TFN Module 1: Overview of Nursing Theories PDF

ANGELES UNIVERSITY FOUNDATION Angeles City COLLEGE OF NURSING NCM 0100 THEORETICAL FOUNDATIONS IN NURSING 1st Semester, A....

ANGELES UNIVERSITY FOUNDATION Angeles City COLLEGE OF NURSING NCM 0100 THEORETICAL FOUNDATIONS IN NURSING 1st Semester, A.Y. 2024-2025 MODULE 1 OVERVIEW OF NURSING THEORIES Module Overview Thinking about Nursing is as important as doing Nursing. The nurses who practice nursing and who teach nursing must know the structure of the discipline of Nursing. Nurses have traditionally based nursing practice on their experiences or the way they were taught. These methods are not necessarily based on scientific practice. Practice that is based on theories makes it possible to derive a rationale for nursing action. Therefore, practice must be based on a sound theoretical background. As the science of nursing develops, nurses will be able to accurately understand and explain past events and predict future events. Practices based on science will support the image of nursing as a discipline. Nursing has been described as a human service concerned with the health and well-being of individuals and groups, specifically a helping service concerned with aiding individuals to accomplish goals for themselves which they are unable to accomplish without help from others. Nursing is a caring profession practiced with an earnest concern for the art of care and the science of health. Although many nurses of the early eras delivered excellent care to patients, much of what was known about nursing was not written down and research to document the effectiveness of the care they delivered was not recorded. Hence, nurses began to move toward the goal of developing nursing knowledge upon which to base their practice. As a profession, nursing is a science, which is involved in identifying its own unique body of knowledge essential to nursing practice. To identify a knowledge base, nurses must develop and recognize concepts and theories that are specific to nursing. The profession involves a humanistic blend of scientific knowledge and holistic nursing practice. Nursing – what it is today is the result of changes in the scientific, technological, political, social and economic climate. Through the years, the concept of Nursing has been expanded and subsequently, the role of the nurse has become broader to meet the changing needs of the society. Learning Outcomes LO1: Integrate relevant principles of social and health sciences in understanding a nursing theory – its characteristics, components, and purpose LO2: Employ the understanding of a nursing theory in the formulation of own definition of the four major concepts TFN Module 1: Overview of Nursing Theories 1 Learning Objectives Upon completion of this module, the student should be able to: 1. Define the terms: Concept, Theory, and Metaparadigm 2. Identify the components and characteristics of a theory 3. Provide the definition of nursing theory 4. Discuss the purposes of nursing theory 5. State the criteria in analyzing a nursing theory 6. List the components of a metaparadigm 7. Enumerate, in order, the structural hierarchy of contemporary nursing knowledge 8. Construct their own nursing paradigm with definition of the four major concepts Definition of Key Terms Before going through this module, the student is advised to read the following terms: Concept – an idea or complex mental image of a phenomenon; the basic ingredient of a theory Conceptual model – a group of concepts that are associated because of their relevance to a common theme; it broadly explains phenomena of interests, expresses assumptions, and reflects a philosophical stance Hypothesis – a testable relationship statement Nursing - is “a dynamic discipline. It is an art and a science of caring for individuals, families, groups and communities geared toward promotion and restoration of health, prevention of illness, alleviation of suffering and assisting clients to face death with dignity and peace. It is focused on assisting the client as he or she responds to health-illness situations, utilizing the nursing process and guided by ethico-legal moral principles.” (Association of Deans of Philippine Colleges of Nursing – ADPCN) Phenomenon – a subject matter of discipline. In the mid twentieth century, American nurses identified their phenomena of concern as human beings and their environments Research – is the application of systematic, scientific methods to study phenomena and generate knowledge Science – the process of observation, identification, description, experimental investigation, and theoretical explanation of natural phenomena; an activity that combines theory (knowledge) and research (advancement of knowledge) Theory – an organized system of accepted knowledge that is composed of concepts, propositions, definitions and assumptions that is intended to explain a set of fact, event or phenomena Definition of Theory A theory is an organized system of accepted knowledge that is composed of concepts, propositions, definitions and assumptions intended to explain a set of facts, events or phenomena. It is derived from the Greek word theoria meaning “a vision, contemplation, speculation, and looking at.” The development of a theory is viewed as a rational and intellectual process leading to the discovery of truth. TFN Module 1: Overview of Nursing Theories 2 Components of a Theory CONCEPTS are the elements used to generate theories; it is an abstract notion; a vehicle of thought that involves images; they are composed of words that describe a phenomenon (any objects, properties, or events). Concepts are the major components of theory. Concepts can be classified as an abstract concept or a concrete concept. 1) ABSTRACT CONCEPTS – independent of a specific time or place; they are indirectly observable Example: hope, freedom, language 2) CONCRETE CONCEPTS – specific to time and place; they are observable with the use of the senses Example: a person’s features such as eye color, height or weight, a chair, a book in nursing, there are four major concepts and are as follows: 1.) person; 2.) nursing; 3.) health; and 4.) environment. These major concepts are presented according to the different views of various nursing theorists and their models. Example: The concept of PERSON by Roy emphasizes a person’s adaptation as a central phenomenon, whereas Rogers emphasizes the person as a unified whole. Therefore, various nursing theorists and their models define the major concepts differently, link the concepts in various ways, and emphasize the relationship among concepts differently because each theorist has different experiences and perceptions. PROPOSITIONS (also called principles) are theoretical statements that specify the proposed relationships of the concepts of a theory. It helps to explain the relationship between and among the different concepts in a theory. Proposition statements are the chains that link the building blocks to build a theory. DEFINITIONS are composed of various descriptions which convey a general meaning and reduce the vagueness in understanding a set of concepts. Definitions also give meaning to concepts. It makes the concepts clearer and better understood. An example is the DEFINITION OF NURSING formulated by Virginia Henderson that states: “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health, its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible” TFN Module 1: Overview of Nursing Theories 3  There are two types of definitions: theoretical or descriptive definition and operational stipulative definition. Below is a table that shows the difference between the two forms of definition. Theoretical Definition Operational Definition or or Descriptive/ Conceptual Definition Stipulative Definition = refers to the accepted meaning of the = the specific use or definition of the term term already used within the theory = comparable to a definition from a = specifies exactly how the concept will literature such as a dictionary, be determined and assessed; it also encyclopedia, and journals identifies the procedures and operations significant to determine concepts. Example 1: body temperature – Example 1: body temperature – homeothermic range of one’s internal degree of temperature measured by oral environment maintained by the thermometer taken for 1 minute under thermoregulatory system of the human the tongue body Example 2: ambulation – to walk from Example 2: ambulation – taking 6 one place to another or to move about steps without assistance ASSUMPTIONS are statements that the theorist or researcher holds as truth and excludes from measurement and testing. They are statements that specify the relationship or connection of factual concepts or phenomena. PURPOSE specifies the context and situation within which the theory is formulated. It answers the question “Why is the theory formulated?”. It suggests a direction in how to view facts and events. Characteristics of a Theory 1) Systematic, logical and coherent There must be orderly reasoning and no contradictions between and among the concepts. There must be proper sequencing of ideas and propositions or theoretical assertions. 2) Creatively structured ideas Concepts are the building blocks of a theory, and they are the mental images resulting from one’s experiences and perceptions. Therefore, when these concepts are interrelated, they create ways of looking at a particular phenomenon, event or object. 3) Tentative, simple, and generally broad in nature A theory can change over time, implying that it is evolving and dynamic. A theory is open to revision as new evidence emerges. As further research and studies are done and as they are enriched by practice, theory can change. However, there are also theories that remain valid in spite of time. 4) Theories can be the source of hypotheses that can be tested for it to be TFN Module 1: Overview of Nursing Theories 4  elaborated. 5) Theories contribute to enriching the general body of knowledge through the studies implemented to validate them. 6) Theories can be used by practitioners to direct and enhance their practice 7) Theories must be consistent with other validated theories, laws and principles but will leave open unanswered issues that need to be tested. DEFINITION OF NURSING THEORY Different nursing theorists from different times and ages have specifically contributed to Nursing Theories. To help understand the definition of nursing theories, below is the list of definitions of nursing theory as viewed by various authors. A nursing theory is a set of concepts, definitions, relationships and propositions derived from nursing models for the purpose of: 1. Describing a phenomena 2. Explaining relationships between a phenomena 3. Predicting consequences of a nursing action 4. Prescribing nursing care According to Barnum, a complete nursing theory is one that has the following components: 1. Context = resembles the environment to which nursing act takes place 2. Content = subject of the theory 3. Process = method by which a nurse acts in using nursing theory Nursing theory is also the term given to the body of knowledge that is used to support nursing practice. Purposes of Nursing Theory Studying nursing theories develops analytical skills and critical thinking ability for the purpose of safe and effective nursing practice. 1) Theory guides and improves nursing practice. Nursing theory was primarily used to develop and guide nursing education in universities. It was once known to be more strongly established in the field of academics rather than in clinical practice. In the 1970s and 1980s, a number of nursing programs recognized the MAJOR CONCEPTS of some NURSING MODELS, structured these concepts into CONCEPTUAL FRAMEWORK, and built the complete curriculum around that framework. With these models, they were able to direct the entire education system to create a more comprehensive curriculum. These theoretical concepts primarily prepare students for practice as members of the professional community. (EDUCATION) Nursing theory gives direction and purpose to nurse practitioners. Without the nursing theories, actions of nurses would be without sound basis and its ideas would be questionable, thus the practitioners would be frail, divided and dangerous. Theory provides the nurse with goals for nursing care. By being goal directed, nursing practice is rendered more efficient and effective. Also, past and present problems in nursing might be solved through the use TFN Module 1: Overview of Nursing Theories 5  of theories. As nursing theory evolves through the repeated process of use-and-testing, nurses become more confident and gain more control over practice because their actions are based on tested theory (evidence-based practice). (CLINICAL PRACTICE) Nursing theory guides critical thinking and decision-making in clinical nursing practice. It enables nurses to have a better understanding of the basis and nature of their work. Nursing theory strengthens professional independence because it guides the deepest and most important part of clinical practice and promotes collaboration with other professionals. Thus, the purpose of nursing theory in education and clinical practice primarily is “to ensure adequate and quality nursing delivery, and to clarify and improve the status of Nursing as a profession”. 2) Theory guides research. According to Meleis, “the primary use of theory is to guide research.” Theory offers a framework for generating knowledge and new ideas by serving as the base for hypothesis testing. Theory is a rich source for research problems. It can assist in identifying knowledge gaps in a specific field of study through identification of questions for study, interpretation of findings, and validation of nursing interventions. Thus, it works as a two-way process: a nursing theory helps guide research and research findings help validate and improve nursing theory. 3) Theory contributes to the development of the discipline’s body of knowledge. Nursing must have a foundation of theoretical knowledge that is based on research findings. Theory in nursing describes, explains, predicts and controls phenomena or events in order to achieve desired outcomes. Theory can show relationships between and among concepts to create a different way of understanding a nursing phenomenon. Nursing theory serves as an excellent help in the development and expansion of knowledge to support nursing education, research and clinical practice. 4) Theory enhances communication. Theory provides a common language so that nursing could be described and explained by common concepts. Thus, nursing theories create a better link between nurse practitioners, nurse educators, nurse researchers and nurse administrators. ANALYSIS OF NURSING THEORY Analysis, critique, and evaluation are methods used to study nursing theoretical works critically. Analysis of theory is carried out to acquire knowledge of theoretical adequacy. It is an important process and the first step in applying nursing theoretical works to education, research, administration, or practice. The analysis process is useful for learning about the works and is essential for nurse scientists who intend to test, expand, or extend the works. When nurse scientists consider their research interests in the context of one of the theoretical works, areas for TFN Module 1: Overview of Nursing Theories 6 further development are discovered through the processes of critique, analysis, and critical reflection. Therefore, analysis is an important process for learning, for developing research projects, and for expanding the science associated with the theoretical works of nursing in the future. Understanding a theoretical framework is vital to applying it in your practice. 1. Clarity Clarity and structure are reviewed in terms of consistency and structural clarity. Clarity speaks to the meaning of terms used, and definitional consistency and structure speaks to the consistent structural form of terms in the theory. Analysis begins as the major concepts and sub concepts and their definitions are identified. Words have multiple meanings within and across disciplines; therefore, a word should be defined carefully and specifically according to the framework (philosophy, conceptual model, or theory) within which it is developed. Clarity and consistency are facilitated with diagrams and examples. The logical development and type of structure used should be clear, and assumptions should be stated clearly and be consistent with the goal of the theory. 2. Simplicity Simplicity is highly valued in nursing theory development. Simple forms of theory, such as middle range, should guide practice. A theory should be sufficiently comprehensive, presented at a level of abstraction to provide guidance, and have as few concepts as possible with simplistic relations to aid clarity. 3. Generality The generality of a theory speaks to the scope of application and the purpose within the theory. “The broader the scope... the greater the significance of the theory”. The generality of a theoretical work varies by how abstract or concrete it is. Understanding the levels of abstraction by doctoral students and nurse scientists facilitated the use of abstract frameworks for the development of middle-range theories. 4. Empirical Precision Accessibility is linked to the empirical indicators for testability and ultimate use of a theory to describe aspects of practice. Accessibility addresses the extent to which empiric indicators for the concepts can be identified and to what extent the purposes of the theory can be attained. Empirical relevance may be determined by examining “the correspondence between a particular theory and the objective empirical data”. The theorist should be able to evaluate and verify results by themselves. Testability of the theory can be evaluated based on the theory’s capacity to “generate hypotheses and be subjected to empirical research”. 5. Derivable Consequences A parallel can be drawn between outcome and importance. Because research, theory, and practice are closely related, nursing theory lends itself to research testing, and research testing leads to knowledge for practice. Nursing theory guides research and practice. Nursing theories generate new ideas, and differentiates the focus of nursing from that of other professions. To be considered useful, “it is essential for a theory to develop and guide practice... theories should reveal what knowledge nurses must, and should, spend time pursuing”. TFN Module 1: Overview of Nursing Theories 7 NURSING PARADIGM Nursing has a model or paradigm that explains the linkages of science, philosophy, and theory that is accepted and applied by the discipline. These nursing paradigms serve as patterns or models to show a clear relationship among the existing theoretical works in nursing. Paradigms can also be referred to as conceptual framework or conceptual model. It is used to denote a prevailing schema within a discipline. It also provides a broad framework of reference for systematic approaches in directing the activity of the nursing profession, which include knowledge development, philosophy, theory, research, and practice. Conceptual models provide different views of nursing by broadly explaining phenomena of interests, express assumptions, and reflect a philosophical standpoint. PARADIGM or CONCEPTUAL MODEL or CONCEPTUAL FRAMEWORK The term model depicts concepts and shows how the concepts are related. It explains an idea by using symbolic and physical visualization to facilitate thinking about concepts and relationships between them. Models serve as pictorials or diagrammatic representation of propositions (statements that explain relationships between the concepts). Models allow one to view the layout, the interrelated parts of the whole – including outlines of all features specific to a theory in picture form. In a simpler view, George defined models as “the representation of the interaction among and between the concepts showing patterns.” Models can be divided into two: 1. Verbal models are worded statements, a form closely related to knowledge development. Example is the Conceptual Models of Nursing, which are word structures that provide a specific view on nursing through the interrelationship of concepts in the structure. 2. Schematic models explain an idea by using schema, symbols or physical visualization. Schematic models may be in the form of diagrams, drawings, graphs or pictures that facilitate understanding. At present, many theories in nursing are focused on relationships among the Four Major Concepts or Metaparadigms (metaparadigm: Greek “meta”, meaning with and “paradeigma” meaning pattern). Metaparadigm is the first and highest knowledge structure level. The Four Major Concepts are presented as follows: 1. PERSON – The recipient of nursing care like individuals, families and communities. Example: Nightingale proposed that the physical, intellectual, and spiritual being of a person is not capable of manipulating the environment to promote health. This means that a person is a passive recipient of care. 2. ENVIRONMENT – The external and internal surroundings of life that influence or affect the person or client Example: Nightingale emphasizes the physical environment in her theory. She focused on ventilation, warmth, noise, light and cleanliness. TFN Module 1: Overview of Nursing Theories 8  3. HEALTH – The holistic level of wellness that the person experiences. It is a dynamic state of well-being occurring on a continuum where the person functions at an optimum level. Nightingale defined nursing as “a profession for women (a calling) with the goal to discover and use the laws governing health in the service of humanity.” She believed that the goal of all nursing activities should promote the 4. NURSING – The intervention of the nurse rendering care in support of, or in cooperation with the client. It is an art and science of caring for individuals, families, groups and communities geared toward promotion of health, prevention of illness, alleviation of suffering and assisting clients to face death with dignity and peace. Example: Nightingale emphasized that a nurse is responsible for promoting the well being of clients by manipulating the environment. Key concepts about the Four Major Concepts: 1. These concepts are collectively referred to as metaparadigms for nursing. It embodies the knowledge base, theory, philosophy, research, practice and educational experience and literature identified with the profession. 2. These Four Major Concepts establish a better direction and understanding of the nursing profession. 3. These given concepts vary in accordance to the experience and views of different nursing theorists. 4. Metaparadigm is the highest level of knowledge THE METAPARADIGM OF NURSING TFN Module 1: Overview of Nursing Theories 9  KNOWLEDGE STRUCTURE LEVELS WITH DEFINITION & EXAMPLES (Structural Hierarchy of Contemporary Nursing Knowledge Components) STRUCTURE LEVEL DEFINITION EXAMPLES METAPARADIGM Greek words: meta meaning Four Major Nursing with and paradigm meaning Concepts/Metaparadigm pattern of Nursing It is the most abstract level Person of knowledge specifying the main concepts that Environment encompass the subject matter and the scope of a Health discipline. Nursing Metaparadigm is defined as the core content of a discipline, stated in the most global or abstract of terms. The functions of metaparadigm are to: 1. summarize the intellectual and social missions of a discipline 2. place a boundary on the subject matter of that discipline. 2. PHILOSOPHY The second knowledge Florence structure level that: Nightingale’s Environmental Theory ✓ specifies the definitions of the metaparadigm Jean Watson’s concepts in each of the conceptual models of Philosophy & Science of nursing. Caring ✓ they are works that specify philosophical approaches to nursing *Theory may be formalized from philosophies TFN Module 1: Overview of Nursing Theories 10  3. CONCEPTUAL A term used to denote the Callista Roy’s Adaptation MODELS/ prevailing schema or Model CONCEPTUAL approaches within a (focuses on adaptation) FRAMEWORK/ discipline. PARADIGM They are a broad frame of reference for systematic approaches to the phenomena with which the discipline is concerned. 4. GRAND THEORY It is broad in scope and Imogene King’s Theory composed of concepts of Goal Attainment representing global and extremely complex Madeleine Leininger’s phenomena. Theory of Culture Care, Diversity & Typically, a grand theory is Universality NOT intended to provide (Transcultural Nursing) guidance for the formation of specific nursing interventions – rather it provides an overall framework for structuring broad, abstract ideas about nursing. 5. MIDDLE It is the least abstract level of Goal Attainment in RANGE theoretical knowledge Adolescent Diabetic THEORY because they include details Patients in the specific to nursing practice. Community Middle-range theories address more concrete and more narrowly defined phenomena or have more concrete and narrower focus than a grand theory. They specify or include the following: 1. information indicating the situation or health condition 2. the patient population or age group 3. the location or area of practice and 4. the action of the nurse or the intervention TFN Module 1: Overview of Nursing Theories 11 REFERENCES Textbook: Alligood, M.R. (2022) Nursing theorists and their work. 10th Edition. Elsevier Singapore Pte. Ltd A. BOOKS: Butts, J.B. and Rich K.L. (2021) Philosophies and theories for advanced nursing practice. 4th Edition. Jones and Bartlett Pub.; Sudbury, MA. Chinn, Peggy L. (2021). Knowledge development in nursing: theory and process. 11th Edition. Mosby Elsevier. Fundamentals of nursing models, theories, and practice. 2 Edition. nd Mosby Elsevier. McEwen, M and Wills, E (2023). Theoretical basis for nursing. 6th Edition. Wolters Kluwer, Philadelphia Peterson, Sandra J. (2020)Middle range theories: application to nursing research and practice. 5th Edition. Mosby Elsevier. Walker, L. and Avant K. (2019) Strategies for theory construction in nursing. 6 th Edition. Prentice Hall; Boston, USA. Prepared by: (SGD)Sarah. S. Nares, RN., MN. Module Contributor: Rochelle G. Gumabon, RN., MN Instructor, NCM 0100 Peer Reviewed by: Mary Angelica P. Bagaoisan, RN, MAN Instructor, NCM 0100 Reviewed by: Debbie Q. Ramirez, R.N., Ph.D. Assistant Dean, College of Nursing Approved by: Zenaida S. Fernandez, R.N., Ph.D. Dean, College of Nursing TFN Module 1: Overview of Nursing Theories 12