Theoretical Foundations in Nursing - Study Notes

Course Overview

Course Code/Number: $NCM ext{ }100$
Course Title: Theoretical Foundations in Nursing
Course Credit/Units: Theory: $3$ Units
Course Total Expected Hours: $54$ lecture hours
Course Description: This course deals with nursing theories as applied to nursing practice on the aspect of the metaparadigm: person, health, environment and nursing. The learners are expected to use these theories as basis and guide in nursing practice.
Learning Outcomes (end of the lesson):
- a. Integrate relevant concepts & metaparadigm of theories on Person, Health, Environment & Nursing in nursing practice.
- b. Apply appropriate nursing concepts & actions holistically and comprehensively.
- c. Appreciate the value of evidence-based nursing practice in the application of nursing & related models/theories.
- d. Ensure a working relationship utilizing relevant concepts/theories of effective communication & interpersonal relationship in nursing practice.
- e. Discuss relevant concepts of collaboration with interpersonal, cultural & related theories.
- f. Describe specific management & leadership concepts & principles in selected theories.
- g. Assume responsibility for lifelong learning, own personal development & maintenance of competence.
EVOLUTION OF NURSING
- A. Introduction to Nursing Theory
- 1. History of Nursing Theory
- 2. Significance for the Discipline & Profession
- B. History of Philosophy of Science
- 1. Rationalism
- 2. Empiricism
- 3. Early 20th Century Views
- 4. Emergent Views
Changes of Education in Nursing (timeline highlights)
- 1874 – The St. Catherine Training School was the first hospital diploma school in Canada where the nursing program moved from apprenticeship to an educational model.
- 1881 – The school for Nurses at the Toronto General Hospital was established.
- 1896 – Mary Agnes Snively developed a 3-year course with 84 hours of practical nursing and 119 hours of instruction by the medical staff.
- 1918 – Following World War I, the influenza pandemic led to support for public health programs and new health care delivery patterns.
- 1919 – The first undergraduate nursing degree program was established at the University of British Columbia.
- 1932 – Demand for transfer of responsibility for nursing education to the general educational system.
- 1950s and 1960s – Experiments with two-year programs for nursing began and the movement to separate nursing education from hospital authority began.
- 1967 – Laurentian University started student intake.
- 2000 – All professional nurses are required to have a bachelor’s degree.
EVOLUTION OF NURSING THEORY
- Since the early $1950$ ’s many nursing theories have been systematically developed to help describe, explain and predict the phenomena of concern to nursing.
A. Introduction to Nursing Theory
- Florence Nightingale – envisioned nurses as a body of educated women, when women were neither educated nor employed in public service.
- She spent her time organizing and caring for the wounded during the Crimean War.
- Her vision and establishment of a school of nursing at St. Thomas Hospital in London mark the birth of modern nursing.
- She was an English lady from a wealthy family during the Victorian era.
- During the Crimean War she was known as the “Lady with the Lamp.”
- A nursing theorist, writer and statistician.
History of Nursing Theory
- The word nurse is derived from the Anglo-French nurice and the Latin word nutrice, both of which mean NOURISH.
- Florence Nightingale’s pioneering activities in nursing practice and her writings served as a guide for establishing nursing schools in the US at the beginning of the 20th century.
- In the last century, nursing began with a strong emphasis on practice.
- Throughout that century, nurses worked toward the development of the profession in what has been viewed as successive HISTORICAL ERAS.
HISTORICAL ERAS
- Curriculum Era: Moving nursing education from hospital-based programs into college and universities.
- Research Era: Research is the path to new knowledge. Part of the curricula of developing graduate programs.

Evolution of Nursing Theory (Expanded)

Since the early $1950$ s, nursing theories have been developed to help describe, explain, and predict nursing phenomena.
A. Introduction to Nursing Theory (continued)
- Florence Nightingale’s contribution is foundational to modern nursing theory and education.
- The shift from practice-focused to theory-informed education marks a key transition in professional identity.

Nursing Theory: Core Concepts and Purpose

BSN – 1D Theory – system of ideas proposed to explain a given phenomenon.
Nursing Theory – a body of knowledge that describes and explains nursing and is used to support nursing practice. (Udan, 2011)
- It predicts and prescribes nursing care or nursing practice.
- It is an organized and systematic articulation of a set of statements related to questions and the discipline of nursing.
Purpose of Nursing Theory
- Guides nursing practice and generates knowledge.
- Helps to describe or explain nursing.
- Provides a perspective to define the what of nursing, the who of nursing, and when nursing is needed.
- Identifies the boundaries and goals of nursing therapeutic activities.
- Enables nurses to know WHY they are doing WHAT.

Significance of Theory for Nursing as a Discipline and a Profession

Discipline vs Profession
- Discipline: academic, related to a branch of education or area of knowledge (e.g., nursing as a discipline).
- Profession: a specialized field of practice founded on theoretical structure of the science and accompanying practice abilities.
Significance for Nursing as a Discipline
- 1. University baccalaureate programs proliferated; master’s programs developed; curricula standardized through accreditation.
- 2. Attention to nursing conceptualizations for research; role of conceptual framework in research; publication of theoretical works.
- 3. Works recognized for their theoretical nature (e.g., Nightingale, Henderson, etc.).
Significance for Nursing as a Profession
- Nursing theory clarifies beliefs, values, and goals.
- Defines the unique contribution of nursing in client care.
- Standards of clinical practice are developed from nursing theories.
- Criteria for a profession guide the development of the profession.
Nursing Theory and the Practicing Nurse
- Theory assists the practicing nurse to organize patient data, understand patient data, analyze patient data, and make decisions about nursing interventions.
- Plan patient care and evaluate patient outcomes.

History and Philosophy of Science

1) Rationalism
- A belief that humans can arrive at truth by using reason rather than relying on past authority, religious faith, or intuition.
- The rationalist view is evident in Einstein’s work, using mathematical equations to develop theories.
- Epistemology: theory of knowledge, what knowledge is and how we deal with it.
- Rationalism is a doctrine that holds that knowledge is derived from reason rather than experience; reason is the ultimate source of knowledge and test of validity.
3 Major Theses of Rationalism
1. Knowledge is derived from intuition (or rational insight) and deductive reasoning, rather than sense perception.
2. The ideas or concepts that constitute the mind’s ability to think are innate.
3. Knowledge of a particular thing is innate.
Implications for rationalists: reality has an intrinsically logical structure; truths exist and the intellect can grasp them directly; these truths are self-evidently true and their negation is self-evidently false.
2) Empiricism
- Based on the central idea that scientific knowledge can be derived only from sensory experience.
- Uses objective and tangible data perceived by the senses to observe and collect data.
- Data are used to formulate knowledge via inductive reasoning.
- In nursing, empiricism is important for patient assessment throughout the nursing process.
- Empiricism: knowledge begins with experience; mind is a blank slate (Tabula rasa) that ideas are molded into by experience.
- Denies innate ideas.
Epistemology and related terms
- A priori: knowledge independent of experience; used in attempting to launch conclusions before experience.
- A posteriori: knowledge derived from experience.
- Innate ideas: ideas you are born with.
- Tabula rasa: the mind starts as a blank slate to be filled by experience.
Conceptual contrasts (Rationalism vs Empiricism)
- Innate ideas, Reason, Deduction vs Induction, Sense perception.
- A priori vs A posteriori.
- Knowledge from experience/experimentation vs knowledge from reason and logic.
- Experimental science as paradigm of knowledge; Mathematics as paradigm; empirical certainty vs rational certainty.
2) Early 20th Century Views
- Nursing leaders recognized the need for a knowledge base for professional nursing practice.
- Nurses worked toward developing substantive nursing knowledge over the last century, first to gain recognition as a profession, then to deliver care as professionals.
- History provides context for understanding nursing theory and rationale for theory in professional practice.
Basic terminology for nursing theory
- Nursing: Recognized profession; Goal: delivering care to patients as professionals.
3) Emergent views
- Empiricists argued that science must maintain objectivity with data collection and analysis independent from theory.
- Brown (1997) argued that new epistemology challenges empiricist view of perception by acknowledging theories play a significant role in determining what scientists observe and how it is interpreted.
- Brown identified three views of the relationship between theories and observation:
- 1. Scientists are merely passive observers; observable data are objective truth waiting to be discovered.
- 2. Theories structure what the scientist perceives in the empirical world.
- 3. Presupposed theories interact with observable data in the process of scientific investigation.