1. DEVELOPMENT OFDEVELOPMENT OF
NURSING PRACTICENURSING PRACTICE
THEORYTHEORY
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2. Objectives
 Define theory and list characteristics of a theory
 Trace the development of a nursing theory
 Describe the components of a theory and its use
 Describe the different types of theories and
examples of each.

3. THEORYTHEORY
 Greek word “theoria” mean vision
 A group of interrelated concepts
• Represents a phenomena
• Explains an event
• Show systematic relationships
• Proposes action and guides practices
3-3

4. FRAMEWORK
• A structure
• A plan
• An out line
• A foundation
That provide a broad frame of reference forThat provide a broad frame of reference for
approaching a phenomenaapproaching a phenomena
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5. 3-5

6. MODELMODEL
• Symbol
• Drawing
• Words or formula
• Diagrams
A model is graphic or symbolic representationA model is graphic or symbolic representation
of phenomena that facilitate understatingof phenomena that facilitate understating
3-6

7. 3-7

8. Components/Elements of theoryComponents/Elements of theory
 PropositionsPropositions
• Are expressions of relational statements between
and among the concepts. It can be expressed as
statements, paradigms or figures
 AssumptionsAssumptions
• Accepted “truths” that are basic and fundamental to
the theory. Or value assumptions where what is
good or right or ought to be. 3-8

9. CHARACTERISTICS OF ACHARACTERISTICS OF A
THEORYTHEORY
 Systematic, logical and coherentSystematic, logical and coherent (orderly reasoning,
no contradictions)
 Creative structuring of ideasCreative structuring of ideas mental images of one’s
experiences and create different ways of looking at a
particular event or object.
 Tentative in natureTentative in nature ( change over time or evolving
but some remain valid despite passage of time)

10. KNOWLEDGE
DEVELOPMENT IN NURSING
 The knowledge in a particular discipline can be
arranged in a hierarchical structure that ranges from
abstract to concrete.
 Theories represent the most concrete component of a
discipline.
 Several theories that share a common view of the
world can be grouped together to form a paradigm.

11. 3-11

13. NURSING KNOWLEDGENURSING KNOWLEDGE
 A Paradigm is a particular viewpoint or
perspective. Each discipline has a defined
Metaparadigm, which is the most abstract
component of knowledge and which can consist
of more than one paradigm (Fawcett, 1989).
 A Metaparadigm is the unifying force in a
discipline that names the phenomena of concern
to that discipline.

14. The Metaparadigm of Nursing
What is it that distinguishes nursing from any otherWhat is it that distinguishes nursing from any other
discipline such as biology, sociology, or psychology?discipline such as biology, sociology, or psychology?
 “Each discipline singles out certain phenomena with
which it will deal in a unique manner” (Fawcett, 1989, p. 5).
The field of biology has defined limits and boundaries
that do not extend into psychology.
Psychology does not extend its concerns into the domain
of sociology, which has as its main focus the social
behavior of human beings.
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15. The Metaparadigm of Nursing
 Disciplines are distinguished from each other by
differing metaparadigm concepts. Most metaparadigms
consist of several major concepts.
 The major concepts that provide structure to the
domain of nursing are person, environment, health,person, environment, health, andand
nursingnursing.
 Each nursing theory presents a slightly different view
of the metaparadigm concepts.

16. NURSING KNOWLEDGENURSING KNOWLEDGE
 Paradigm revolution is the turmoil and conflict that occur in a
discipline when a competing paradigm gains acceptance over
the dominant paradigm. If the competing paradigm answers
more questions and solves more problems for the discipline
than the prevailing paradigm, then a paradigm shift occurs.
 Paradigm shift refers to the acceptance of the competing
paradigm over the prevailing paradigm or a shifting away from
one worldview toward another worldview. Again, by
consensus the competing paradigm becomes the dominant
paradigm and the process begins again.
(Kuhn, 1970
Knowledge is developed that makes a differenceKnowledge is developed that makes a difference
in health carein health care

17. PARADIGMS IN NURSINGPARADIGMS IN NURSING
 Several nursing scholars have proposed that the
discipline of nursing is in the midst of a paradigm
revolution.
 Several authors have present different paradigms in
nursing
 According to Parse (1987), there are currently two
paradigms in nursing:
1. Totality Paradigm
2. Simultaneity Paradigm
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18. 3-18

19. PARADIGMS IN NURSINGPARADIGMS IN NURSING
 Totality Paradigm
• “The goals of nursing in the totality paradigm focus on health
promotion, care and cure of the sick, and prevention of illness.
Those receiving nursing care are persons designated as ill by
societal norms”
 Simultaneity Paradigm
• “The goals of nursing in the simultaneity paradigm focus on
the quality of life from the person’s perspective. The authority
and prime decision maker in regard to nursing is the person
not the nurse”
(Parse, 1987).

20. DEBATE, DIALOGUE, DISCUSSION,DEBATE, DIALOGUE, DISCUSSION,
THEORY DEVELOPMENTTHEORY DEVELOPMENT
Some nursing scholars argue about the structural
elements of the discipline; some debate the value of
competing paradigms; and some present alternative
metaparadigm elements.
Yet,Yet,
with all the uncertainty that is created by these questionswith all the uncertainty that is created by these questions
and alternative ideas, the ongoing dialogue is a healthyand alternative ideas, the ongoing dialogue is a healthy
sign of the development of the nursing profession.sign of the development of the nursing profession.
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21. THEORY DEVELOPMENTTHEORY DEVELOPMENT
 SEVERAL FACTORS TO BE EXAMINESEVERAL FACTORS TO BE EXAMINE
• Relationship among theory, research and practice
• Approaches to theory development based on the
source of initiation
• Process of theory development

22. RELATIONSHIP BETWEEN THEORY,RELATIONSHIP BETWEEN THEORY,
AND RESEARCHAND RESEARCH
 Theory
• An explanation about how and why something is
• It allows to go beyond the known facts,
suggesting what you might expect in the future,
and allowing you to organize the facts you
already have.
• Research validates and modifies theory
• It explore significant nursing problem
potential for development of nursing knowledge

23. RELATIONSHIP BETWEEN THEORYRELATIONSHIP BETWEEN THEORY
AND PRACTICEAND PRACTICE
 The so-called correlation of theory and practice seems
to be a continuing issue of concern.
 Theory and practice are reciprocally related.
"Theory without practice is sterile and practice"Theory without practice is sterile and practice
without theory is blind”without theory is blind”
 Practice is the basis for nursing theory development and
nursing theory must be validated in practice

24. RELATIONSHIP BETWEEN THEORYRELATIONSHIP BETWEEN THEORY
AND PRACTICEAND PRACTICE
 How does theory influence practice ?
 Organizes nursing care
 Sets standards for practice
 Describes settings in which practice occurs
 Identifies recipients of nursing care.
 Sets the nursing process format and content.
 Designs systems of nursing care delivery.
The Theory Practice GapThe Theory Practice Gap
The so-called integration of theory and practice hasThe so-called integration of theory and practice has
not yet been achieved, but seems to be anot yet been achieved, but seems to be a
continuing issue of concern.continuing issue of concern.

25. RELATIONSHIP BETWEEN THEORYRELATIONSHIP BETWEEN THEORY
AND PRACTICEAND PRACTICE
 Research is the key to the development of a discipline
 Middle ranged and practice theory may be tested in
practice through clinical research
 There is need to encourage nurses to test and refine
theories and model to develop their own personal
models of practice
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26. THEORY DEVELOPMENTTHEORY DEVELOPMENT
 Four strategies of theory development
1.1. THEORY PRACTICE THEORYTHEORY PRACTICE THEORY ( theory developed
in other discipline and used in nursing situations)
2.2. PRACTICE THEORYPRACTICE THEORY evolved from clinical practice
3.3. RESEARCH THEORY OR INDUCTIVE METHODRESEARCH THEORY OR INDUCTIVE METHOD
Must evolve from research findings or empirical evidence.
4. THEORY RESEARCH THEORYTHEORY RESEARCH THEORY
theories developed by other disciplines are utilized but given
unique nursing perspective. Original theory
examined and given a new research findings.

27. APPROACHAPPROACH 11
 THEORY PRACTICE THEORYTHEORY PRACTICE THEORY
 Selection of theory may be used to describe a clinical situation
(Stress, adaptation)
 Modify concepts and its relationships
• Have basic knowledge of non nursing theory
• Theory analysis
• Use assumption, proposition to describe clinical situation
• Refine assumption, proposition and concepts to reflect nursing
• Reconstruct a theory
Examples Benner’s use of Dreyfus’ Model of skill AcquisitionExamples Benner’s use of Dreyfus’ Model of skill Acquisition

29. APPROACH 2APPROACH 2
PRACTICE THEORYPRACTICE THEORY evolved from clinical practice
No appropriate theory exist
Inductively developed from clinical situation
Grounded theory approach is used
 Observation of new phenomena
 Development of concepts
 Labeling, describe the properties of concepts
 Analysis
 Develop concepts and propositional statement and linkage
Example A model for multicultural nursingExample A model for multicultural nursing ( Rooda,( Rooda,
1992)1992)

30. APPROACH 3APPROACH 3
RESEARCH THEORY OR INDUCTIVE METHODRESEARCH THEORY OR INDUCTIVE METHOD
Scientific TheoryScientific Theory
Most accepted strategy for theory development
Select a phenomena and list its characteristics
Develop a measurement tool
Measurement are analyzed
Discovery of pattern
Formulation of theoretical statement
Example
Development of taxonomy of passive behavior in people withDevelopment of taxonomy of passive behavior in people with
Alzheimer diseaseAlzheimer disease

31. Approach 4Approach 4
 THEORY RESEARCH THEORYTHEORY RESEARCH THEORY
 Theory Testing
• Theory derives the Research Question
• Theory is selected to explain the phenomena of interest
• Redefined
• Finding synthesized
- Used to modify, refine or develop original theory , new
theory
Example Peaceful end of lifeExample Peaceful end of life (Ruland and Moore, 1998)

32. PROCESS OF THEORY DEVELOPMENTPROCESS OF THEORY DEVELOPMENT
 THREE BASIC STEPSTHREE BASIC STEPS
1. Concept Development
 Creation of conceptual meaning
1. Statement development
 Formulation and validation of relational statement
1. Theory Construction
 Systematic organization of linkages
 Two Additional Steps
4. Empirical Testing (correlating the theory with demonstrable experience)
5. Application of theory

33. PROCESS OF KNOWLEDGEPROCESS OF KNOWLEDGE
DEVELOPMENTDEVELOPMENT

34. IMPORTANCE OF NURSINGIMPORTANCE OF NURSING
THEORIESTHEORIES
 Nursing theory aims to describe, predict and explain the
phenomenon of nursing (Chinn and Jacobs,1978)
 It should provide the foundations of nursing practice, help to
generate further knowledge and indicate in which direction
nursing should develop in the future (Brown, 1964)
 Theory is important because it helps us to decide what we know
and what we need to know (Parsons,1949)
 It helps to distinguish what should form the basis of practice by
explicitly describing nursing.

35. IMPORTANCE OF NURSING THEORIESIMPORTANCE OF NURSING THEORIES
 The benefits of having a defined body of theory in nursing
include better patient care, enhanced professional status for
nurses, improved communication between nurses, and guidance
for research and education (Nolan, 1996)
 The main exponent of nursing – caring – cannot be measured, it is
vital to have the theory to analyse and explain what nurses do.
 As medicine tries to make a move towards adopting a more
multidisciplinary approach to health care, nursing continues to
strive to establish a unique body of knowledge.
 This can be seen as an attempt by the nursing profession to
maintain its professional boundaries.

36. 3-36Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.