MODULE 1: The 1980’s

EVOLUTION OF NURSING THEORY • Many nursing theories were revised based on the research
findings that expanded them • “Nurses Times”, magazine that
first questioned Racism in the Nursing Profession.
SIGNIFICANT HIGHLIGHTS
• “Nurses Times”, magazine that first questioned Racism in the
Florence Nightingale (1859/1992)
Nursing Profession.
• History of professional nursing began with Florence Nightingale
o “Envisioned nurses as a body of educated women”
The 1990’s
• “Notes on Nursing” presents the first nursing theory that focus • Research studies that tested & expanded nursing theories were
on the manipulation of the environment for the patient’s numerous.
benefit.
• Mid 1800's -Nightingale described a nurse proper function is NURSING KNOWLEDGE ERAS
putting the patient in the best condition for nature to act upon Curriculum Era (1900-1940s)
him or her • It emphasized on courses included in nursing programs.
The Columbia School (The 1950’s) • Goal is to develop specialized knowledge & higher education.
• The need to prepare the nurses at the graduate level for • 1930's a standardized curriculum had been published and
administrative & faculty positions was recognized. adopted by diploma programs
• The first intensive care units were established and created the • hospital based
specialty of critical care nursing 1950's - Awareness of the • emergence of nursing education into colleges and universities
need to develop nursing theory • course selection and content for nursing programs
• 1956 – Columbia University School of Nursing Offered the first Research Era (1950s-1970s)
Master’s Degree in Nursing • This era emphasizes role of nurses and what to research.
o emergence of nursing as a science
• Period wherein Research Studies has been incorporated in the
The Yale School & The 1960’s curricula
• The focus of theoretical thinking in moved from problem/need • Connection between Concept and Development Theory
& functional role focus to the relationship between the nurse & • Two (2) Major Milestone in this Era:
the patient. o Standardization of curricula for a nursing master’s education by the
• Over 5,000 nurses served during the war National League for Nursing
o Higher-degree programs – doctoral education for nurses should be in
• 1960’s – Part of the Graduate Education Era (Alligood)
nursing (Alligood, 2014).
• Carving out an advanced role and basis for nursing practice
Graduate Education Era (1950’s – 1970’s)
• Focus graduate education on knowledge development
• Emphasis is carving out in an advanced role & basis for nursing
• Era that introduced Research in Clinical Nursing Practice
practice.
The 1970’s
• Master's degree in nursing emerged to meet the need for
• Research Emphasis Era
nurses for specialized clinical practice
• Higher education - research is the path to new nursing
• Nursing courses include concept development and nursing
knowledge
models, introducing students to early nursing theorist
o (First Doctoral Program for Nurses Case Western Reserve University)
• Nurse researchers - worked to develop and clarify a
• nursing research revealed that nursing studies lacked
specialized body of nursing knowledge with the goal of:
conceptual connections and theoretical framework
o improving the quality of patient care
• Many nursing theories were first presented. Most of these o providing professional style of practice
theories have been revised since their original presentation o achieving recognition as a profession
Theory Era (1980-1990s)
• The emphasis is that there are many ways to think about
nursing. Emergent goal is that theories guide nursing research
& practice.
• Research and theory were required to produce nursing science
• Nursing Metaparadigms has been introduced (Person, Health,
Nursing, Environment)
Theory Utilization Era (21st Century)
• theory application in nursing practice, education and Significance of Nursing Theory
administration and research • It recognized nursing as an academic discipline and a
• middle range theory and valuing of nursing framework for profession.
thought and action of nursing practice was realized Nursing • It led to the development of a body of substantive knowledge to
theory guides research, practice, education & administration. guide nursing practice.
• Theory based nursing, evidence – based nursing practice and • It guides critical thinking in nursing practice.
future theory development • It recognizes that theory informs practice and practice informs
• Quality care in all areas of practice theory.
• It is the backbone of clinical care.
NURSING THEORY • It is a tool for reasoning and decision making for quality nursing
Discipline practice.
• A discipline is specific to academia and refers to a branch of • It has taken nursing to higher levels of education and practice.
education, a department of learning, or a domain of Rationalism VS Empiricism
knowledge.
Profession
• A profession refers to a specialized field of practice, founded on
the theoretical structure of the science or knowledge of that
discipline and accompanying practice abilities.
Nursing Theory
• “Is a group of interrelated concepts that are developed from The Early 20th Century Theory
various studies of disciplines and related experiences”, Balita & • Development of knowledge was mainly affected by the
Octaviano, 2008. different nursing leaders and theorist of the early 20th century.
• “An articulated and communicated conceptualization of • Evolution of Nursing Science throughout the time was further
invented or discovered reality (central phenomena and studied and tested that led to the contemporary practices of
relationships) in or pertaining to nursing for the purpose of nursing.
describing, explaining, predicting, or prescribing nursing care”, • Role of nurse became more defined.
Meleis, 1991. • As nursing is evolving it brings into being the different theories
• “Nursing Theory is one that has context, content and process”, that guides clinical practice. It uses evidence-based science to
Bernum, 1994. support the intervention performed in the care of patients.
 NURSING METAPARADIGM • It emphasizes scientific research is important to nursing

Person knowledge.
• Clinical and conceptual knowledge are the keys to nursing
• The recipient of nursing care
practice.
Environment
• Empirical knowing focuses on evidence-based research for
• The internal and external surrounding that affect the patient
effective and accurate nursing practice.
Health
Evidence-based Practice
• Holistic level of wellness that the person may experience
• It involves accurate and thoughtful decision making about
Nursing health care delivery for clients.
• The interventions of the nurse rendering care in support of or in • This is based on the result of the most relevant and supported
cooperation with the client. evidence derived from research in response to preferences
and expectations.
• It promotes quality care that has been demonstrated to be
KNOWLEDGE STRUCTURE LEVEL
effective.
Metaparadigm AESTHETIC
• Global concept that identifies phenomenon
• Also known as Esthetics Knowing.
Philosophy • Deals with the emphatic (primary form) aspect of Nursing.
• Are broad address general ideas about nursing • The art and act of nursing and is gained through practice and
Conceptual models critique.
• Set of concepts and statement • Related to understanding what is of significance to particular
Grand theory patients such as feelings, attitudes, points of view (Carper,
• Broad, scope, and highly abstract 1978).
Theory • The manifestation of the creative and expressive styles of the
• Is organize, coherent set of concepts and their relationship with nurse (Kenny, 1996)
each other that offers explanation, and prediction about • Knowing the distinctive characteristic of the individual instead
phenomena. of the typical, stereotype whole.
ETHICAL
SOURCES OF KNOWLEDGE • Describes, analyzes, and clarifies moral obligation and values
in nursing.
Authoritative
• The moral directions of Nursing.
• An idea by a person of authority which is perceived as true
• It requires knowledge of different philosophical positions what
because of his or her expertise.
is good and right in making moral actions and decisions,
Scientific
particularly in the theoretical and clinical components of
• Knowledge that arrived at through scientific method
nursing.
Traditional
• It includes all deliberate nursing actions involving and under
• Knowledge that is pass down from generation to generation
the jurisdiction of ethics and professionalism (Kenny, 1996)
• The code of morals or code of ethics that leads the conduct of
FOUR WAYS OF KNOWING nurses is the main basis for Ethical Knowing.
EMPIRICAL • It is deeply rooted in the concept of human dignity, service and
• The scientific discipline of Nursing. respect for life.
• The science of nursing, the knowledge gained through • Lessening suffering, upholding and preserving health is one of
empirical research. the key elements why nursing is a core service in society
• It is the information source or base of knowing.
PERSONAL ▪ Have a stronger relationship with research and
• It involves therapeutic use of self. practice.
• It takes a lot of time to fully know the nature of oneself in ▪ Are specific to nursing practice and specify the area
relation to the world around. of practice, age range of the patient, nursing action
• It stresses that human beings are not in a fixed state but are or intervention, and proposed outcome.
constantly engaged in a dynamic state of changes. (Kenny, ▪ It focuses on concepts of interest to nurses: pain,
1996) empathy, grief, self-esteem, hope, comfort, dignity
• Gained through practicing nursing and interacting with and quality of life.
patients and through thinking, listening and reflecting.

ANALYSIS AND EVALUATION OF THEORY

STRUCTURE LEVEL OF NURSING KNOWLEDGE • Fawcett (1989) distinguishes analysis and evaluation.
Philosophies of Nursing (Metatheory) ANALYSIS VS. EVALUATION
• It set forth the general meaning of nursing and nursing
phenomena through reasoning and the logical presentation of
ideas.
• They are broad and address general ideas about nursing.
Because of their breadth, nursing philosophies contribute to the
discipline by providing direction, clarifying values and forming
a foundation for theory development (Alligood, 2006).
• They are theoretical works that address one or more
metaparadigm concepts and are philosophical in nature.
Conceptual Models of Nursing (Grand Theories) Criteria In Evaluating a Theoretical Work according to
• Also called paradigms or frameworks. Chinn & Kramer (1991)
• It is composed of abstract and general concepts and Clarity
propositions that provide a frame of reference for members of • Semantics (study of the meaning of language, symbols and
the discipline. This frame of reference determines how the logic) and structure are considered important.

world is viewed by the members of a discipline and guide the Simplicity

• Adequately comprehensive at a level of abstraction to offer
members as they propose questions and make observations
direction however, it must have as few concepts as possible
relevant to the discipline (Fawcett, 1944).
having simple relations to assist clarity.
• It is a set of concepts and statements that integrate the
Generality
concepts into a meaningful configuration.
• The scope of concepts and goals within the theory.
Nursing Theories • Situation in which the theory is applicable should be boundless.
• It is a conceptualization of some aspect of reality (invented or The broader the scope, the greater its significance.
discovered) that pertains to nursing. The conceptualization is Empirical Precision
articulated for the purpose of describing, explaining, predicting • The degree in which the defined concepts are observable in
or prescribing nursing care (Meleis, 2007, p.41). actual setting. It is in line with the testability and ultimate use
• They vary in scope and level of abstraction: of the theory.
o Middle-range theory Derivable consequences
▪ Moderately abstract, comprehensive, organized • It should lead itself to research testing which would result to
within a limited scope and have a limited number of additional knowledge that would guide practice.
variables, which are testable in a direct manner.
• It should give direction to research and practice, create new • Are words or phrases that are used to represent the
ideas, and ought to distinguish the focus of nursing to other phenomenon observed or experienced. It is a mental construct.
professions. It must develop and guide practice. Theoretical
INTERDEPENDENCE OF • Described according to how these concepts are
defined in the dictionary.
NURSING PRACTICE, NURSING THEORY & NURSING
Operational
RESEARCH • Based on how these concepts are used or will be used
within the context of the phenomenon being observed
or experienced.
Abstract
• Indirectly observed or intangible.
• It is independent of time and place.
Concrete
• Directly observed or tangible.
• Relate more to a specific time or place.
Proposition
• Explains the relationships of different concepts.
• Observations in nursing practice, questions raised and
Definition
conceptual models are formulated – leads to theory
• Composed of various descriptions which convey a general
development and testing through research.
meaning and reduces the vagueness in understanding a set of
• Theory interacts with and guide nursing practice.
concepts.
• Research validates and modifies theory, which then changes
Assumption
nursing practice.
• A statement that specifies the relationship or connection of
factual concepts or phenomena.
THEORY
• Statements that the theorists hold as factual.
Theory
Hypothesis
• A vision or a beholding scene
• Educated guesses.
• Comes from the Greek word “theoria”
• A tentative explanation for an observation, phenomenon or
• Is an explanation of a set of related observations or events
scientific problem that can be tested by further investigation.
based upon proven hypotheses and verified multiple times by
• A testable relationship statement.
detached groups of researches.
Theoretical Model or Framework
• A set of concepts, definitions, relationships and assumptions
• A highly established set of concepts that are testable.
that projects a systematic view of phenomenon. (Potter –
• Represents an equation that describes the path or explains the
Perry)
phenomenon being observed or experienced.
• An organized system of accepted knowledge that is composed
• It is typically accompanied by a pictorial representation of
of concepts, propositions and assumptions intended to explain
these variables and their interrelationships.
a set of fact, event or phenomena.
Phenomenon
COMPONENTS OF A THEORY • Occurrence or circumstance that is observed, something that
Concept impresses the observer as an extraordinary or a thing that
• Building blocks of theories which can either be an empirical or appears to and is constructed by the mind.
abstract data. • Observable fact that can be perceived through the senses and
• An idea formulated by the mind or an experience perceived explained.
and observed such as justice, love, war, and disease. • An empirical data that can be observed.
• It is concerned with how an individual person reacts using the
human senses concerning their surrounding and assessing the CHARACTERISTICS OF A THEORY
different behaviors and factors that affect such behaviors. • Theories can correlate concepts in such a way as to generate a
OTHER TERMINOLOGIES different way of looking at a certain fact or phenomenon.
Philosophy • Theories must be logical in nature.
• Comes from the greek word “philisopia” which means love of • Theories should be simple but generally broad in nature.
knowledge or love of wisdom. • Theories can be the source of hypothesis that can be tested for
• The study of the most general and abstract features of the it to be elaborated.
world and categories with which we think: mind, matter, • Theories contribute in enriching the general body of knowledge
reason, proof, truth, etc. through the studies implemented to validate them.
Conceptual Models • Theories can be used by practitioners to direct and enhance
• Are representations of an idea or body of knowledge based on their practice.
the own understanding or perception of a person or researcher • Theories must be consistent with other validated theories, laws,
on a certain topic, phenomena or theory. and principles but will leave open unanswered issues that need
• Also called paradigms or frameworks. It is a set of concepts to be tested.
and statements that integrate the concepts into a meaningful
configuration. PURPOSES OF NURSING THEORY
• They can be represented thru a diagram or in narrative form Education
which shows how concepts are interrelated. • Provides a general focus for curriculum design.
Science • Guide curricular decision making.
• Comes from the Latin word “scientia” meaning “knowledge”. Research
• Knowledge attained through study or practice. • Offer a framework for generating knowledge and new ideas.
• A system of acquiring knowledge based on scientific method or • Assist in discovering knowledge gaps in specific field of study.
research. • Offer a systematic approach to identify questions for study,
Research select variables, interpret findings and validate nursing
• Use of systematic methods to study a phenomenon and create interventions.
a general knowledge. (Powers and Knapp) Practice
• SCIENCE = RESEARCH + THEORY • Assist nurse to describe, explain and predict everyday
Induction experiences.
• A type of reasoning that uses specific details to form a general • Serve to guide assessment, intervention and evaluation of
conclusion. nursing care.
Deduction • Provide a rationale for collecting reliable and valid data about
• A type of reasoning wherein general conclusions that are made the health status of clients, which are essential for effective
based from specific concepts. decision making and implementation.
Epistemology • Help establish a criteria to measure the quality of nursing care.
• Branch of inquiry that is concerned with the theory of • Help build a common terminology to use in communicating
knowledge or how knowledge came to be. with other health professionals. Ideas are developed and words

Law defined.
• Enhance autonomy of nursing by defining its own independent
• A statement of fact that aims to explain, in brief and simple
functions.
terms, an action or set of actions.
• It is generally accepted to be true and universal.
 SOURCES OF KNOWLEDGE
Knowledge
• Information, skills and experience acquired by a person
through various life experiences or formal/informal learning.
• The abstract or workable understanding of a subject or idea.
• What is known in a particular field or discipline or study.
• Facts and information or awareness or familiarity gained by
experience of a fact or situation.
COGNITIVE PROCESS
• PERCEPTION – achieving understanding of sensory idea.
• ASSOCIATION – combining two or more concepts/ideas to
form a new concept, or for comparison.
• LEARNING – acquiring experience, skills, information and
values.
• REASONING – mental process of seeking conclusions through
reason.
• COMMUNICATION – transferring data from sender to receiver
using different mediums or tools of communication