SEMINAR ON OVERVIEW

OF NURSING THEORIES
PRESENTED BY, RESEARCH GUIDE
R. SUGANTHI DR. U. RAMYA
PHD SCHOLAR ASSOCIATE PROFESSOR
MAHER, CHENNAI. MAHER, CHENNAI.
 INTRODUCTION
• Theory is the term given to the body of knowledge that is
used to support nursing practice. In their professional
education nurses will study a range of interconnected
subjects which can be applied to the practice setting. Most
universally agreed upon is that nursing is a science
involving people, environment and process fuelled by a
vision of transcendence in the context of health care.
 DEFINITIONS
THEORY
 Theory is the body of generalizations and principles developed in association
with practice in a field of activity and forming its content as an intellectual
discipline.
 It is a 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 controlling phenomena (Chinn
and Jacobs, 1987).
 It is a creative and rigorous structuring of ideas that projects a tentative
purposeful and systematic view of phenomena (Chinn and Kramer, 1995).
NURSING THEORY
 It is 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 (Meleis,1997).
 DEFINITION
 CONCEPTS :
These are words that describe objects, properties, or events and are basic
components of theory. It is an idea of an object, property or event and can be
empirical or concrete, inferential or abstract that is derived from individual
perceptual experience.
 MODELS:
It is a representations of the interaction among and between the concepts
showing patterns.
 CONSTRUCT:
A phenomena that cannot be observed and must be inferred.
 CONCEPTUAL MODELS:
A model, as an abstraction of reality, provides a way to visualize reality to
simplify thinking
 METAPARADIGM:
It is the most global conceptual or philosophical framework of a discipline
or profession. Metaparadigm helps to define and explain relationship between ideas
and values. Metaparadigm to guide the organization of theories and models.
CONCEPTS(METAPARADIGM) OF NURSING THEORY

Four concepts are generally considered central to the discipline of

nursing
• The person
• The environment
• Nursing
• Health
 IMPORTANCE OF NURSING THEORIES

 Nursing theory aims to describe, predict and explain the phenomenon of

nursing (Chinn and jacobs,1978).

 It should provide the foundations of nursing practice, help to generate

further knowledge and indicate in which direction nursing should
develop in the future (brown, 1964).

 Theory is important because it helps us to decide what we know and

what we need to know (parsons,1949).
 IMPORTANCE OF NURSING THEORIES
 The benefits of having a defined body of theory in nursing include
better patient care, enhanced professional status for nurses,
improved communication between nurses, and guidance for
research and education. In addition, because the main exponent of
nursing – caring – cannot be measured, it is vital to have the theory
to analyse and explain what nurses do.
 As medicine tries to make a move towards adopting a more
multidisciplinary approach to health care, nursing continues to
strive to establish a unique body of knowledge.
 This can be seen as an attempt by the nursing profession to
maintain its professional boundaries.
 CHARACTERISTICS OF THEORIES
 They interrelate concepts in such a way as to create a
different way of looking at a particular phenomenon.
 They are logical in nature.
 They are generalizable.
 They are the bases for hypotheses that can be tested.
 CHARACTERISTICS OF THEORIES
 They increase the general body of knowledge within the discipline
through the research implemented to validate them.

 They are used by the practitioners to guide and improve their practice.

 They are consistent with other validated theories, laws, and principles but
will leave open unanswered questions that need to be investigated.
 HISTORY OF NURSING THEORY

The original role of the nurse was primarily to care for the
patient as prescribed by a physician. This evolved into the biomedical
model of nursing care which still strongly influences nursing practice
today. The biomedical model focuses heavily upon pathophysiology
and altered homeostasis but fails to identify individual differences and
whilst it works well for traditional medical and physical care, it focuses
solely on the treatment of disease, making little account of
psychological, social, cultural, and economic differences between
individuals.
 FLORENCE NIGHTINGALE ENVIRONMENTAL
THEORY
The environmental theory by Florence nightingale defined nursing as “the

act of utilizing the environment of the patient to assist him in his recovery.” It
involves the nurse’s initiative to configure environmental settings appropriate for
the gradual restoration of the patient’s health and that external factors associated
with the patient’s surroundings affect the life or biologic and physiologic processes
and his development. Nightingale discussed the environmental theory in her
book notes on nursing: what it is, what it is not. She is considered the first theorist
in nursing and paved the way in the foundation of the nursing profession we know
today.
FLORENCE NIGHTINGALE ENVIRONMENTAL
MODEL
 PELAU’S THEORY(1952)

• Hildegard E. Peplau’s theory defined nursing as “an interpersonal

process of therapeutic interactions between an individual who is sick
or in need of health services and a nurse especially educated to
recognize, respond to the need for help.” It is a “maturing force and
an educative instrument” involving an interaction between two or
more individuals with a common goal.
PEPLAU’S THEORY
 VIRGINIA HENDERSON’S NEED THEORY(1955)

• Virginia Henderson developed the nursing need theory to define the unique focus
of nursing practice. The theory focuses on the importance of increasing the
patient’s independence to hasten their progress in the hospital. Henderson’s
theory emphasizes the basic human needs and how nurses can meet those needs.
 KING GOAL ATTAINMENT THEORY(1960)
• The theory of goal attainment states that “nursing is a process of action, reaction, and interaction
by which nurse and client share information about their perception in a nursing situation” and “a
process of human interactions between nurse and client whereby each perceives the other and the
situation, and through communication, they set goals, explore means, and agree on means to
achieve goals.”
•
Imogene king’s personal philosophy about human beings and life influenced her assumptions
about the environment, health, nursing, individuals, and nurse-patient interactions. King’s
conceptual system and theory of goal attainment were “based on an overall assumption that the
focus of nursing is human beings interacting with their environment, leading to a state of health
for individuals, which is an ability to function in social roles.”
 ABDELLAH’S THEORY(1960)

• According to Faye Glenn Abdellah’s theory, “nursing is based on an art and

science that molds the attitudes, intellectual competencies, and technical skills of
the individual nurse into the desire and ability to help people, sick or well, cope
with their health needs.”
• The patient-centered approach to nursing was developed from Abdellah’s
practice, and the theory is considered a human needs theory. It was formulated to
be an instrument for nursing education, so it most suitable and useful in that
field. The nursing model is intended to guide care in hospital institutions but can
also be applied to community health nursing, as well.
ABDELLAH’S 21 NURSING PROBLEM
 ORLANDO THEORY(1962)
• Ida Jean Orlando developed her theory from a study conducted at the yale university school of
nursing, integrating mental health concepts into a basic nursing curriculum. She proposed that
“patients have their own meanings and interpretations of situations and therefore nurses must
validate their inferences and analyses with patients before concluding.”

The deliberative nursing process has five stages: assessment, diagnosis, planning, implementation,
•

and evaluation. Nurses use the standard nursing process in Orlando’s nursing process discipline
theory to produce positive outcomes or patient improvement. Orlando’s key focus was the
definition of the function of nursing. The model provides a framework for nursing, but her
theory does not exclude nurses from using other nursing theories while caring for patients.
 DORATHY JOHNSON THEORY(1968)

• Dorothy e. Johnson is well-known for her “behavioral system model,” which was first proposed in
1968. Her model was greatly influenced by Florence nightingale’s book, notes on nursing. It

advocates fostering efficient and effective behavioral functioning in the patient to prevent illness
and stresses the importance of research-based knowledge about the effect of nursing care on
patients.
• Dorothy Johnson’s theory defined nursing as “an external regulatory force which acts to preserve
the organization and integration of the patient’s behaviors at an optimum level under those
conditions in which the behavior constitutes a threat to the physical or social health, or in which
illness is found.”
 ROGERS’ THEORY OF UNITARY HUMAN BEINGS(1970)

• Rogers’ theory defined nursing as “an art and science that is humanistic and humanitarian. It is
directed toward the unitary human and is concerned with the nature and direction of human
development. The goal of nurses is to participate in the process of change.”
• According to Rogers, the science of unitary human beings contains two dimensions: the science of
nursing, which is the knowledge specific to the field of nursing that comes from scientific
research; and the art of nursing, which involves using the science of nursing creatively to help
better the lives of the patient.
DOROTHEA OREM: SELF-CARE DEFICIT THEORY(1971)

• Dorothea Orem’s self-care deficit theory defined nursing as “the act of assisting others in the
provision and management of self-care to maintain or improve human functioning at the home
level of effectiveness.” It focuses on each individual’s ability to perform self-care, defined as “the
practice of activities that individuals initiate and perform on their own behalf in maintaining life,
health, and well-being.”
• There are instances wherein patients are encouraged to bring out the best in them despite being
ill for a period of time. This is very particular in rehabilitation settings, in which patients are
entitled to be more independent after being cared for by physicians and nurses.
 The Neuman systems model views the client as an open system that responds to stressors
in the environment. The client variables are physiological, psychological, sociocultural,
developmental, and spiritual. The client system consists of a basic or core structure that is protected
by lines of resistance. The usual health level is identified as the normal defense line protected by a
flexible line of defense. Stressors are intra-, inter-, and extra personal in nature and arise from the
internal, external, and created environments. When stressors break through the flexible line of
defense, the system is invaded, and the lines of resistance are activated. The system is described as
moving into illness on a wellness-illness continuum. If adequate energy is available, the system will
be reconstituted with the normal defense line restored at, below, or above its previous level.
BETTY NEUMAN'S HEALTH CARE SYSTEMS
MODEL
 ROY ADAPTATION THEORY(1979)

• The Roy adaptation model defined the innate and acquired coping processes as two sub-systems .
The regulator subsystem consists of neuro-chemical and endocrine response. Internal and
external stimuli include social, physical and psychological factors. The cognator subsystem is
related more to attention, memory, learning, problem solving, decision-making, excitement, and
defense status.

• The four modes of adaptation defined in Roy adaptation model are physiologic, self-concept, role
function and interdependence modes. Nurses help to meet the needs of individuals in these
modes of adaptation.
ROY’S ADAPTATION MODEL
 JEAN WATSON THEORY OF HUMAN CARING( 1979)

• According to Watson’s theory, “nursing is concerned with promoting health, preventing illness,
caring for the sick, and restoring health.” It focuses on health promotion, as well as the treatment
of diseases. According to Watson, caring is central to nursing practice and promotes health better
than a simple medical cure.
• The nursing model also states that caring can be demonstrated and practiced by nurses. Caring
for patients promotes growth; a caring environment accepts a person as they are and looks to
what they may become.
 CLASSIFICATION OF NURSING THEORIES
DEPENDING ON THEIR FUNCTION:
1.Descriptive theories
2. Explanatory theories
3.Predictive theories
4.Prescriptive theories
DEPENDING ON THE GENERALISABILITY OF THEIR PRINCIPLES:
1. Meta theory
2. Grand theory
3. Middle-Range theory
4. Practice theory
 DISCRIPTIVE THEORY
• It is also known as “factor-isolating theories

 This is the primary level of theory development.

 Identify and describe major concepts of phenomena.

 Do not explain relationship of the concepts.

 Main aim is to present a phenomenon based on the five senses together with their
corresponding meaning.

• Example: a descriptive research about the Filipino nursing practices like Use of herbal
medicines and other alternative forms of treatment.
 EXPLANATORY THEORY

• It is also known as “factor-relating theories”

 This theory presents relationship among concepts and propositions.

 It provides information on how or why concepts are related.

 Cause and effect relationship are well explained in this type of

theory.

• Example: a research study about the factors affecting newborns

failing to thrive.
 PREDICTIVE THEORY
• It is also known as “situation-relating theories”

 They are achieved when the relationships of concepts under a certain

condition are able to describe future outcomes consistently.

 This theory is generated and tested using experimental research.

• Example: a theoretical model based on the observation of the effects of an

sanitary environmental condition on the recovery of the post-operative
patients.
 PRESCRIPTIVE THEORIES

• It also known as “situation-producing theories”

 Deal with nursing actions, and test the validity and certainty of a specific nursing
intervention.

 This kind of theory is commonly used in testing new nursing interventions.

• Example:
 META THEORY
• It is the theory concerned with the investigation, analysis, or description
of theory itself
• The theory of theory. Identifies specific phenomena through abstract
concepts.
• Metatheory a theory concerned with the investigation, analysis, or
description of theory itself. (Webster’s unabridged dictionary)
 GRAND THEORY
• Grand theories have the broadest scope and complex. It also called broad range
theories “systematic constructions of the nature of nursing, the mission of nursing
and the goals of nursing care”. Grand theories contain summative concepts
that incorporate smaller range theories. Provides a conceptual framework under
which the key concepts and principles of the discipline can be identified.

•Examples: Orem's self-care deficit theory of nursing, Martha e roger's unitary

human beings, Imogene king's system framework and theory of goal attainment
and Betty neuman's systems model.
 MIDDLE-RANGE THEORY
It is more precise and only analyses a particular situation with a
limited number of variables. Middle range theories are narrower in
scope than grand theories. It is effective bridge between grand theories
and nursing practice. It is more precise than grand theories and focus
on theoretical statement to answer about nursing. Many of these new
theories are built on content of related disciplines and brought into
nursing practice.
 PRACTICE THEORY
• Explores one particular situation found in nursing. It identifies explicit goals and
details how these goals will be achieved. It has the most limited scope and level of
abstraction. It is developed for use within a specific range of nursing situations.
Theories developed at this level have a more direct impact on nursing practice.
Nursing practice theory provides frameworks for nursing interventions and
predicts outcomes and the impact of nursing practice. This level theories also
known as prescriptive theory, situation-specific theory and micro theory.

EXAMPLE: Environmental theory, self care deficit theory,…

 OTHER THEORIES
Theories can also be categorized as:

 Needs theories.

 Interaction theories.

 Outcome theories.

 Humanistic theories.

 System theories.

These categories indicate the basic philosophical underpinnings of the theories.

 NEED THEORY
 These theories are based around helping individuals to fulfil their
physical and mental needs. The basis of these theories is well-
illustrated in roper, logan and Tierney's model of nursing (1980).

 Needs theories have been criticized for relying too much on the
medical model of health and placing the patient in an overtly
dependent position.
 INTERACTION THEORY

 As described by Peplau (1988), these theories revolve around the

relationship’s of nurses form with patients.

 Such theories have been criticized for largely ignoring the medical
model of health and not attending to basic physical needs.
 OUTCOME THEORY

 These portray the nurse as the changing force, who enables

individuals to adapt to or cope with ill health (Roy 1980).

 Outcome theories have been criticized as too abstract and difficult

to implement in practice (Aggleton and Chalmers 1988).
 HUMANISTIC THEORY
 Humanistic theories developed in response to the psychoanalytic thought that a person's
destiny was determined early in life.

 Humanistic theories emphasize a person's capacity for self- actualization.

 Humanists believes that the person contains within himself the potential for healthy and
creative growth.

 Carl rogers developed a person-cantered model of psychotherapy that emphasizes the

uniqueness of the individual.

 The major contribution that rogers added to nursing practice is the understanding that
each client is a unique individual, so person-cantered approach now practice in nursing.
 SYSTEM THEORY
 Systems theory is concerned with changes caused by interactions among all the factors
(variables).

 A system is defined as “a whole with interrelated parts, in which the parts have a function
and the system as a totality has a function” (Auger, 1976).

 A general systems approach allows for consideration of the subsystems levels of the human
being, as a total human being, and as a social creature who networks himself with others
in hierarchically arranged human systems of increasing complexity. Thus, the human
being, from the level of the individual to the level of society, can be conceptualized as the
client and becomes the target system for nursing intervention (Sills and Hall, 1977).
 SYSTEM THEORY
An example of systems interaction:

 Input

 Throughput

 Output

 Feedback

Two nursing models based on systems theory are:

 Imogene king's systems interaction model

 Betty Neuman's health care systems model.

 CRITICISMS OF NURSING THEORIES

 To understand why nursing theory is generally neglected on the wards it is

necessary to take a closer look at the main criticisms of nursing theory and the
role that nurses play in contributing to its lack of prevalence in practice.

 Use of language Scott (1994) states that the crucial ingredients of nursing theory
should be accessibility and clarity.

 One of the main criticisms of nursing theory is its use of overtly complex language
(Kenny 1993).

 It is important that the language used in the development of nursing theory be

used consistently
 CRITICISMS OF NURSING THEORIES
 Not part of everyday practice despite theory and practice being viewed as inseparable concepts, a theory-practice
gap still exists in nursing (upton 1999).

 Yet despite the availability of a vast amount of literature on the subject, nursing theory still means very little to
most practicing nurses. Perhaps this is because the majority of nursing theory is developed by and for nursing
academics (lathlean 1994).

 It has been recognized that traditionally nurses are used to ‘speaking with their hands’ (levine 1995).

 Therefore, many nurses have not had the training or experience to deal with the abstract concepts presented by
nursing theory.

 This makes it difficult for the majority of nurses to understand and apply theory to practice (miller 1985).
THANK YOU