• Nightingale is considered the mother of nursing research because of her interest in the
scientific methods of inquiry and statistics.
• She was able to gather and analyze data efficiently and resourcefully.
• She was the first to use polar diagrams in presenting study data.
• However, Nightingale’s theory lack complexity and testability which limits her theory in
that it cannot generate the nursing research that is employed to test modem theories.
• However, the concepts of Nightingale’s theory still serve as bases for current research. This
can add to understanding modern nursing science and practice.

Lydia Hall’s Core, Care, Cure Model

“Nursing is a distinct body of knowledge that provides nursing care to patients who are in
need of nursing care in support of medical interventions, in collaboration with other members
of the health team, or exclusively and independently by the nurse herself”
Concepts and Definitions
• Core refers to the person or the recipient of care and includes the use of therapeutic self to
relate with the patient.
• Cure refers to medical interventions that are performed on the patient. The foundation for
this concepts stems from pathological and therapeutic sciences that include microbiology,
parasitology, pharmacology, and pathology. It includes nursing activities that are dependent
upon the orders of the physician.
• Care is the exclusive domain of nursing.

Core, Care, and Cure Model of Nursing

• It is a philosophy of nursing that proposed nursing functions differ insofar as aspects of
patient care is concerned.
• She postulated that individuals could be conceptualized in three separate domains: care
(hand on bodily care), core (using the self in relationship to the patient), and cure (applying
medical knowledge).
• Hall believed that patients should receive care only from professional nurses. Nursing
involves interacting with a patient in a complex process of teaching and learning. Hall was
not pleased with the concept of team nursing.
• She maintained that nurses functioned in all three domains but in different degrees.
• For example, the nurse’s function in the cure domain is limited to helping patients or
families deal with the measures instituted by the physician.
• She left that the care domain was exclusive to nursing. The core domain was shared with
social workers, psychologists, clergy, and other professions.
• Nurses also share the same domains or circles with other health care providers.
• Hall believed that professional nursing hastened the recovery of patients and that more
professional nursing care and health teaching was needed in the light of decreasing medical
care rendered to the patient.
• Lydia Hall emphasizes the autonomy inherent in professional nursing.
• Her model encompasses adult patients who have passed the acute stage of disease and who
are now in the rehabilitation phase of healthcare.
• The goal is to make sure that the patient achieves success in self- actualization and self-love
after the disease.

Theory Assertions
• Nursing is viewed as a distinct body of knowledge that provides nursing care to patients
who are in need of nursing care.
• Care of patients can be performed in support of medical interventions, in collaboration with
other members of the health team, or exclusively and independently by the nurse herself.
• Nursing is described as interacting with a patient in a complex process of teaching and
learning.
• The patient, or person, in this case is the recipient of care which may come from three
different domains.
• One aspect of care addresses his social needs while another takes care of his medical
concern.
• The third domain takes care of his bodily needs through direct effective nursing care.
Application of the Theory
• laid the foundation for classifying the professional nurse’s functions today
• Nurses are able to carry out nursing interventions independently, dependently, or
interdependently.
• The core aspect of the theory maintains that it is our responsibility to make sure that the
patient receives the highest level of care possible from all concerned health professions. The
role of the nurse is in the collaboration, coordination, and cooperation with other members of
the health care team on matters that pertain to the patient’s welfare.
• The cure aspect of the theory clearly delineates nursing functions that are dependent on the
members of the medical profession. Example of these includes medication administration,
performance of diagnostic procedures, and some other interventions that need a written order
from the doctor.
• The care domain of the theory refers to the independent roles and functions of the nurse
insofar as her skills about the patient’s conditions will allow her to carry on with her nursing
responsibilities.