NCM 103 –

FUNDAMENTALS OF
NURSING
Chapter 3 – Nursing
Theories & Conceptual
Framework
Maria Lourdes L. Reposar
Nursing Theories and Conceptual Frameworks

Nurses must develop and recognize concepts and

theories specific to nursing. Because theories in some
other disciplines were developed and used much
before nursing theories, it is helpful to explore briefly
how theory has been used by those disciplines before
considering theory in nursing
Definitions of Terms:
• Paradigm
• A pattern of shared understanding and
assumptions about reality and the world
• Includes notions of reality that are largely
unconscious or taken for granted
• Become clear when realities or world
views clash
• Paradigm of religious fundamentalism
versus paradigm of evolution
 Role of Nursing Theory
• Links among nursing theory,
education, research, and clinical
practice
• Contributes to knowledge
development
• May direct education, research, and
practice
Figure 3–1 The living tree of nursing theories.
From “The Living Tree of Nursing Theories,” by C. Tourville & K. Ingalls, 2003,
Nursing Forum, 38(3), p. 23. Copyright © 2003 Blackwell Publishers. Reprinted with
permission.
Role of Nursing Theory
 Direct links exist among theory, education, research and
clinical practice.
 In many cases, nursing theory guides knowledge
development and directs education, research and
practice although each influences the others.
 The interface between nursing experts in each area
helps to ensure that work in the other area remains
relevant, current, useful and ultimately influences health
 In Education

• In 1970s and 80s, nursing programs:

 Identified major concepts
 Organized concepts into conceptual
framework
 Built curriculum around framework
 Elucidated central meanings of the profession
 Improved status of the profession
 • Identifies philosophical assumptions or conceptual
frameworks
• Midlevel (mid-range) theories focus on the
exploration of concepts.
• Pain, self-esteem, and learning
• Critical theory describes theory that helps
elucidate how social structures affect human
experiences from art to social practices.
 How race, gender, sexual orientation affect patient
experience and health outcomes
 In Clinical Practice
• Primary contribution in reflecting, questioning, and
thinking about what nurses do
• Practice theories describe relationships amongst
variables as applied to specific clinical situations.
• Theory of postpartum depression
• Debates about the role of theory in practice is
evidence that nursing is maturing
• Academic disciplines and clinical profession
Overview of Selected Nursing Theories
 The nursing theories discussed will vary considerably in
a)Level of abstraction
b)Conceptualization of the client, health/illness,
environment and nursing, and
c)Ability to describe, explain or predict phenomena.

 A philosophy is a belief system, often an early effort to

define nursing phenomena, and serves as the basis for
later theoretical formulations.
 Overview of Selected Nursing Theories
1. Florence Nightingale
 Founder of Modern Nursing and Pioneer of
the Environmental Theory.
 Defined Nursing as “the act of utilizing the environment of
the patient to assist him in his recovery.”
 Stated that nursing “ought to signify the proper use of fresh
air, light, warmth, cleanliness, quiet, and the proper selection
and administration of diet – all at the least expense of vital
power to the patient.”
 Identified five (5) environmental factors: fresh air, pure
water, efficient drainage, cleanliness or sanitation, and light
or direct sunlight.
•
2. Hildegard E. Peplau
 Pioneered the Theory of Interpersonal Relations
 Peplau’s theory defined Nursing as “An interpersonal process
of therapeutic interactions between an individual who is sick
or in need of health services and a nurse specially educated
to recognize, respond to the need for help.”
 It helps nurses and healthcare providers develop more
therapeutic interventions in the clinical setting.
 Nurse–client relationship
• Orientation Identification Exploitation Resolution
3. Virginia Henderson
 Developed the Nursing Need Theory
 Focuses on the importance of increasing the patient’s
independence to hasten their progress in the hospital.
 Emphasizes the basic human needs and how nurses can
assist in meeting those needs.
 “The nurse is expected to carry out a physician’s
therapeutic plan, but individualized care is the result of
the nurse’s creativity in planning for care.”
4. Martha E. Rogers
 In Roger’s Theory of Human Beings, she defined Nursing as
“an art and science that is humanistic and humanitarian.
 The Science of Unitary Human Beings contains two
dimensions: the science of nursing, which is the knowledge
specific to the field of nursing that comes from scientific
research; and the art of nursing, which involves using
nursing creatively to help better the lives of the patient.
 A patient can’t be separated from his or her environment
when addressing health and treatment.
5. Dorothea E. Orem
 In her Self-Care Theory, she defined Nursing as “The act of
assisting others in the provision and management of self-care
to maintain or improve human functioning at the home level
of effectiveness.”
 Focuses on each individual’s ability to perform self-care.
 Composed of three interrelated theories: (1) the theory of
self-care, (2) the self-care deficit theory, and (3) the theory of
nursing systems, which is further classified into wholly
compensatory, partially compensatory, and supportive-
educative.
6.Imogene M. King
 Conceptual System and Middle-Range Theory of Goal Attainment
 “Nursing is a process of action, reaction and interaction by which
nurse and client share information about their perception in a
nursing situation” and “a process of human interactions between
nurse and client whereby each perceives the other and the
situation, and through communication, they set goals, explore
means, and agree on means to achieve goals.”
 Focuses on this process to guide and direct nurses in the nurse-patient
relationship, going hand-in-hand with their patients to meet good
health goals.
 Explains that the nurse and patient go hand-in-hand in communicating
information, set goals together, and then take actions to achieve those
goals.
7. Betty Neuman
 In Neuman’s System Model, she defined nursing as a “unique
profession in that is concerned with all of the variables affecting
an individual’s response to stress.”
 The focus is on the client as a system (which may be an
individual, family, group, or community) and on the client’s
responses to stressors.
 The client system includes five variables (physiological,
psychological, sociocultural, developmental, and spiritual). It is
conceptualized as an inner core (basic energy resources)
surrounded by concentric circles that include lines of resistance,
a normal defense line, and a flexible line of defense.
8. Sister Callista Roy
 In Adaptation Model, Roy defined nursing as a “health
care profession that focuses on human life processes and
patterns and emphasizes the promotion of health for
individuals, families, groups, and society as a whole.”
 Views the individual as a set of interrelated systems that
strives to maintain a balance between various stimuli.
 Inspired the development of many middle-range nursing
theories and adaptation instruments.
9. Madeleine M. Leininger
Culture Care Theory of Diversity and Universality
 Defined transcultural nursing as “a substantive area of
study and practice focused on comparative cultural care
(caring) values, beliefs, and practices of individuals or
groups of similar or different cultures to provide culture-
specific and universal nursing care practices in promoting
health or well-being or to help people to face
unfavorable human conditions, illness, or death in
culturally meaningful ways.”
 Involves learning and understanding various cultures
regarding nursing and health-illness caring practices,
beliefs, and values to implement significant and efficient
nursing care services to people according to their
cultural values and health-illness context.
 It focuses on the fact that various cultures have
different and unique caring behaviors and different
health and illness values, beliefs, and patterns of
behaviors.
10. Jean Watson
 She pioneered the Philosophy and Theory of Transpersonal
Caring.
 “Nursing is concerned with promoting health, preventing
illness, caring for the sick, and restoring health.”
 Mainly concerns with how nurses care for their patients and
how that caring progresses into better plans to promote
health and wellness, prevent illness and restore health.
 Focuses on health promotion, as well as the treatment of
diseases.
 Caring is central to nursing practice and promotes health
better than a simple medical cure.
11.Rosemarie Rizzo Parse
 Human Becoming Theory
 “Nursing is a science, and the performing art of nursing is
practiced in relationships with persons (individuals, groups,
and communities) in their processes of becoming.”
 Explains that a person is more than the sum of the parts,
the environment, and the person is inseparable and that
nursing is a human science and art that uses an abstract
body of knowledge to help people.
 It centered around three themes: meaning, rhythmicity, and
transcendence.
 Critique of Nursing Theory
 There are several arguments opposing the use of nursing
models, five discussed by McCrae (2011) are:
1.There is not a single global, commonly accepted
definition of nursing and, thus, how can there be a
theory of nursing?
2.The existing theories and models are too vague of too
complex to clearly guide practice
3.Because many theories are untested, they cannot be
considered to provide evidence-based practice.
4. Interprofessional teamwork and overlapping of
health care professional roles suggest that a
theory guiding nursing practices cannot be unique
to nursing.
5. Science and the world in general have changed so
much that historically fundamental theories or
models do not fit with 21st century nursing
practice.
 Most things in the world have both positive and
negative implication.
 Theory can be used to broaden our perspective in
nursing and facilitate the altruistic and humanistic
values of the profession.