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THEORY AND KEY CONCEPTS

  • Evolution of nursing theory is guided by the saying: "THEORY without PRACTICE is EMPTY; and PRACTICE without THEORY is BLIND.

  • ORIGINS: Theory comes from Latin/Greek roots; "THEORIA" meaning to speculate or contemplate.

  • What is THEORY?

    • An organized system of accepted knowledge composed of concepts, propositions, definitions, and assumptions intended to explain a set of facts, events, or phenomena.

    • An abstract statement formulated to predict, explain, or describe relationships among concepts, constructs, or events; tested by observation and research using factual data.

    • A creative and rigorous structuring of ideas that projects a tentative, purposeful, systemic view of phenomena.

  • COMPONENTS OF THEORY:

    • Concepts

    • Propositions

    • Assumptions

    • Definitions

  • WHAT IS CONCEPT?

    • An idea formulated by the mind or an experience perceived and observed such as justice, love, war, and disease.

    • Mental image of phenomenon

    • It is formed by generalized an abstract idea from our experiences

    • Building blocks of theories.

    • Types:

    • Indirectly observed or intangible (abstract): e.g., love, care, freedom.

    • Directly observed or tangible (concrete): e.g., nurse, mother, pain.

  • WHAT IS PROPOSITION?

    • Explains the linkages and interactions among the concepts in a theory.

    • Example: The relationship between fear of injections and children’s avoidance of staying in the hospital.

  • WHAT IS ASSUMPTION?

    • A statement that specifies the relationship or connection of factual concepts or phenomena; assumed to be true by the theorist.

    • Example: “All patients who are not able to take good care of themselves need nurses.”

  • WHAT IS DEFINITION?

    • Description that conveys general meaning and reduces vagueness in understanding a set of concepts.

  • SYSTEMATICALLY ORGANIZED

    • Theory comprises: Concepts, Propositions, Assumptions, Definitions.

  • PHENOMENA AND THEORY VIEW

    • Phenomena: sets of empirical data or experiences; can be observed.

  • TYPES OF THEORY ACCORDING TO PURPOSE

    • DESCRIPTIVE: To know the properties and workings of a discipline.

    • EXPLANATORY: To explain cause-and-effect relationships among properties or phenomena.

    • PREDICTIVE: To describe future outcomes under certain conditions (predict relationships).

    • PRESCRIPTIVE: Situation-producing theories; guide nursing actions and test the validity/certainty of a nursing intervention.

  • EXAMPLES OF DESCRIPTIVE THEORIES

    • Filipino nursing practices (herbal medicines, alternative treatments).

  • EXAMPLES OF EXPLANATORY THEORIES

    • Studies on factors affecting newborns’ failure to thrive.

  • EXAMPLES OF PREDICTIVE THEORIES

    • The capacity to predict outcomes given specific nursing circumstances.

  • EXAMPLES OF PRESCRIPTIVE THEORIES

    • Theories that specify nursing actions to produce desired health outcomes.

  • TYPES OF THEORY ACCORDING TO SCOPE (CATEGORIES OF THEORY)

    • 1) GRAND NURSING THEORIES: Broadest scope; general concepts and propositions; may not be empirically testable; e.g., Betty Neuman’s Systems Model.

    • 2) MIDDLE-RANGE NURSING THEORIES: Narrower scope; bridge between grand theories and practice; guide theory-based research and practice strategies.

    • 3) MICRO-RANGE (MICRO) NURSING THEORIES: Most concrete and narrow; situation-specific; limited to particular population or field of practice.

  • METAPARADIGMS OF NURSING

    • The meta-paradigm of nursing comprises four concepts:

    • PERSON (or PATIENT)

    • HEALTH

    • ENVIRONMENT

    • NURSING

  • CONNECTIONS TO FOUNDATIONAL PRINCIPLES

    • These frameworks guide how nurses think about care, research questions, and clinical decision-making.

  • ETHICAL/PHILOSOPHICAL IMPLICATIONS

    • Theories emphasize dignity, holistic care, intersubjectivity, autonomy, and the moral obligation to care.

  • PRACTICAL IMPLICATIONS

    • Theories inform nursing curricula, practice models, and evidence-based interventions.

  • BRIEF NOTE ON EVIDENCE-BASE (slide reference)

    • Evidence-based practice is framed within the evolution of nursing theory and its connection to science/history of nursing.

  • QUOTES AND CONTEXTUAL POINTS

    • Nursing theories are used to explain, describe, predict, and prescribe nursing care.

    • Theoretical models help nurses determine what to ask, observe, and focus on during practice.

THEORY AND KEY CONCEPTS: CONCEPTS AND DEFINITIONS

  • CONCEPTS: mental images or abstract ideas derived from experiences/observations; building blocks of theories.

  • TYPES OF CONCEPTS:

    • Abstract/Indirectly observed (e.g., love, care, freedom)

    • Concrete/Directly observed (e.g., nurse, mother, pain)

  • PROPOSITIONS: statements describing linkages between concepts.

  • ASSUMPTIONS: assumed truth about relationships among concepts.

  • DEFINITIONS: descriptions that convey general meaning and reduce vagueness, organizing concepts, propositions, assumptions, and definitions.

TYPES OF THEORY: PURPOSES AND EXAMPLES

  • DESCRIPTIVE THEORIES

    • Purpose: present a phenomenon through sensory description and meaning.

    • Example: Filipino nursing practices (herbal medicines, alternative treatments).

  • EXPLANATORY THEORIES

    • Purpose: explain causal linkages between factors; cause-and-effect relationships.

    • Example: factors affecting newborns’ growth and thriving.

  • PREDICTIVE THEORIES

    • Purpose: identify conditions under which relationships occur; forecast outcomes.

  • PRESCRIPTIVE THEORIES

    • Purpose: propose nursing actions and interventions; test their validity in practice.

    • Example: guidance on implementing a specific nursing intervention.

TYPES OF THEORY ACCORDING TO SCOPE (CATEGORIES OF THEORY)

  • GRAND NURSING THEORIES

    • Broad, general concepts; may reflect/guide practice but not always empirically testable.

    • Example: Betty Neuman’s Systems Model.

  • MIDDLE-RANGE NURSING THEORIES

    • Narrower scope; bridge between grand theories and practice; guide theory-based research and practice strategies.

  • MICRO-RANGE NURSING THEORIES

    • Most concrete and narrow; situation-specific; limited to specific populations or practice areas.

METAPARADIGMS OF NURSING

  • PERSON (PATIENT)

    • Recipient of care; holistic being (individuals, families, communities).

  • HEALTH

    • Holistic wellness; related to harmony but can be understood as health perception and functioning.

  • ENVIRONMENT

    • External and internal life factors influencing the person; environment can be manipulated to promote healing.

  • NURSING

    • Interventions and actions to promote health, described as both a knowledge domain and a caring practice.

NURSING PARADIGMS: KEY THEORETICAL FRAMEWORKS

  • FLORENCE NIGHTINGALE – ENVIRONMENTAL THEORY (NURSING AS ENVIRONMENTAL MODULATION)

    • Biography: Born May 12, 1820; known as the Lady with the Lamp; established nursing education.

    • Core idea: Nursing is an act of utilizing the environment to support recovery.

    • Five environmental factors (Nightingale’s Canons):

    • Ventilation and warming

    • Light

    • Cleanliness/Sanitation

    • Noise

    • Food

    • Also included: fresh air, pure water, drainage, bed and bedding, variety of conditions.

    • Focus: Create the best possible conditions for nature to act; deficiencies in these factors lead to illness; proper environment facilitates healing.

    • Conceptual framework includes: HOUSES/ENVIRONMENT, HOPES, CLEANLINESS, VENTILATION, LIGHT, NOISE, BEDDING, VARIETY, FOOD, AIR.

  • VIRGINIA HENDERSON – 14 BASIC NEEDS

    • The nurse assists the patient to achieve these 14 basic needs to function independently.

    • The list includes:

    • Breathing normally extBreathingext{Breathing}

    • Eating and drinking adequately extNutritionext{Nutrition}

    • Elimination

    • Movement and position

    • Sleep and rest

    • Personal hygiene and dressing

    • Maintaining body temperature

    • Keeping the body clean and well-groomed

    • Avoiding danger/harm

    • Communicating with others

    • Worshiping according to one’s faith

    • Working/achieving a sense of accomplishment

    • Playing or enjoying recreational activities

    • Learning, discovering, and satisfying curiosity

  • HILDEGARD PEPLAU – INTERPERSONAL RELATIONS THEORY

    • Emphasizes the therapeutic nurse–client relationship and the phases of the nurse-patient relationship.

  • LYDIA HALL – CORE-CARE-CURE MODEL

    • Three interrelated components: Core (person’s essential being), Care (nursing actions), Cure (medical treatment), applied to geriatric care.

  • MARY (MARTHA) ROGERS – SCIENCE OF UNITARY HUMAN BEINGS (SUHB)

    • Human beings are energy fields in continual interaction with the environment.

    • Postulates include: Energy fields, openness, pattern, and pan dimensionality.

    • Three principles of science of unitary health: Homeodynamics, Resonance, Helicy, Integrality.

    • Four-dimensional, negentropic, open system model; person and environment are inseparable.

    • Nursing process (assessment, mutual patterning, evaluation) focuses on total patterns in space-time and environmental fields.

  • JEAN WATSON – PHILOSOPHY AND SCIENCE OF CARING

    • Caring as the moral ideal of nursing; authentic caring preserves dignity and wholeness.

    • The essence: caring is a human science and a societal mission, blending arts and humanities with science.

    • Ten Carative Factors (not a checklist but a guiding framework):
      1) Forming a humanistic-altruistic system of values
      2) Enabling and sustaining faith-hope
      3) Cultivation of sensitivity to one’s self and others
      4) Developing a helping-trusting, caring relationship
      5) Promoting and accepting expression of positive and negative feelings
      6) Engaging in creative, individualized, problem-solving caring processes
      7) Promoting interpersonal teaching-learning
      8) Attending to human needs for privacy and safety in environments
      9) Assisting with gratification of human needs while preserving dignity
      10) Allowing existential phenomenological and spiritual dimensions of caring and healing

    • Transpersonal caring relationship: nurse and patient connect on a level beyond the physical, addressing meaning and wholeness.

    • Caring moment: a focal point in space and time when genuine caring occurs.

  • KATIE ERIKSSON – CARITATIVE CARING THEORY

    • Caritas: love, charity, and reverence for human dignity; caring is an ethical as well as existential practice.

    • Caring communion: intimate connection forming the basis of caring reality.

    • Suffering and reconciliation: suffering is ontological; reconciliation is transformation toward wholeness.

    • Dignity and culture: caring culture emphasizes respect for human dignity and cultural ethos.

    • Ethics of caring: caring as a manifestation of unconditional love (caritas) guiding healing.

  • BETTY NEUMAN – SYSTEMS MODEL (GRAND THEORY)

    • Focus on system-level factors affecting stressors and patient responses; conceptualizes protection of patient system boundaries.

  • OREM – GENERAL THEORY OF NURSING (SELF-CARE THEORY, SELF-CARE DEFICIT THEORY, NURSING SYSTEMS)

    • Metaparadigm: PERSON, ENVIRONMENT, HEALTH, NURSING

    • SELF-CARE THEORY: individuals perform self-care activities to maintain life, health, and well-being.

    • SELF-CARE AGENCY: ability to perform self-care; SELF-CARE REQUISITES: needs to be met via self-care.

    • HEALTH DEVIATION SELF-CARE REQUISITES: needs arising from illness/injury or medical treatment.

    • NURSING SYSTEMS THEORY: how self-care needs are met by nurse, client, or both; three classifications:

    • WHOLLY COMPENSATORY: nurse does all care

    • PARTIALLY COMPENSATORY: both nurse and client contribute

    • SUPPORTIVE-EDUCATIVE: nurse educates and supports self-care capacity

    • Five METHODS OF NURSING HELP: Acting for, Guiding, Teaching, Supporting, Providing an environment to support current/future self-care needs.

    • Conditioning factors: basic factors affecting Self-Care Agency, Self-Care Demands, and Nursing Agency (e.g., age, gender, health state, sociocultural factors).

  • PATRICIA BENNER – NOVICE TO EXPERT MODEL

    • Based on the Dreyfus model of skill acquisition; five levels: Novice, Advanced Beginner, Competent, Proficient, Expert.

    • Four domains of nursing: Person, Health, Environment/Situation, Nursing.

    • Key idea: experience in clinical settings expands knowledge and enables holistic, competent care; practice evolves from rule-based to intuitive decision-making.

  • MARTHA ROGERS, JEAN WATSON, FLORENCE NIGHTINGALE, VIRGINIA HENDERSON, KATE ERIKSSON, LYDIA HALL, HILDEGARD PEPLAU, PATRICIA BENNER, BETTY NEUMAN, OREM, LEININGER etc. (ADDITIONAL NURSES/THEORISTS APPEAR IN SLIDES)

DETAILED THEORETICAL MODELS AND THEIR CORE IDEAS

  • FLORENCE NIGHTINGALE – ENVIRONMENTAL THEORY (NURSING AS ENVIRONMENTAL MODULATION)

    • Core belief: Nursing is the act of utilizing the environment to assist in recovery.

    • Key environment factors (canons):

    • Ventilation and warming

    • Light

    • Noise

    • Cleanliness/Sanitation

    • Health of houses

    • Bed and bedding

    • Variety and Food

    • Health concept: Health is supported by a favorable environment; illness can be mitigated by environmental improvements.

    • Practice implication: NURSE manipulates environment to promote healing; emphasizes observation and sanitation, ventilation, cleanliness, nutrition, and humane care.

  • MARY (MARTHA) ROGERS – SCIENCE OF UNITARY HUMAN BEINGS (SUHB)

    • Ontology: Humans are energy fields in continuous interaction with the environment.

    • Postulates:

    • ENERGY FIELDS are living and non-living, dynamic and infinite.

    • OPEN SYSTEM with no rigid boundaries; perpetual openness.

    • PATTERN CHANGING continuously; identity of human-environment field.

    • PANN-DIMENSIONALITY: non-linear domain beyond traditional time/space.

    • POSTULATES DEFINED: energy fields, openness, pattern, pan dimensionality.

    • PRINCIPLES OF SCIENCE OF UNITARY HUMAN BEING:

    • HOMEODYNAMICS: dynamic, ever-changing life and world; includes resonance, helicy, integularity.

    • RESONANCE: constant fluctuations in frequency and pattern of fields.

    • HELICY: increasing diversity of field patterns.

    • INTEGRALITY: changing human and environmental fields are inseparable.

    • NURSING PROCESS IN SUHB: assessment of total patterns in space-time; voluntary mutual patterning; evaluation with ongoing pattern appraisal (nutrition, sleep, pain, relationships).

  • JEAN WATSON – PHILOSOPHY AND SCIENCE OF CARING

    • Core aim: authentic caring preserves dignity and wholeness; caring is a moral imperative and a human science.

    • Carative Factors (Ten): guided nursing practice beyond checklist; elements of caring moments and therapeutic relationships.

    • Transpersonal Caring Relationship: nurse connects with patient at a soul/meaning level; care extends beyond physical needs.

    • Caring Moment: a pivotal time where caring occurs; both nurse and patient are influenced by choices.

    • Health: unity of mind, body, and soul; illness may reflect inner disharmony; health is the ability to use one’s powers well.

    • Environment: part of caring framework; caring occurs within a supportive environment.

  • KATIE ERIKSSON – CARITATIVE CARING THEORY

    • Core concepts: caritas (love/charity) and reverence for human dignity; caring is a presence that alleviates suffering.

    • Caritative Caring vs. Nursing Ethics: distinguishes caring ethics from clinical nursing ethics.

    • Caring Communion: intimate, intentional connection between carer and patient; cannot be taken for granted.

    • Suffering: ontological concept; involves struggle and potential reconciliation to restore wholeness.

    • Reconciliation: transformation that creates new wholeness after suffering; sacrifice may be involved.

    • Caring Culture: ethos of care; traditions, rituals, values; culture can invite caring when it aligns with ethos.

  • VIRGINIA HENDERSON – 14 BASIC NEEDS (NURSING FUNCTION)

    • List (summary):

    • Breathing normally

    • Eating and drinking adequately

    • Elimination

    • Movement and position

    • Sleep and rest

    • Personal hygiene and dressing

    • Maintaining body temperature

    • Keeping the body clean and well-groomed

    • Avoiding danger

    • Communicating with others

    • Worshiping according to faith

    • Working for a sense of accomplishment

    • Playing or recreational activities

    • Learning, discovering, and satisfying curiosity

  • HILDEGARD PEPLAU – INTERPERSONAL RELATIONS THEORY

    • Emphasizes therapeutic nurse-client relationships, including orientation and working phases of interaction.

  • LYDIA HALL – CORE/CARE/CURE MODEL

    • Core: patient as a unique being; Care: nursing actions; Cure: medical interventions; applied to geriatric care.

  • SISTER CALLISTA ROY – ADAPTATION MODEL

    • Four adaptive modes: Physiologic-Physical, Self-Concept-Physical, Role Function, Interdependence.

    • Stimuli types: focal, contextual, and residual.

    • Nursing role: promote adaptation by influencing stimuli and providing coping resources.

  • LEININGER – CULTURE CARE THEORY (Culture Care Diversity and Universality)

    • Focus on culturally congruent care; care that respects and integrates cultural beliefs and practices.

SUMMARY OF KEY TERMS AND CONCEPTS TO KNOW FOR EXAM

  • Theory and its components: Concepts, Propositions, Assumptions, Definitions.

  • Types of concepts: Abstract vs. Concrete; Indirect vs. Direct.

  • Types of theory by purpose: Descriptive, Explanatory, Predictive, Prescriptive.

  • Types of theory by scope: Grand, Middle-range, Micro (Small) range.

  • Metaparadigms of nursing: Person, Health, Environment, Nursing.

  • Major theorists and their core ideas: Nightingale, Henderson, Peplau, Hall, Rogers, Watson, Eriksson, Orem, Benner, Neuman, Leininger, Roy, etc.

  • Core nursing actions and philosophical stances:

    • Caring as a moral and human science (Watson).

    • Caritas love and dignity in care (Eriksson).

    • Environment as a lever for healing (Nightingale).

    • Self-care and independence in patients (Orem).

    • Unitary human beings and energy-field worldview (Rogers).

    • Novice-to-expert development and clinical competence (Benner).

  • Practical implications: how these theories inform assessment, planning, intervention, and evaluation in nursing practice; role of evidence-based practice.

CONNECTIONS TO PRACTICE AND REAL-WORLD RELEVANCE

  • Theories guide what questions to ask in patient interviews, what observations to make, and what data to collect.

  • They inform the design of care plans, patient education, and the use of environment or holistic strategies to promote healing.

  • The ethical and philosophical dimensions (dignity, solidarity, culture, spirituality) shape patient-centered care and professional norms.

  • Comparative value of theories: some explain broad system interactions (Neuman), others emphasize patient self-management (Orem), others foreground caring and human connectedness (Watson, Eriksson), and others highlight professional development (Benner).

SELECTED NUMERICAL REFERENCES (FOR EXAM PURPOSES)

  • Year references and historical anchors: 19761976 (Nursing Theory intro slide date), Nightingale era (mid-1800s), Benner’s work published 1984-2000s ranges, Eriksson and others in late 20th century.

  • Percent figures observed in slides (used to gauge emphasis in lecture): 70 ext{%} appears multiple times (e.g., slide headers indicating emphasis).

  • Notation for key concepts uses standard numeric items (e.g., the ten carative factors, fourteen Henderson needs).

REMINDERS FOR EXAM PREP

  • Be able to define: theory, concepts, propositions, definitions, assumptions.

  • Distinguish between descriptive, explanatory, predictive, prescriptive theories.

  • Distinguish grand vs. middle-range vs. micro theories; give at least one example for each.

  • Memorize the four metaparadigms and a brief description of what each entails.

  • Memorize core propositions of Nightingale, Henderson, Orem, Rogers, Watson, Eriksson, Peplau, Benner, Neuman, Leininger, Hall, and Roy (as covered in class slides).

  • Be able to discuss how a theory would guide nursing practice in a concrete clinical scenario (assessment questions, intervention planning, evaluation criteria).

  • Understand the ethical and humanistic implications embedded in caring theories (Watson, Eriksson).

REFERENCES (FROM SLIDES)

  • “Evolution of Nursing Theory without Practice is EMPTY; and PRACTICE without THEORY is BLIND.”

  • Nightingale environmental canon list and notes on nursing as environmental manipulation.

  • Henderson’s 14 basic needs (as listed in lecture materials).

  • Peplau, Hall, Roy, Orem, Rogers, Watson, Eriksson, Benner, Neuman, Leininger, Nightingale, Hall, and other mentioned theorists and models were covered in lecture slides.

  • Metaparadigms: Person, Health, Environment, Nursing (as foundational nursing concepts).

  • The Ten Carative Factors and Transpersonal Caring Relationship (Watson).

  • The Core-Care-Cure Model (Lydia Hall).

  • The four domains of Benner’s framework and the Dreyfus model for skill acquisition.

  • The Science of Unitary Human Beings’ postulates and principles (Rogers).

  • Caritative Caring and Caring Communion (Eriksson).

  • Adaptation Model and Stimuli (Roy).

  • Culture Care Theory (Leininger).

  • Five methods of nursing helped by Orem’s theory.

SUMMARY OF KEY FORMULAS AND NOTATION

  • There are no explicit mathematical formulas in the slides; where numerical references appear, they are to be understood in context (e.g., years, percentages). If you must present them in math format for study cards, you can convert as follows:

    • Year references: 1976,1820,1861,1961,1966,1973,1990s,2011,1995−1996,2007,20091976, 1820, 1861, 1961, 1966, 1973, 1990s, 2011, 1995-1996, 2007, 2009

    • Percent emphasis: 70%70\%

    • Conceptual lists (no equations): presented as bullet-based schemas above.