Theories, Frameworks, and
Concepts in Nursing
Donna Hinson Brown
Winston-Salem State University
NUR 2312
Spring 2012

What is nursing?
• Science?
• Art?
• What makes nursing different?
• How do we know?
• What is a theory?
• “Theory helps us bear our ignorance of the
facts.” George Santayana

What theory should be…
“Enthusiastic discourse that that fits the
description…a place where people work at the
very edges of their abilities, constantly
pushing each other’s thinking into new
territory, giving names to things that have
gone unnamed, dreaming of better ways,
describing common ground and finding ways
to realize shared dreams”
Belenky, Clinchy, Goldberg, & Tarule (1996).

Person trauma Nurse-patient
relationship
health CARE
Health-
HOPE Wellness wellness
continuum
CONCEPTS
Story of Hope
FRAMEWORK
THEORY

Theories
• Represent abstract ideas rather than concrete
facts
• Can be broad or limited
• Grand theories
• Middle-range or midrange theories
• Practice theories (situation-specific theories)

Grand Theories
• Florence Nightingale’s Environmental Theory
• Martha Rogers’ Science of Unitary Human Beings
• Dorothea Orem’s Self-Care Deficit Theory
• Roy’s Adaptation Model
• Neuman’s Systems Model
• Watson’s Science of Philosophy and Caring
• Peplau’s Interpersonal Process
• King’s Theory of Goal Attainment
• Leininger’s Cultural Care Theory

Middle Range Theories
• Uncertainty in Illness (Mishel & Clayton)
• Theory of Self-Transcendence (Pam Reed)
• Theory of Community Empowerment (Persily
& Hildebrandt)
• Theory of Self-Efficacy (Resnick)
• Theory of Unpleasant Symptoms (Lenz &
Pugh)
• Story Theory (Smith & Liehr)

Practice Theories
• Less abstract
• Limited scope and focus (single phenomenon)
• Situational (does not transcend time, place)
• Answers a specific question
• Sociopolitical, cultural, historical in
perspective; easily recognizable in clinical
practice setting
• Examples

Where to begin???
• What are my interests?
• How do I think about my nursing process and
practice?
• What do I want to know?
• Sources (original)
• Sources (secondary/ application)

Story Theory: Theoretical Model
Developing story-plot
Intentional Dialogue
NURSE PERSON
Complicating health challenge
Creating Ease
Movement toward resolving
Smith, M.J., & Liehr, P.R. (2008). Middle Range Theory for Nursing, 2nd ed. New York: Springer

Purpose
• Stories as a part of human experience
• Stories bind people and time
• Stories as expressions of who we are, where
we have been and where we are going
• Story theory = context for nurse-person health
promoting process
• Structure to guide nursing in practice and
research by collecting stories about health
situations that are important to the person

Story Theory
• The major concepts:
1. Person
2. Environment
NURSING
3. Health PRACTICE
4. Nursing
• Clinical practice use for story theory

Questions and Comments