THEORETICAL FOUNDATIONS IN NURSING (NCM 100) Historical Eras:

Prepared By: Mae Esther E. Arones, RN, MN

a. Curriculum Era (1900-1940)
- courses included in nursing programs
Module 1: Evolution of Nursing - emphasized course selection and content for nursing
A. Introduction to Nursing Theory programs.
- Standardized curricula for diploma programs.

History of Nursing Theory - Develop specialized knowledge and higher

education.
 Florence Nightingale - envisioned nurses as a
body of educated women at a time when women
were neither educated or employed in public b. Research Era (1950-1970)
service.
 School of Nursing of St. Thomas' Hospital in - roles of nurses and what to research
London - marked the birth of modern nursing
- nurse leaders embraced higher education and came
to an understanding of the scientific age and the
research path to new nursing knowledge.
Period of Nursing
Intuitive - instinctive work (intuition and experience)
c. Graduate Education Era (1950-1970)
Apprentice - skills were acquired through on-the-job
training - carving out an advanced role and basis for nursing
practice
Educative - education became more formalized with
the establishment of nursing schools. - Master's degree programs in nursing emerged
across the country to meet the need for nurses as
specialists for clinical practice.
Theory - an organized system of accepted knowledge
that is composed of concepts, propositions, definitions
and assumptions intended to explain a set of fact, d. Theory Era (1980-1990)
event, phenomena.
- there are many ways to think about nursing
Concept - an idea formulated by the mind or
- the explosive proliferation of nursing doctoral
experience perceived and observed. Can be abstract
programs from the 1970s and nursing theory literature
and concrete.
substantiated that nursing doctorates should be in
Proposition - explains the relationships of different nursing rather than in other disciplines.
concepts.
Definition - composed of various descriptions which
e. Theory utilization Era (21st century)
convey a general meaning and reduces the vagueness
in understanding a ret of concepts. - nursing theory guides research practice, education
and administration.
Assumption - a statement that specifies the
relationship or connection of factual concepts and - gave way to new levels of development and use of
phenomena. nursing theory for evidence-based professional
practice.
Phenomena - an observable fact that can be perceived
through the senses and explained. - New theories and new research methodologies and
approaches continue to expand.
 b. Constantly enlarges the body knowledge it uses and
improves its techniques of education and service
Nursing Theory through the use of scientific method
- Group of interrelated concepts that are developed c. Entrusts the education of its practitioners to
from various studies of discipline and related institutions of higher level
experiences
d. Applies its body of knowledge in practical services
- Aims to view the essence of nursing care. (Meleis vital to human and social welfare
1991)
e. Functions autonomously in the formulation of
- An articulated and communicated conceptualization professional policy and thereby in the control of
of invented or discovered reality in or pertaining to professional activity.
nursing for the purpose of describing, explaining,
predicting or prescribing nursing care. f. Attracts individuals with intellectual and personal
qualities of exalting service above personal gain who
recognize their chosen occupation a life work.
2. Significance of Nursing Theory for the Discipline
and Profession g. Strives to compensate its practitioners of providing
freedom of action, opportunity for continuous
professional growth and economic security.
Discipline - specific to academia and refers to a branch
of education, a department of learning, or a domain of
knowledge. Types of Treatment
Significance:  Independent - actions a nurse can initiate without
requiring order from a healthcare provider.
a. standardized curriculum  Dependent - require a provider's order or
b. Discipline is dependent on theory for its continued prescription.
existence  Collaborative - involve teamwork and
communication among different healthcare
c. Taken nursing to higher levels of education professionals.
d. Helps students develop analytical skills and critical
thinking ability as they clarify their values and Module 1: Evolution of Nursing
assumptions.
B. History and Philosophy of Science
1. Rationalism – emphasizes the importance of a
Profession - a specialized field of practice, founded on priori reasoning
a structure of the science or theoretical knowledge of
that discipline and accompanying practice abilities. • Deductive type of reasoning – starts from general to
specific knowledge
Significance:
• Theory-then-research strategy
a. Improve patient care
• Emphasizes the use of reasoning for the main
b. Enhanced professional status purpose of knowing the harm or benefits of an act to
c. Improved communication between nurse an individual
professionals
d. Guide for research and education. 2. Empiricism – based on the central idea that
scientific knowledge can be derived only from
sensory experience
Criteria for Development of the professional status of
Nursing: • Scientific truth was discovered through generalizing
observed facts
a. Utilizes in its practice a well-defined and well-
organized body of specialized knowledge that is on the • Inductive type of reasoning – data are used to
intellectual level of the higher learning formulate general knowledge
• Research-then-theory strategy
• Important in the assessment of patients all • 1962, Ida Jean Orlando – Nursing Process Theory
throughout the entire nursing process emphasized the reciprocal relationship between
patient and nurse and viewed the professional
function of nursing as finding out and meeting the
3. Early 20th Century – philosophers focused on the patient’s immediate need for help.
analysis of theory structure whereas scientists focused • 1968, Dorothy Johnson - Behavioral System Model -
on empirical research upheld the fostering of efficient and effective
Major Developments: behavioral functioning in the patient to prevent
illness.
a. The use of experimentation to gain new knowledge
as nurses strive to base their actions on evidence and • 1970, Martha Rogers – Unitary Human Being
scientific data. viewed nursing as both a science and an art as it
provides a way to view the unitary human being, who
b. Positivism – first used by Comte emerged; believed is integral with the universe.
that empirical research and logical analysis were two
approaches that would produce scientific knowledge • 1971, Dorothea Orem - Self-care Theory- states in
her theory that nursing care is required if the client is
c. Theoretical propositions must be tested through unable to fulfill biological, psychological,
observation and experimentation developmental, or social needs.
• 1971, Imogene King‘s -Theory of Goal attainment
4. Emergent Views and Theory in the Late 20th states that the nurse is considered part of the
Century patient’s environment and the nurse-patient
relationship is for meeting goals towards good health.
- Argue that for science to maintain its objectivity, data
collection and analysis must be independent of a • 1972, Betty Neuman – Health Care system model in
theory her theory states that many needs exist, and each may
disrupt client balance or stability. Stress reduction is
Brown (1977) - theories play a significant role in the goal of the system model of nursing practice.
determining what the scientists observe and how it is
interpreted. • 1979, Sr. Callista Roy - Adaptation Model viewed
the individual as a set of interrelated systems who
strives to maintain the balance between these various
stimuli.
History of Nursing Theories
• 1979, Jean Watson – Theory of Human Caring
• 1860, Florence Nightingale defined nursing in her
developed the philosophy of caring highlighted
“Environmental Theory” as “the act of utilizing the
humanistic aspects of nursing as they intertwine with
environment of the patient to assist him in his
scientific knowledge and nursing practice.
recovery.”
• In the 1950s, there is a consensus among nursing
scholars that nursing needed to validate itself through Nursing Leaders of the 20th Century
the production of its own scientifically tested body of
knowledge. Mary Grant Secole (England) – 1854

• In 1952, Hildegard Peplau - Theory of Interpersonal - Worked with Florence Nightingale during the
Relations - emphasis on the nurse-client relationship Crimean War
as the foundation of nursing practice.
• In 1955, Virginia Henderson - Nursing Need Theory Florence Nightingale (England) – 1859
conceptualized the nurse’s role as assisting sick or
healthy individuals to gain independence in meeting - Lady with the Lamp and contributed to the
14 fundamental needs. development of nursing education, practice and
administration
• 1960, Faye Abdellah - “Typology of 21 Nursing
Problems” - shifted the focus of nursing from a
disease-centered approach to a patient-centered Dorothea Lynde Dix (USA) – 1861
approach.
- Superintendent of the Female Nurses of the Union
Army during the American Civil War
 Lilian Wald (USA) – 1867-1940
Louisa May Alcott (USA) – 1862-1863 - Founder of Public Health Nursing, Henry Street
Settlement and Visiting Nurse Service which provided
- Wrote “Hospital Sketches” that described the works nursing services educationally, socially and culturally.
of volunteer nurses during the Civil war

Ethel Bedford Fenwick (England) – 1899

Harriet Tubman (USA) – 1861-1865
- Established the International Council of Nurses in
- The Moses of Her People; served the slaves of the Great Britain
underground railroad during the Civil war

Clara Louise Maass (USA) – 1876-1901

Walt Whitman (USA) – 1862-1865
- Worked as a contract nurse with the US Army during
- Worked with Louisa Alcott during the Civil war the Spanish-American War
- gave her life for yellow fever research
Sojouner Truth (USA) – 1862-1865
- Worked as a nurse during the Civil War and a nurse- Margaret Higgins Sanger (USA) – 1879-1966
counselor for the Freedman’s Relief Association after
- Founder of Planned Parenthood which initiated and
disseminated the use of birth control information
Jean Henri Dunant (Switzerland) – 1862-1865 Lavinia L. Dock (USA) – 1858-1956
- Organized the International Conference that founded - Contributed in the 19th Amendment of the American
the Red Cross during the Geneva Convention Constitution, particularly in protest for the rights of
women during her time

Lucy Osburn (Australia) – 1868

- Developed Australia’s first school for nurses after Mary Breckinridge (USA) – 1881-1965
training in St. Thomas Hospital and became the - Established the Frontier Nursing Service which in
superintendent at Sydney Hospital Kentucky, opened the first midwifery training schools

Linda Richards (USA) – 1873 Dr. Lauranne Sams (USA) – 1971

- America’s first trained nurse - Served as the first president of the National Black
Nurses Association

Mary Mahoney (USA) – 1879

- America’s first trained black nurse M. Lucille Kinlein (USA) – 1972
- First independent Nurse Practitioner

Clara Barton (USA) – 1812-1912

- Organized and established the American Red Cross Dr. Ildaura Maurillo-Rohde (USA) – 1974
- First president of National Hispanic Nurses
Association
Mary Agnes Snively (Canada) – 1884
- Developed the Toronto General Hospital School of
Nursing and the first president of the Canadian Nurses Eddie Bernice Johnson (USA) – 1992
Association - First nurse to be elected to the United States House
of Representatives
 - Author of the Code of Ethics for Nurses (PRC BON res
#633, 1982)
Julia R. Plotnick (USA) – 1992
- Chairman, Committee on Legal Aspect of Nursing
- Chief Nurse Officer, Rear Admiral and became an which created the first Philippine Nursing Law known
active leader in policy coordination for the US Surgeon as the Republic Act No. 877 S.1953
General

Ada Sue Hinshaw (USA) – 1993

Anastacia Giron Tupaz
- Directed the National Center for Nursing Research to
become International Institute for Nursing Research - First Filipino Nurse with a title of Nursing
under the National Institutes for Health Superintendent Chief Nurse at the Philippine General
Hospital (PGH)
- Founder of the Filipino Nurses Association (FNA) at
Prominent Nursing Leaders in the Philippines present known as the Philippine Nurses Association
Cesaria Tan - First Filipino Nurse who had Master's (PNA)
Degree in Nursing in the United States

Rosario Montemayor Delgado

Socorro Sirilan - Reformed social service for - First President of the FNA
indigenous patients at San Lazaro Hospital

Why are nursing theories important?

Magdalena Valenzuela - First Filipino Industrial Nurse
a. Nursing theories help recognize what should set the
foundation of practice by explicitly describing nursing.
Annie Sand - Founded the National League of b. By providing a definition of nursing, nursing theory
Philippine Government Nurses also helps nurses to understand their purpose and role
in the healthcare setting.

Cornel Elvegia Mendoza - First female Military Nurse c. Theories serve as a rationale or scientific reasons for
nursing interventions and give nurses the knowledge
base necessary for acting and responding
Loreto Tupaz - Known as the Dean of Philippine appropriately in nursing care situations.
Nursing Education; Florence Nightingale of Iloilo d. Nursing theories provide the foundations of nursing
practice, helps generate further knowledge, and
indicate in which direction nursing should develop in
Socorro Diaz - First editor of "The Message" the first the future (Brown, 1964).
journal of Philippine Nurses Association (PNA)
previously known as FNA (Filipino Nurses Association) e. By providing nurses a sense of identity, nursing
theory can help patients, managers, and other
healthcare professionals to acknowledge and
understand the unique contribution that nurses make
Conchita Ruiz - First editor of "The Filipino Nurses" the
to the healthcare service (Draper, 1990).
second journal of PNA
f. Nursing theories prepare the nurses to reflect on the
assumptions and question the values in nursing, thus
Dr. Julita Sotejo - Considered as "Florence Nightingale further defining nursing and increasing knowledge
of the Philippines" base.

- Founder and first dean of the University of the g. Nursing theories aim to define, predict, and
Philippines College of Nursing (UPCN), gave way to demonstrate the phenomenon of nursing
professional nursing in the Philippines (Chinn and Jacobs, 1978).
h. It can be regarded as an attempt by the nursing • More limited in scope (as compared to grand
profession to maintain and preserve its professional theories) and present concepts and
limits and boundaries. propositions at a lower level of abstraction.
They address a specific phenomenon in
i. In many cases, nursing theories guide knowledge nursing.
development and directs education, research,
and practice although each influence the others. • They specify things as the health condition,
(Fitzpatrick and Whall, 2005). patient population and the location of practice
and the different interventions of the nurse
• Examples: Hildegard Peplau’s Psychodynamic
d. Practice-Level Nursing Theories
D. Structure of Nursing Knowledge
• Practice nursing theories are situation specific
Classification of Nursing Theory theories that are narrow in scope and focuses
1. Depending on their function on a specific patient population at a specific
time.
2. Levels of abstraction
• Practice-level nursing theories provide
3. Goal orientation. frameworks for nursing interventions and
1. By abstraction: suggest outcomes or the effect of nursing
practice.

2. By Goal Orientation
a. Descriptive Theories
• Descriptive theories are the first level of
theory development. They describe the
phenomena and identify its properties and
components in which it occurs.
a. Metaparadigm: Greek ‘meta’ (with) and
• Descriptive theories are not action oriented or
“paradiegma” (pattern)
attempt to produce or change a situation.
- broad conceptual boundaries of nursing knowledge
• There are two types of descriptive
theories: factor-isolating
theory and explanatory theory.
Nursing paradigm – patterns or models used to show a
clear relationship among the existing theoretical
works in nursing
Factor-Isolating Theory
• Also known as category-formulating or
Nursing theories are focused on relationships among labeling theory.
the four major concepts:
• Identify and describe major concepts of
a. Person – recipient of nursing care phenomena

b. Health – holistic level of wellness that the person • They present phenomena based on the five
experiences; degree of wellness senses with their meanings

c. Environment - external and internal aspects of life

that influence the person
Explanatory Theory
d. Nursing – interventions of the nurse rendering
• Aims to provide information on how and why
care in support of or in cooperation with
concepts are related
the client.
• Cause and effect

c. Middle-Range Nursing Theories

b. Prescriptive Theories - Situation-producing theories situations within the perspective of the model
or theory from which they are derived.
• Deals with nursing actions and test the validity
and certainty of a specific nursing
interventions
• Used in testing new nursing interventions.
c. Predictive Theories – Situation-relating theories
• Achieved when the relationship of concepts
under a certain condition are able to describe
future outcomes consistently.
Other Ways of Classifying Nursing Theories
Classification According to Meleis: Characteristics of a Theory:
a. Needs-Based Theories. The needs theorists a. Theories can correlate concepts in such a way
were the first group of nurses who thought as to generate a different way of
of giving nursing care a conceptual order. looking at a certain fact or phenomena
Theories under this group are based on
helping individuals to fulfill their physical b. Theories must be logical in nature
and mental needs. c. Theories should be simple but generally broad
b. Interaction Theories. These theories placed in nature
the emphasis of nursing on the establishment d. Theories can be the source of hypotheses that
and maintenance of relationships and can be tested for it to be elaborated
highlight the impact of nursing on patients
and how they interact with the environment, e. Theories contribute in enriching the general
people, and situations. body of knowledge through the studies
implemented to validate them
c. Outcome Theories. These theories describe
the nurse as controlling and directing patient f. Theories can be used by practitioners to direct
care by using their knowledge of the human and enhance their practice
physiological and behavioral systems.
g. Theories must be consistent with other
validated theories, laws and principles but will
leave open unanswered issues that need
Classification According to Alligood: to be tested.
a. Nursing Philosophy. Is the most abstract type
and sets forth the meaning of nursing
phenomena through analysis, reasoning, and Analysis of Theory
logical presentation.
Criteria in Evaluating a Theoretical Work:
b. Nursing Conceptual Models. Are
1. Clarity:
comprehensive nursing theories that are
regarded by some as pioneers in nursing. a. How clear is the theory?
These theories address the nursing
metaparadigm and explain the relationship b. Is the theory clearly stated?
between them. c. Is it easily understood?
c. Grand Nursing Theories. Are works derived - Semantics (study of the meaning of language,
from nursing philosophies, conceptual symbols and logic) and structure are considered
models, and other grand theories that are important
generally not as specific as middle-range
theories. - Needs to identify major concepts and sub-concepts;
words should be defined operationally or how it is
d. Middle-Range Theories. Are precise and used according to the framework used
answer specific nursing practice questions.
They address the specifics of nursing - Diagrams should be clear and consistent all through
out
- Follow a logical sequence
- Assumptions should be consistent with the defined
goals of the theory

2. Simplicity:
a. How simple is the theory?
- A theory must be adequately comprehensive at a
level of abstraction to offer direction
- Most useful theory is the one that offers greatest
sense of understanding
3. Generality:
a. How general is the theory?
b. How broad is the scope of the theory?
- Speaks to the scope of application and the purpose
within the theory
- Chinn and Kramer – situations in which the theory is
applicable should be boundless
- The broader the scope of the theory, the greater its
significance

4. Accessibility:
a. How accessible is the theory?
b. Is the theory testable?
- 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
- Testability and ultimate use of the theory

5. Importance:
a. How important is the theory?
b. Does this theory create understanding that is
important to nursing?
- Because research, theory and practice are closely
related, nursing theory leads itself to research testing
and research testing leads itself to knowledge for
practice.