Theoretical Foundation of Nursing

1st semester | Lectures & PPT | Ma’am Llorin

LECTURE 1 – EVOLUTION OF NURSING
- Nursing Theory explains, describes,
Introduction to Nursing Theory predicts, and prescribes nursing care
 “The systematic accumulation of knowledge is
essential to progress in any profession. However, Importance of Nursing Theory
theory and practice must be constantly interactive.”  Assist the nursing discipline in clarifying beliefs,
 Theory without practice is empty values, and goals
 Practice without theory is blind.  Help to define the unique contribution of nursing in
the care of clients
 Standards of clinical practice are developed out of
Definition of Terms nursing theories
o Theory
- Begin with observations (structure & function  FLORENCE NIGHTINGALE’s
- Observation leads to functional relation ENVIRONMENTAL THEORY
- Functional relations = facts
o Nursing Paradigms
- Immerge from generalization (broader to
simplified) - Patterns or models used to show a clear
- Set of scientific facts relationship among existing theoretical
- Abstract principles (concepts) works in nursing
- Constructed to explain particular basic facts as FOUNDATION OF NURSING THEORY
possible
– the metaparadigm consists of four fundamental concepts
 Scientific Theories begin with that define the nursing discipline and together they form
Scientific Facts the foundation for the field. The four concepts are
 Scientific theories emerge from
Person, Health, Environment, and Nursing.
generalizations
o Philosophy
Common Definition:
- the next knowledge level after
- Guess, Opinion, General Beliefs, metaparadigm. It specifies the definition of
Hypothesis, & System of ideas/statements metaparadigm concepts

Scientific Definition: o Conceptual Models

- representations of an idea or body of
- Set of scientific facts, abstract principles knowledge based on the own understanding
derive therefrom, and the use of those or perception of a person or researcher on a
principles to explain new facts certain topic.
- Present a systematic view of the - Input – Process – Output (IPO)
phenomenon by specifying relationships - Entry – Personal – Exit
among variables with the purpose of
explaining and predicting the phenomenon. o Science
- Includes preposition linking concepts in the - the organized body of knowledge gained
form of hypotheses to be tested through research.
o Nursing Theory Scientific Method:
- Systematic accumulation of knowledge  Observation
essential to progress in any education  Gathering Data
- Used to describe, develop, discriminate, and  Forming Hypothesis
use present knowledge in nursing  Experimental Investigation
- Set of concepts, definition, relationships,  Conclusion/ Theoretical Framework
and assumptions or propositions
o Knowledge
-
- Information, skills, and expertise
derived from nursing models or other acquired by a person through
disciplines formal/informal learning
- Project a purposive, systematic view of Sources of Knowledge:
phenomena by designing specific inter-
relationship among concepts  Tradition

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 refers to the knowledge, innovations, experienced and related to a particular

and practices of indigenous and local time or place.
communities around the world.  e.g stethoscope
 Authority  Abstract – non-observable; mentally
 a person with specialized expertise and
recognition for that expertise
constructed independently of a specific
time or place.
 Scientific inquiry/research  e.g self-concepts, beliefs
 the most objective and the source of
nursing knowledge. Basic Concept & Components of Nursing
 Research conducted within a
disciplined format is the most  Person Component
sophisticated method of acquiring
- Focuses on the receiver of care
knowledge that humans have
developed. - The person connection also includes family
 The current emphasis on evidence- members and other groups important to the
based health care requires nurses to patient
base their clinical practice—to the - Considers the person’s spiritual and social
extent possible. needs as well as health care needs
- Resulting health outcome is attributed to
 Personal experience
 individual knowledge shaped through
how the person interacts with these physical
being personally involved in situations and social connections
and events in practice. (intuition & tacit - The premise is that the person is empowered
knowledge) to manage his health and well-being with
dignity and self-preservation with positive
 Logical reasoning
personal connections
 combines experience, intellectual
faculties, and formal systems of
thought.  Health Component
 The intellect captures truth and - Refers to the extent of wellness and health
knowledge directly. care access that a patient has
- Characterized as one with multiple
o Phenomenon dimensions in a constant state of motion
- an idea or response about an event, a - Health and wellness cover a person’s
situation, a process, a group of events, or a lifespan and genetic makeup, and how the
group of situations. Phenomena may be physical, emotional, intellectual, social, and
temporary or permanent. Nursing theories spiritual well-being is integrated into health
focus on the phenomena of nursing. care for maximum health benefits
- sets of empirical data or experiences that can - The theory is that these factors influence the
be physically observed or tangible such as patient’s state of well-being
crying or grimacing when in pain
- Nursing phenomena have been defined as  Environmental Component
concepts, constructs, nursing diagnoses, - Theorizes that a person can modify her
human responses to actual or potential environmental factors to improve her health
illness, life processes, behaviors (signs), or status
experiences (symptoms). - Surroundings that affect the patient
- Response of an individual to actual/ - Consists of internal and external influences,
potential illnesses & life processes and contends that how a person continuously
interacts with her surroundings has a bearing
on health and wellness
o Concept - Interactions with family, friends and other
- Thought or notion people are part of the environment, as are
- often called the building blocks of theories. physical and social factors such as economic
They are primarily the vehicles of thought conditions, geographic locations, culture,
that involve images. social connections, and technology.
- to help describe or label a phenomenon
- Two types:  Nursing Component
 Empirical/Concrete – observed or - applies principles of knowledge, skills,
experienced through senses; Are directly technology, collaborations, professional

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judgment, and communication to carry out o Nursing theories and models are derived from concepts.
duties and responsibilities for achieving the
best possible scenario in patient health  Concept is an idea of an object, property or event.
outcome  Concepts are basically vehicles of thought involving
- involves the delivery of optimal health mental images.
outcomes for the patient through a mutual  In nursing, concepts have been borrowed from other
relationship in a safe and caring disciplines (culture, homeostasis) as well as
environment developed directly from nursing practice and research
- values a high degree of service, and (maternal-infant bonding).
integrates with other metaparadigm  Concepts are building blocks of theory
components for patient well-being

SUMMARY

o
T

he foundation of any profession is the development of a

specialized body of knowledge.

 In the past, the nursing profession relied on

theories from other disciplines, such as medicine,
psychology and sociology as a basis for practice.
 For nursing to define its activities and develop its Additional Knowledge:
research, it must have its own body of knowledge.
 Normal Sound of the Heart = Lub-dub
 This knowledge can be expressed as conceptual
MODELS and THEORIES.
 Primitive Heart Sound = Lub-dubdub

o Nursing theories and models provide information about:

 Definitions of nursing and nursing practice.

 Principles that form the basis for practice.
 Goals and functions of nursing.
 Clarifies the scope of nursing practice.

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LECTURE 2 – HISTORY OF NURSING THEORY
o Process
WHAT IS NURSING THEORY?
 “an organized framework of concepts and purposes
designed to guide the practice of nursing at a more
concrete and specific level”. - Processes are organized steps, changes, or
 Are organized bodies of knowledge to define what functions intended to bring about the desired
nursing is, what nurses do, and why they do it. result.
 Nursing theories provide a way to define nursing as a o Paradigm
unique discipline that is separate from other - A paradigm refers to a pattern of shared
disciplines understanding and assumptions about reality and
 Nursing as a PROFESSION, is committed to the world, worldview, or widely accepted value
recognizing its own unparalleled body of system.
knowledge vital to nursing practice—nursing o Metaparadigm
- most general statement of discipline and
science. To distinguish this foundation of
functions as a framework
knowledge, nurses need to identify, develop,
- more restricted structures of conceptual models
and understand concepts and theories in line
develop.
with nursing.
o Definitions
 Nursing as a SCIENCE, is based on the - Definitions are used to convey the general
theory of what nursing is, what nurses do, and meaning of the concepts of the theory.
why. Nursing is a unique discipline and is Definitions can be theoretical or operational.
separate from medicine. It has its own body of  Theoretical Definitions. Define a particular
concept based on the theorist’s perspective.
knowledge on which delivery of care is based.
 Operational Definitions. States how
 Nursing as an ART, is the nurse's ability to be concepts are measured.
compassionate, caring, and communicative. o Relational Statements
These behaviors enable nurses to - define the relationships between two or more
interpersonally connect with patients, a skill concepts. They are the chains that link concepts
that is critical to quality patient-centered care to one another.
o Assumptions
and deeply valued by patients and families.
- are accepted as truths and are based on values
and beliefs. These statements explain the nature
of concepts, definitions, purpose, relationships,
Definition of Terms and structure of a theory.
o Philosophy
- beliefs and values that define a way of thinking Importance of Nursing Theories
generally known and understood by a group or
discipline.  Nursing theories are the basis of nursing practice today.
o Models  In many cases, nursing theory guides knowledge
- Models are representations of the interaction development and directs education, research, and practice.
among and between the concepts showing  Historically, nursing was not recognized as an academic
patterns. They present an overview of the discipline or as a profession we view today.
theory’s thinking and may demonstrate how  Before nursing theories were developed, nursing was
theory can be introduced into practice. considered to be a task-oriented occupation; the
o Conceptual framework accomplishments of nursing led to the recognition of
- A conceptual framework is a group of related nursing in an academic discipline, research, and
ideas, statements, or concepts. It is often used profession
interchangeably with the conceptual model and  The training and function of nurses were under the
with grand theories. direction and control of the medical profession.

o Proposition To nursing practice:

- Propositions are statements that describe the
 Nursing theories help recognize what should set the
relationship between the concepts.
foundation of practice by explicitly describing nursing.
o Domain  By defining nursing, a nursing theory also helps nurses
- The domain is the perspective or territory of a
understand their purpose and role in the healthcare setting
profession or discipline.

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 The primary purpose of theory in nursing is to improve often subordinate to powerful institutional forces and
practice by positively influencing the health and quality of traditions, introducing any framework that encourages
life of patients. nurses to reflect on, question, and think about what they
do provide an invaluable service.
 Nursing theories are also developed to define and describe
nursing care, guide nursing practice, and provide a basis
for clinical decision-making.

Academic Discipline:

 Much of the earlier 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.
Who Develops Nursing Theories
 These models’ unique language was typically introduced  The majority of nursing theories are developed by
into program objectives, course objectives, course nurses, but at times other healthcare professionals,
descriptions, and clinical performance criteria. such as physicians have provided input into the
development of nursing theories.
 The purpose was to explain the fundamental implications
of the profession and enhance the profession’s status.  Nurse theorists often have a desire to explain, predict
and describe elements of nursing care and practice.
In Research
 Nurse theorists frequently draw from their academic
 The development of theory is fundamental to the research
and clinical experiences when formulating their
process, where it is necessary to use theory as a
theories. Many of the most clinically applicable
nursing theories have been developed by nurses who
are active in nursing practice and most acutely aware
of the current state of the healthcare environment.
Other times, nurse theorists are inspired by the works
of previous nurse theorists and incorporate portions
of another nursing theory into their own.

framework to provide perspective and guidance to the

research study.
HISTORY OF NURSING THEORY
 Theory can also be used to guide the research process by The first nursing theories appeared in the late 1800s
creating and testing phenomena of interest. when a strong emphasis was placed on nursing
 To improve the nursing profession’s ability to meet education.
societal duties and responsibilities, there needs to be a
 In 1860, Florence Nightingale defined nursing
continuous reciprocal and cyclical connection with
in her “Environmental Theory” as “the act of
theory, practice, and research.
utilizing the patient’s environment to assist him
 This will help connect the perceived “gap” between in his recovery.”
theory and practice and promote the theory-guided
practice.  In the 1950s, there is a consensus among nursing
scholars that nursing needed to validate itself
To Profession: through the production of its own scientifically
 Clinical practice generates research questions and tested body of knowledge.
knowledge for theory.

 In a clinical setting, its primary contribution has been the

facilitation of reflecting, questioning, and thinking about
what nurses do. Because nurses and nursing practice are

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 In 1972, Betty Neuman, in her theory, states

that many needs exist, and each may disrupt
client balance or stability. Stress reduction is the
goal of the system model of nursing practice.
 In 1979, Sr. Callista Roy viewed the individual
as a set of interrelated systems that maintain the
 In 1952, Hildegard Peplau introduced her balance between these various stimuli
Theory of Interpersonal Relations which (Adaptation Model).
emphasizes the nurse-client relationship as the
foundation of nursing practice.  In 1979, Jean Watson developed the philosophy
of caring, highlighting humanistic aspects of
 In 1955, Virginia Henderson conceptualized nursing as they intertwine with scientific
the nurse’s role as assisting sick or healthy knowledge and nursing practice (Theory of
individuals to gain independence in meeting 14 Human Caring).
fundamental needs. Thus her Nursing Need
THE HISTORY & EVOLUTION OF NURSING THEORY
Theory was developed.  ANCIENT CIVILIZATION
 In 1960, Faye Abdellah published her work – nursing was noted to be as old as time.
 It basically started from INSTINCT, HUMAN
“Typology of 21 Nursing Problems,” which NATURE, NURTURING, CARING, & NURSING.
shifted the focus of nursing from a disease-
centered approach to a patient-centered  EGYPTIAN RITES
approach.  health and healing beliefs of Ancient Civilization.
 SUPERSTITION AND BLACK MAGIC
 In 1962, Ida Jean Orlando emphasized the  Injuries from war and other tragic events.
reciprocal relationship between patient and nurse
and viewed nursing’s professional function as  BIBLICAL RECORDS
finding out and meeting the patient’s immediate  Jesus healing the wounded and inflicted.
need for help (Nursing Process Theory).  Good Samaritan law.

 In 1968, Dorothy Johnson pioneered the  CHRISTIAN ORGANIZATIONS AND ORDERS CRUSADES
 Knights of St. John of Jerusalem
Behavioral System Model and upheld the
 aka Knights of Hospitaller
fostering of efficient and effective behavioral  descendants are the Knights Templars
functioning in the patient to prevent illness.  The first nursing orders – Monastic Orders of St.
Augustine.
 In 1970, Martha Rogers viewed nursing as both
a science and an art as it provides a way to view  Sister of Charity
the unitary human being, who is integral to the  established by St. Vincent de Paul in France.
universe.
 Monastic Orders
 In 1971, Dorothea Orem stated in her theory  Order of deaconesses
that nursing care is required if the client is  Founded in Kaiserwerth, Germany
unable to fulfill biological, psychological,  Recognized the role of women in taking care of
developmental, or social needs (Self-Care the sick
 Initiated the establishment of training school for
Theory).
nurses.
 In 1971, Imogene King‘s Theory of Goal  Founders of the Training Schools: Pastor
Theodore Fliedner and Frederika Fliedner (wife)
attainment stated that the nurse is considered
part of the patient’s environment, and the nurse-  Founders of the orders
patient relationship is for meeting goals towards  Kaiserwerth Institute of Deaconesses
good health.  One of the students of this training school

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Florence Nightingale dedicated care, and compassion that make nursing a

o An English Lady from LECTUREa wealthy3 family during DEVELOPMENT
– HISTORICAL the critical element
OF THEORY of healthcare.
IN NURSING
victorian era
o During the Crimean war, she was known as the “Lady Historical Development of Theory
with a Lamp”  RATIONALISM
o A nursing theorist, writer, and statistician.
PRIOR TO FLORENCE NIGHTINGALE IS THE DARK - Rationalist epistemology (scope of knowledge)
AGE FOR NURSING BECAUSE… emphasizes the importance of a priori reasoning
as the appropriate method for advancing
Nursing is considered as : knowledge.
- A priori reasoning utilizes deductive logic by
o A very low job in terms of social hierarchy
reasoning from the cause to an effect or from a
o A job for the uneducated and poor generalization to a particular instance.
o A desperate occupation - An example in nursing is to reason that a lack of
social support (cause) will result in hospital
WHO are the Nurses? readmission (effect). This causal reasoning is a
theory until disproven. The traditional approach
o Women of the lowest social standing
proceeds by explaining hospitalization with a
o Wayward women of low status, instead of going to
systematic explanation (theory) of a given
prison, were asked to serve as nurses phenomenon.
o Monastic women or untrained helpers of low repute - This conceptual system is analyzed by
o Poor unmarried woman with no family or no chance addressing the logical structure of the theory and
of getting married the logical reasoning involved in its
development.
 Florence Nightingale changed the image of nursing - Theoretical assertions derived by deductive
 Dubbed as the “Lady with a Lamp” reasoning are then subjected to experimental
 NOTES ON NURSING (1859) testing to corroborate the theory.
 “What it is and What it is not” - Reynolds (1971) labeled this approach the
 SCHOOL OF NURSING theory-then-research strategy. If the research
 in 1860, Nightingale laid the foundation of findings fail to correspond with the theoretical
professional nursing when the first school of assertions, additional research is conducted or
nursing was established modifications are made in the theory and further
tests are devised; otherwise, the theory is
 Nightingale Training School at St. Thomas
discarded in favor of an alternative explanation
Hospital.
- Popper (1962) argued that science would evolve
 ENVIRONMENTAL THEORY
more rapidly through the process of conjectures
 maintaining a safe and clean environment to promote
and refutations by devising research in an
well-being.
attempt to refute new ideas.
 TRANSFORMATION OF NURSING INTO A
- For example, his point is simple; you can never
PROFESSION
prove that all individuals without social support
 Nightingale Nurses – Linda Richards, the first
have frequent rehospitalizations since there
American-trained nurse (1870) became a great
might be one individual that presents with no
nursing pioneer in USA and Japan
rehospitalization.
 Some nurses became the matrons at several
- A single person with no social support that does
leading hospital (St. Mary‘s, Westmisnter
Hospital, Royal Victoria Hospital, Sydney not have readmission disproves the theory that
all individuals with a lack of social support have
Hospital)
 Nightingale describes Nursing as: hospital readmissions.
- From Popper’s perspective, “research consists of
 SCIENCE – nursing is a body of specific
knowledge using empirics. generating general hypotheses
and then attempting to refute them. So the
 ART – nursing has its own way proper way of
hypothesis that a lack of social support
doing things and applying knowledge. (i.e. the
interaction between a health consumer and a
results in hospital readmission is a phenomenon
nurse.)
of interest to be refuted.
 Nursing is indeed an art and science. Science helps to
explain the work of a nurse, while art addresses the
 EMPIRISM
human connections, empathetic communication,

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- There was minimal interest in the history of

- The empiricist view is based on the central idea science, the nature of scientific discovery, or the
that scientific knowledge can be derived only similarities between the philosophical view of
from sensory experience (i.e., seeing, feeling, science and scientific methods.
hearing facts). - Positivism, a term first used by Comte, emerged
- Francis Bacon (1979) received credit for as the dominant view of modern science (1979).
popularizing the basis for the empiricist Modern logical positivists believed that
approach to inquiry. Bacon believed that empirical research and logical analysis
scientific truth was discovered through (deductive and inductive) were two approaches
generalizing observed facts in the natural world. that would produce scientific knowledge.
- This approach, called the inductive method, is - The logical empiricists offered a more lenient
based on the idea that the collection of facts view of logical positivism and argued that
precedes attempts to formulate generalizations, theoretical propositions (a proposition that
or as Reynolds (1971) called it, the research- affirms or denies something) must be tested
then-theory strategy. through observation and experimentation (1977).
- One of the best examples to demonstrate this - This perspective is rooted in the idea that
form of logic in nursing has to do with empirical facts exist independently of theories
formulating differential diagnoses. Formulating a and offer the only basis for objectivity in
differential diagnosis requires collecting the facts science.
and then devising a list of possible theories to - In this view, objective truth exists independently
explain the facts. of the researcher, and the task of science is to
- The strict empiricist view is reflected in the work discover it, which is an inductive method.
of the behaviorist Skinner. In a 1950 paper, - This view of science is often presented in
Skinner asserted that advances in the science of research method courses as: ―The scientist first
psychology could be expected if scientists would sets up an experiment; observes what occurs ….
focus on the collection of empirical data. reaches a preliminary hypothesis to describe the
- He cautioned against drawing premature occurrence; runs further experiments to test the
inferences and proposed a moratorium on theory hypothesis [and] finally corrects or modifies the
building until further facts were collected. hypothesis in light of the results.
Skinner’s (1950) approach to theory construction - The increasing use of computers, which permit
was clearly inductive. His view of science and the analysis of large data sets, may have
the popularity of behaviorism has been credited contributed to the acceptance of the positivist
with influencing psychology’s shift in emphasis approach to modern science.
from the building of theories to the gathering of - However, in the 1950s, the literature began to
facts between the 1950s and 1970s. reflect an increasing challenge to the positivist
- The difficulty with the inductive mode of inquiry view, thereby ushering in a new view of science
is that the world presents an infinite number of in the late twentieth century.
possible observations, and, therefore, the -
scientist must bring ideas to his or her
experiences to decide what to observe and what  Late Twentieth Century: An Emergent Views on
to exclude. Summary Science and Theory
- Deductive inquiry uses the theory-then-research
approach; - In the latter years of the twentieth century,
- Inductive inquiry uses the research-then-theory several authors presented analyses challenging
approach; the positivist position, thus offering the basis for
- Both approaches are utilized in the field of a new perspective of science.
nursing. - Foucault (1973) published his analysis of the
epistemology (knowledge) of human sciences
 EARLY TWENTIETH CENTURY VIEWS OF from the seventeenth to the nineteenth century.
SCIENCE AND THEORY - His major thesis stated that empirical knowledge
was arranged in different patterns at a given time
- During the first half of this century, philosophers and in a given culture and that humans were
focused on the analysis of theory structure, emerging as objects of study.
whereas scientists focused on empirical research - The Phenomenology of the Social World, Schutz
(1977). (1967) argued that scientists seeking to
understand the social world could not cognitively

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know an external world that is independent of and "self-actualization" to describe the pattern
their own life experiences. through which human motivations generally
- Phenomenology, set forth by Edmund Husserl move.
(1859 to 1938) proposed that the objectivism of - This means that in order for motivation to arise
science could not provide an adequate at the next stage, each stage must be satisfied by
apprehension of the world (Husserl 1931, 1970). the individual themselves.
- A phenomenological approach reduces - Additionally, this theory is the main base in
observations or text to the meanings of knowing how effort and motivation are
phenomena independent of their particular correlated when discussing human behavior.
context. This approach focuses on the lived Each of these individual levels contains a certain
meaning of experiences. amount of internal sensation that must be met in
- In 1977, Brown argued an intellectual revolution order for an individual to complete their
in philosophy that emphasized the history of hierarchy.
science was replacing formal logic as the major - The goal of Maslow's theory is to attain the fifth
analytical tool in the philosophy of science. level or stage: self-actualization.
- One of the major perspectives in the new
philosophy emphasized science as a process of  SYSTEMS THEORIES
continuing research rather than a product focused - Systems theory is the interdisciplinary study
on findings. In this emergent epistemology, the of systems. A system is a cohesive
emphasis shifted to understanding scientific conglomeration of interrelated and
discovery and process as theories change over interdependent parts which can be natural or
time. human-made.
- Empiricists view phenomena objectively, collect - Every system is bounded by space and time,
data, and analyze them to inductively propose a influenced by its environment, defined by its
theory. structure and purpose, and expressed
- This position is based upon objective truth through its functioning.
existing in the world, waiting to be discovered. - A system may be more than the sum of its
Brown (1977) set forth a new epistemology parts if it expresses synergy or emergent
challenging the empiricist view proposing that behavior.
theories play a significant role in determining - Changing one part of a system may affect
what the scientist observes and how it is other parts or the whole system. It may be
interpreted. possible to predict these changes in patterns
Non-Nursing Theories of behavior.
- For systems that learn and adapt, the growth
 ABRAHAM HAROLD MASLOW’S HUMAN and the degree of adaptation depend upon
NEED THEORY how well the system is engaged with its
- Abraham Harold Maslow was an American environment.
psychologist who was best known for creating - Some systems support other systems,
Maslow's hierarchy of needs. maintaining the other system to prevent
- The theory of psychological health is predicated failure.
on fulfilling innate human needs in priority, - The goals of systems theory are to model a
culminating in self-actualization. system's dynamics, constraints, and
- Maslow's hierarchy of needs is a motivational conditions, and to elucidate principles (such
theory in psychology (1943) comprising a five- as purpose, measure, methods, and tools)
tier model of human needs, often depicted as that can be discerned and applied to other
hierarchical levels within a pyramid. systems at every level of nesting, and in a
- From the bottom of the hierarchy upwards, the wide range of fields for achieving optimized
needs are: physiological, safety, love and equifinality.
belonging, esteem, and self-actualization. - General systems theory is about developing
- There is little scientific basis to the theory: broadly applicable concepts and principles,
Maslow himself noted this criticism. as opposed to concepts and principles
- Maslow's hierarchy of needs is used to study specific to one domain of knowledge.
how humans intrinsically partake in behavioral - It distinguishes dynamic or active systems
motivation. from static or passive systems.
- Maslow used the terms "physiological", "safety",
"belonging and love", "social needs" "esteem",

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- Active systems are activity structures or - The concepts addressed by grand theories
components that interact in behaviors and cannot easily be operationalized into
processes. variables or used in hypotheses.
- Passive systems are structures and - In his view, grand theory is more or less
components that are being processed. separate from concrete concerns of everyday
For example, a program is passive life and its variety in time and space
when it is a disc file and active when
it runs in memory

KEY CONCEPTS

- System: An entity made up of

interrelated, interdependent parts.
- Boundaries: Barriers that define a
system and distinguish it from other
systems in an environment.
- Homeostasis: The tendency of a
system to be resilient with respect to
external disruption and to maintain
its key characteristics.
- Adaptation: The tendency of a
system to make the internal changes
to protect itself and keep fulfilling its
purpose.
- Reciprocal Transactions: Circular or
cyclical interactions that systems engage in
such that they influence one another.
- Feedback Loop: The process by which
systems self-correct based on reactions from
other systems in the environment.
- Throughput: Rate of energy transfer
between a system and its environment over
time.
- Microsystem: The system closest to the
client.
- Mesosystem: Relationships among systems
in an environment.
- Exosystem: A relationship between two
systems that has an indirect effect on a third
system.
- Macrosystem: A larger system that
influences clients, such as policies,
administration of entitlement programs, and
culture.
- Chronosystem: A system composed of
significant life events affecting adaptation.

 GRAND THEORY
- Grand theory is a term coined by the
American sociologist C. Wright Mills in The
Sociological Imagination to refer to the form
of highly abstract theorizing in which the
formal organization and arrangement of
concepts takes priority over understanding
the social reality

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LECTURE 4 – FLORENCE NIGHTINGALE
 After receiving formal training at the Institute of St.
Historical Development of Theory Vincent de Paul in Alexandria, Egypt, she became
Florence Nightingale Theory 1820- 1910 Her Life Before the head nurse at a hospital in London.
Nursing  She made sure that the conditions of the hospitals
were very clean. Everything was washed
 Born in Florence, Italy  This helped to keep disease from spreading and the
 12 May 1820 patient's health improved faster
 named after the city of birth
 2nd daughter THE CRIMEAN WAR (1853-1856)
 a wealthy family from England
 Sidney Herbert, who sent British soldiers to fight
 educated by her father William with sister Parthenope
against Russia in the Crimean War, had heard of
& private teachers
Florence Nightingale and admired her work.
 excelled in math
 More wounded soldiers were dying from disease and
 love to read books & to write
infections they acquired in the field hospitals, than
 always scribble notes, write letters or writing in her died from the wounds of battle.
diary
 Sidney sent for Florence and her nurses to help.
 One of Florence Nightingale’s childhood homes –
 Florence came at once with a team of trained nurses.
Lea Hurst, Derbyshire
When they arrived, they had very little to work with.
 The Nightingales spent part of the year here and part There was no access to water and no medical
of the year in Hampshire equipment.
 Florence was a wealthy woman in the early 1800's.  Florence organized a kitchen and a laundry and
 During this time period, her "class" of women were worked very hard to improve the terrible conditions.
expected to get married, have children and throw  She worked up to 20 hours a day
parties for the other wealthy families of England.
 At night she would carry a lantern to the bedsides of
 Florence was not happy with the way her life was the wounded to check on them. The soldiers began to
supposed to be, and she knew she could make a call Florence, "The Lady with the Lamp".
difference in the lives of people, if she could serve
 The wounded would often kiss her shadow as it
would pass over their beds.
NURSING  Thousands of soldiers were saved because of the
work of Florence and her nurses.
 In 1844, Florence decided to go into the nursing
profession LATER IN LIFE
 This decision greatly upset her family
 Her parents refused to let Florence become a nurse.  In 1856, after the war, Florence returned to London a
 Nurses in England had a reputation for being national heroine.
drunken, untrained and uneducated.  In 1859, Florence wrote two books that were
 Nurses were people who cooked for the sick and published. Notes on Nursing and Notes on Hospitals.
sometimes bathed them.  In 1860, she opened the Nightingale Training
 Hospitals were dirty, smelly, overcrowded places that School.
were full of diseases.  Every time a "Nightingale" nurse was sent to a
 The only people in the hospitals were poor people faraway nursing job, Florence would have a bouquet
who could not afford a private doctor of flowers waiting for her arrival.
 Florence was heartbroken when she was told she  "Nightingales" were in great demand and came
could not become a nurse highly recommended.
 She fell into depression. Her parents finally
THE NIGHTINGALE SCHOOL OF NURSING
approved, and Florence began caring for the sick.
 She started by visiting them, bringing them clean  In 1861 she advised the United States Secretary of
cloths, good food and medicine. War on setting up army hospitals for the northern
soldiers, wounded in the Civil War.
 Her focus was on the patients' health.  In 1872, the International Committee of the Red
 She realized that once the patients were clean and Cross founder, Henry Dunant, testifies that his ideas
genuinely cared for, their health improved. were influenced by the work of Florence Nightingale
 Florence learned basic nursing skills while during the Crimean war.
volunteering in hospitals around Germany and France  In 1907, at the age of 87, Britain's King Edward VII
bestowed the Order of Merit on Florence

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Nightingale. She was the first woman to receive this affect life or biologic and physiologic processes, and
award which honors civilians for their services to his development.
Britain.  Nightingale discussed the Environmental Theory in
 1883 ROYAL RED CROSS her book Notes on Nursing: What it is, What it is
 1907 ORDER OF MERIT Not.
 Florence Nightingale died of old age in her sleep on  She is considered as the first theorist in nursing and
August 13, 1910 paved the way in the foundation of the nursing
 She was buried near to her parents’ home in profession we know today.
Hampshire.

HER CONTRIBUTION TO NURSING MAJOR CONCEPTS NURSING

 Florence Nightingale founded many schools of ―What nursing has to do… is to put the patient in
Nursing to provide sound theoretical and practical the best condition for nature to act upon him‖ –
basis in the training of nurses to care for the sick. Nightingale
 She was the first to stress on the following aseptic  Nightingale stated that nursing ―ought to signify the
precautions while caring for the patient. proper use of fresh air, light, warmth, cleanliness,
 Her favourite dictum was ―Do Patient No Harm” quiet, and the proper selection and administration of
diet – all at the least expense of vital power to the
 Florence is remembered today as the person
patient.‖
responsible for improving conditions in the hospitals
and making nursing an acceptable job  She reflected the art of nursing in her statement that,
―the art of nursing, as now practiced, seems to be
 Today, thenurses take the Florence Nightingale
expressly constituted to unmake what God had made
pledge before being formally initiated into the
disease to be, viz., a reparative process.‖
profession of nursing
HUMAN BEINGS

Human beings are not defined by Nightingale

“ The specifically. They are defined in relation to their
ultimate environment and the impact of the environment upon
them.
ENVIRONMENT

The physical environment is stressed by Nightingale

in her writing.
 In her theory, Nightingale’s writings reflect a
community health model in which all that surrounds
human beings is considered in relation to their state
of health.
HEALTH

 Nightingale (1859/1992) did not define health

destination of all nursing is the nursing of the sick in specifically. She stated, “We know nothing of health,
their own homes… I look to the abolition of all the positive of which pathology is negative, except
hospitals and workhouse infirmaries” for the observation and experience
 Given her definition that of the art of nursing is to
“unmake what God had made disease,” then the goal
FLORENCE NIGHTINGALE of all nursing activities should be client health.
 She believed that nursing should provide care to the
“ENVIRONMENTAL THEORY” healthy as well as the ill and discussed health
promotion as an activity in which nurses should
 The Environmental Theory by Florence Nightingale engage.
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 SUBCONCEPTS OF ENVIRONMENTAL THEORY
restoration of the patient‘s health, and that external
factors associated with the patient‘s surroundings  Health of Houses

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 ―Badly constructed houses do for the healthy what  This organic matter enters the sheets and stays there
badly constructed hospitals do for the sick. unless the bedding is changed and aired frequently.
 Once ensure that the air is stagnant and sickness is  She believed that the bed should be placed in the
certain to follow.” lightest part of the room and placed so the patient
could see out of a window.
Ventilation and Warming  She also reminded the caregiver never to lean against,
sit upon, or unnecessarily shake the bed of the
 ―Keep the air he breathes as pure as the external air, patient.
without chilling him.”
 Nightingale believed that the person who repeatedly Personal Cleanliness
breathed his or her own air would become sick or
remain sick  ―Just as it is necessary to renew the air round a sick
 She was very concerned about ―noxious air‖ and person frequently to carry off morbid effluvia from
foul odors that came from excrement the lungs and skin, by maintaining free ventilation, so
 She also criticized ―fumigations,‖ for she believed it is necessary to keep pores of the skin free from all
that the offensive source, not the smell, must be obstructing excretions.”
removed.  ―Every nurse ought to wash her hands very
 The importance of room temperature was also frequently during the day.”
stressed by Nightingale.
 The patient should not be too warm or too cold. Nutrition and Taking Food
 The temperature could be controlled by an
appropriate balance between burning fires and  Nightingale noted in her Environmental Theory that
ventilation from windows. individuals desire different foods at different times of
the day and that frequent small servings may be more
Light beneficial to the patient than a large breakfast or
dinner.
 Nightingale believed that second to fresh air, the sick  She urged that no business be done with patients
needed light. while they are eating because this was a distraction.
 She noted that direct sunlight was what patients
wanted.
Chattering Hopes and Advice
Noise
 Florence Nightingale wrote in her Environmental
 She stated that patients should never be “waked Theory that to falsely cheer the sick by making light
intentionally” or accidentally during the first part of of their illness and its danger is not helpful.
sleep.  She encouraged the nurse to heed what is being said
 She asserted that whispered or long conversations by visitors, believing that sick persons should hear
about patients are thoughtless and cruel. the good news that would assist them in becoming
 She viewed unnecessary noise, including noise from healthier.
female dress, as cruel and irritating to the patient.
Variety Social Considerations

 She discussed the need for changes in color and form,  Nightingale supported the importance of looking
including bringing the patient brightly colored beyond the individual to the social environment in
flowers or plants. which he or she lived.
 She also advocated rotating 10 or 12 paintings and
engravings each day, week, or month to provide ENVIRONMENTAL FACTORS
variety for the patient.
 Nightingale also advocated reading, needlework, In Florence Nightingale’s Environmental Theory, she
writing, and cleaning as activities to relieve the sick identified five (5) environmental factors: fresh air, pure water,
of boredom. efficient drainage, cleanliness or sanitation, and light or direct
sunlight.
Bed and Bedding
1. Pure fresh air – “to keep the air he breathes as pure as
 Nightingale noted that an adult in health exhales the external air without chilling him. ”
about three pints of moisture through the lungs and 2. Pure water – “well water of a very impure kind is
skin in a 24-hour period. used for domestic purposes. And when epidemic

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disease shows itself, persons using such water are  Still, above all this, it is very much clear the
almost sure to suffer.” Nightingale’s Environmental Theory is superb as a
3. Effective drainage – “all the while the sewer maybe starting point of the progression of our profession and
nothing but a laboratory from which epidemic disease served as a catalyst for nursing’s improvement.
and ill health is being installed into the house.”
4. Cleanliness – “the greater part of nursing consists in
preserving cleanlines” ASSUMPTIONS
5. Light (especially direct sunlight) – “the usefulness of
light in treating disease is very important.” The assumptions of Florence Nightingale in her
 The factors posed great significance during Environmental Theory are as follows:
Nightingale’ s time when health institutions had poor
 Florence Nightingale believed that five points
sanitation, and health workers had little education
were essential in achieving a healthful house:
and training and were frequently incompetent and
“pure air, pure water, efficient drainage,
unreliable in attending to the needs of the patients.
cleanliness, and light.”
 Also emphasized in her environmental theory is the
 A healthy environment is essential for healing.
provision of a quiet or noise-free and warm
She stated that “nature alone cures.
environment, attending to patient’s dietary needs by
 Nurses must make accurate observations of their
assessment, documentation of time of food intake,
patients and be able to report the state of the
and evaluating its effects on the patient.
patient to the physician in an orderly manner.
 Deficiencies in these five factors produce illness or
 Nursing is an art, whereas medicine is a science.
lack of health, but with a nurturing environment, the
Nurses are to be loyal to the medical plan, but
body could repair itself.
not servile.

ANALYSIS – ENVIRONMENTAL FACTOR Strength

 In the era that we are in today, we are faced with  The language Florence Nightingale used to
environmental conditions beyond what was ought to write her books was cultured and flowing,
be natural and nurturing. logical in format, and elegant in style.
 Some of the global environmental issues that we have  Nightingale’s Environmental Theory has
now are global warming, nuclear radiation threats, broad applicability to the practitioner.
manmade environmental calamities, and pollution.  Her model can be applied in most complex
 From these occurrences, Nightingale‘s model seemed hospital intensive care environment, the
to be very ideal. Her concept of providing fresh air to home, a work site, or the community at
patients is in question with today‘s industrialization large.
effects.  Reading Nightingale’s Environmental
 In addition to the analysis of the concept of Theory raises consciousness in the nurse
ventilation, it is not always beneficial for all clients to about how the environment influences client
have fresh air. outcomes.
 Natural air has its impurities which in turn may infect
open wounds and drainages such as in burns. Weaknesses
 With the idea of providing light, the light emitted by
 In Nightingale’s Environmental Theory,
the sun today is proven to be harmful already because
there is scant information on the
of the destruction of the ozone layer of the Earth.
psychosocial environment when compared
 Exposing the patient constantly to direct sunlight may to the physical environment.
then be more destructive to the patient’s betterment
 The application of her concepts in the
than being beneficial.
twentieth century is in question.
 It is true that a healthy environment heals as what
Nightingale stated but the question now is how our CONCLUSION
environment would remain health amidst the negative
effects of the progress of technology and
industrialization.
 The Environmental Theory of Nursing is a patient-
 Since the applicability of some of the concepts to care theory.
specific situations today is non-feasible, development
 It focuses on the alteration of the patient’s
of Page | 33 this theory is utterly needed to
environment in order to affect change in his or her
accommodate the changes of the environment that we
health.
currently have.

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 Caring for the patient is of more importance rather “There is no part of my life, upon which I can look back
than the nursing process, the relationship between without pain.”
patient and nurse, or the individual nurse.
 In this way, the model must be adapted to fit the “Moses was the greater man; for whereas Plato only formed a
needs of individual patients. school, which formed the world, Moses went straight to work
 The environmental factors affect different patients upon the world.”
unique to their situations and illnesses, and the nurse
must address these factors on a case-by-case basis in
order to make sure the factors are altered in a way NURSING CONTRIBUTION
that best cares for an individual patient and his or her
needs. Appointed resident lady superintendent of An Establishment
for Gentlewomen During Illness
LECTURE 4A LIFE HISTORY In 1854 assembled party of 38 nurses to serve in Crimean War
a) Born on May 12, 1820, Florence, Italy Founded the Nightingale School and Home for Nurses at Saint
Thomas’ Hospital in London
b) Raised in Derbyshire, England
Wrote Notes on Nursing, the first textbook for nurses
c) Felt called by God to serve Him on February 7, 1837 d)
Never married; marriage would destroy the chance of her
serving God's call
MATHEMATICAL CONTRIBUTION
e) Died in London on August 13, 1910
 Developed a Model Hospital Statistical Form for hospitals to
collect and generate consistent data and statistics
EDUCATION Published statistical graph in 1859 which showed the losses of
 Home schooled by her father the British army in the Crimean war
 Trained in nursing at the Institute of Saint Vincent de Used data to persuade the Government to improve army
Paul in Alexandria, Egypt. hygiene
 Studied at the Institute for Protestant Deaconesses at
Kaiserswerth, Germany. Created spectacular graphics designed to show how
improvements in hygiene could save many lives
HONORS First to create a line chart which showed death rates of soldiers
a) Became first woman to receive the British Order of in peacetime
Merit Credited with inventing the pie chart
b) Crimean Monument in Waterloo Place, London was
erected in her honor
c) King Edward VII bestows the Order of Merit; it isthe
first time that the Order is given to a woman CLASSIFICATION OF NURSING THEORIES
d) Became a Fellow of the Royal Statistical Society
e) Honorary member of the American Statistical 1. By Abstraction
Association- There are three major categories when classifying nursing
theories based on their level of abstraction: grand theory,
QUOTES OF FLORENCE NIGHTINGALE middle-range theory, and practice-level theory.

“To be a good nurse one must be a good woman, or one is

truly nothing but a tinkling bell”
Grand Nursing Theories
“….Till a married woman can be a possession of her own
 Grand theories are abstract, broad in scope and
property there can be no love or justice.”
complex, therefore requiring further research for
“You can arrest in some degree the course of the knave, but clarification.
with the fool you don’t know where you will find him next.”  Grand nursing theories do not provide a guidance for
specific nursing interventions but rather provide a
general framework and ideas about nursing.

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 Grand nursing theorists develop their works based on

their own experiences and the time they were living
explaining why there is so much variation among Explanatory Theory
theories.
Explanatory theories describe and explain the nature of
 Address the nursing metaparadigm componenets of
relationships of certain phenomena to other phenomena.
person, nursing, health, and environment.

Middle-Range nursing theories Prescriptive Theories

 More limited in scope (as compared to grand  Address the nursing interventions for a phenomenon, guide
theories) and present concepts and propositions at a practice change, and predict consequences.
lower level of abstraction. They address a specific
phenomenon in nursing.  Includes propositions that call for change.
 Due to the difficulty of testiung grand theories,
nursing scholars proposed using this level of theories.  In nursing, prescriptive theories are used to anticipate the
 Most middle-range theories are based on the works of outcomes of nursing interventions.
a grand theorist but they can be concieved from
research, nursing practice, or the theories of other
discipliune.
Other Ways of Classifying Nursing Theories Classification
Practice-level Nursing Theories According to Meleis

 Practice nursing theories are situation specific  Afaf Ibrahim Meleis (2011), in her book Theoretical
theories that are narrow in scope and focuses on a Nursing: Development and Progress, organizes the major
specific patient population at a specific time. nurse theories and models using the following headings: needs
 Practice-level nursing theories provide frameworks theories, interaction theories, and outcome theories. These
for nursing interventions and suggest outcomes or the categories indicate the basic philosophical underpinnings of
effects of nursing practice. the theories.
 Theories developed at this level have a more direct
effect on nursing practice as compared to more
abstract theories. 1. Needs-Based Theories.
 These theories are interrelated with concepts from  The needs theorists were the first group of nurses who
middle-range theories or grand theories
thought of giving nursing care a conceptual order. Theories
under this group are based on helping individuals to fulfill
2. By Goal Orientation
Theories can also be classified based on their goals, they can their physical and mental needs. Theories of Orem,
be descriptive or prescriptive. Henderson, and Abdella are categorized under this group.
Need theories are criticized for relying too much on the
Descriptive Theories medical model of health and placing the patient in an overtly
dependent position.
Descriptive theories are the first level of theory development.
They describe the phenomena and identify its properties and 2. Interaction Theories.
components in which it occurs.  These theories placed the emphasis of nursing on the
establishment and maintenance of relationships and highlight
Descriptive theories are not action oriented or attempt to the impact of nursing on patients and how they interact with
produce or change a situation. the environment, people, and situations. Theories of King,
There are two types of descriptive theories: factor-isolating Orlando, and Travelbee are grouped under this category.
theory and explanatory theory. 3. Outcome Theories.
 These theories describe the nurse as controlling and
directing patient care by using their knowledge of the human
Factor-Isolating Theory physiological and behavioral systems. Nursing theories of
Johnson, Levine, Rogers, and Roy belong to this group.
Also known as category-formulating or labeling theory.
Theories under this category describe the properties and Classification According to Alligood
dimensions of phenomena.

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 In her book, Nursing Theorists and Their Work, Raile

Alligood (2017) categorized nursing theories into four
headings: nursing philosophy, nursing conceptual models,
nursing theories and grand theories, and middle-range nursing
theories.

1. Nursing Philosophy.
 Is the most abstract type and sets forth the meaning of
nursing phenomena through analysis, reasoning, and logical
presentation. Works of Nightingale, Watson, Ray, and Benner
are categorized under this group.

2. Nursing Conceptual Models.

 Are comprehensive nursing theories that are regarded by
some as pioneers in nursing. These theories address the
nursing metaparadigm and explain the relationship between
them. Conceptual models of Levine, Rogers, Roy, King, and
Orem are under this group.

3. Grand Nursing Theories

 Are works derived from nursing philosophies, conceptual
models, and other grand theories that are generally not as
specific as middle-range theories. Works of Levine, Rogers,
Orem, and King are some of the theories under this category.

4. Middle-Range Theories.
 Are precise and answer specific nursing practice questions.
They address the specifics of nursing situations within the
perspective of the model or theory from which they are
derived. Examples of Middle-Range theories are that of
Mercer, Reed, Mishel, and Barker

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LECTURE 5 – JEAN WATSON’S THEORY

JEAN WATSON

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