Examples of Middle range theory include Rogers’ Theory of Accelarating Change, Roy’s Theory of the Person as an Adaptive system, and King’s Theory of Goal Attainment
Situation relating :For example, the post open-heart surgery patient will experience cardiac arrhythmias if the blood potassium level goes below 3.5 meq Situation producing control: Examples include: pregnant women receive RHO-gram to prevent possible hemolysis in their infants; and the frequent turning and positioning of bed-ridden patients to prevent pressure ulcers.
Formative testing is a logistic teaching strategy, because, a course is conceived as consisting of separate and definite units, and tests are constructed to measure attainment of each unit.
Nursing profession is still under an evolution phase,
a phase of receding and evolving new paradigms.
Nursing theories and models provide information
about definitions of nursing and nursing practice,
principles that form the basis for practice, goals and
functions of nursing.
The 21st century opened changes for the nursing
profession a shortage of practicing nurses, an increasing
demand for nurses, fewer nursing faculty, and a rapidly
changing global healthcare arena.
A complex mental formulation of an object, property
or event that is derived from individual perception and
experience (Chinn and Jacob)
Concepts are vehicles of thoughts that involve
Concepts create images abstract in nature these
concepts tend to have different meanings can lead to
Therefore concepts are words that describe
objects, properties or events and are basic components of
TYPES OF CONCEPTS:TYPES OF CONCEPTS:
the real world
“Models are representations of the interaction among
and between the concepts showing the
Model is a pictorial representation of a proposition
where proposition are explained as the statements that
explain relationship between the concepts.
Are required in order to understand & draw a relational
Model represents mental image of a phenomena
Model aid to determine the relationship among the
TYPES OF MODELSTYPES OF MODELS
Physical or Isomorphic Model
PHYSICAL OR ISOMORPHIC MODELPHYSICAL OR ISOMORPHIC MODEL
 Empirical Model
 Represents reality of structure &
HOMOMORPHIC MODELHOMOMORPHIC MODEL
Similar to empirical model
Model builder deliberately leaves out
some of the properties of real object as
they are not needed.
SYMBOLIC MODELSYMBOLIC MODEL
Also called Theoretical Model.
No physical resemblance to reality.
Numbers or symbols such as shapes or
words are used to map out the real
situation but follows the original.
CONCEPTUAL MODELCONCEPTUAL MODEL
Here the words or symbols do not represent
mere ideas or perceptions but concepts.
This reflects reality by placing words and
symbols which are concepts in to the model.
 It is a conceptual diagramIt is a conceptual diagram
 It is a patternIt is a pattern
 It serves as an example.It serves as an example.
 Originates from two Greek words:
Meta, meaning “with” and paradigm, meaning
 It is the most global conceptual or philosophical
framework of a discipline or profession.
 It defines and describes relationships among
major ideas and values.
 It guides the organization of theories and models
for a profession.
COMPONENTS OF METAPARADIGM:COMPONENTS OF METAPARADIGM:
1. Person: Refers the recipient of nursing care, including physical,
spiritual, psychological, and sociocultural components, and can
include an individual, family or community.
2. Environment: Refers to all the internal and external conditions,
circumstances, and influences affecting the person.
3. Health: Refers to the degree of wellness or illness experienced by
4. Nursing: Refers to the actions, characteristics, and attributes of the
individual providing the nursing care.
 Theoria (Greek word) Vision
 A theory is a conceptual system or frame work intended
for some purpose.
 It composed of interrelated – concepts, models, and
propositions based on assumptions.
 They provide a framework to develop new and validate
current knowledge. They help to describe, explain and
predict to prescribe.
Theory can be defined as “an internally consistent group of
relational statements (concepts, definitions and propositions) that
present a systematic about a phenomenon and which is useful for
description, explanation, prediction and control”
(BODIE AND CHITTY)
 Set of interpretative assumptions, principles or propositions that
helps, explain or guide action. ( young,Taylor & Repenning, 2001 )
 Creative and rigorous structuring of ideas that project a tentative
purposeful and systematic view of phenomena ( chinn & krammer
16. Nursing theory:
“Nursing theories are used to describe, develop,
discriminate and use present knowledge in nursing.”
“ a nursing theory is a set of concept, definition,
relationships and assumptions or propositions derived
from nursing models or from other disciplines and
project a purposive, systematic view of phenomena by
designing specific inter-relationship among concepts for
the purpose of describing, explaining, predicting or
“ nursing theory is define as a conceptualization of
some aspects of nursing reality communicated for
the purpose of describing phenomena, explaining
relationship between phenomena, predicting
consequences or prescribing nursing care.”
Nursing theories provide framework for nurses
to systematize their nursing actions: what to
ask? What to observe? What to focus on? And
what to think about?
CHARACTERISTICS OF A THEORY:CHARACTERISTICS OF A THEORY:
• Theories can interrelate concepts in such a way as to create a
different way of looking at a particular phenomenon.
• Theories must be logical in nature.
• Theories should be relatively simple yet generalizable.
• Theories can be basis for hypotheses that can be tested.
• Theories contribute to and assist in increasing the general body of
knowledge within the discipline through the research implemented
to validate them.
• Theories can be utilized by the practitioners to guide and improve
• Theories must be consistent with other validated theories, laws
and principles but will leave open unanswered questions that need
to be investigated.
• Theories are composed of concepts and propositions.
• Theories can consist of separate theories about the same phenomenon
that interrelate the same concepts but describe and explain them
• Can describe a particular phenomenon; explain relationships among
phenomenon on another; or be used to produce or control a desired
• Theories differ from conceptual model; both can describe, explain, or
predict a phenomenon, but only theories provide specific direction to
guide practice; conceptual models are more abstract and less specific
than theories but can provide direction for practice.
CHARACTERISTICS OF A THEORY:CHARACTERISTICS OF A THEORY:
Society / Environment
Human / Individual
21. Important of theory:
Easy communication of nursing scope.
Documentation of nursing practice.
Empirical evidence of patient outcome.
Measuring nurses satisfaction about patient outcome
through nursing actions.
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.
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
Nursing theory aims to describe, predict and explain the
phenomenon of nursing.
It provides the foundations of nursing practice help to
generate further knowledge and indicate in which
direction in the future.
Theory is important because it helps to decide what we
know and what we need to know.
It helps to distinguish what should form the basis of
practice by explicity(stated in detail) describing nursing.
KINDS OF THEORIES:KINDS OF THEORIES:
Science of Unitary
Self care theory
CATEGORISATION OF THEORIESCATEGORISATION OF THEORIES
Theories are categorized in various ways by
According to Meleis:
Categorized with reference to Nursing’s
domain concept that reflect focus on nursing
education and practice.
• Nursing Clients.
• Human being environment interactions
• Nursing Therapeutics
CATEGORISATION OF THEORIES (MELEIS)CATEGORISATION OF THEORIES (MELEIS)
DOMAIN CONCEPT NURSING THEORIST / WORK
Nursing clients Johnson: Behavioral System Model for Nursing
Roy : Roy Adaptation Model
Neuman: Neuman System Model
Rogers : Science of Unitary Human Beings
Interactions King: Theory of Goal Attainment
Orlando: Dynamic Nurse Patient relationship
function, process & principles
Paterson Zderad: Humanistic Nursing
Wiednenbach: Clinical Nursing Art
Nursing Therapeutics Levine: Conservation Principles of Nursing
Orem: Orem’s General Theory of Nursing
CATEGORISATION OF THEORIESCATEGORISATION OF THEORIES
Categorization based on scope or level of abstraction:
Philosophy or Metatheory
Middle Range Theories
Categorization based on purpose:
Categorization based on Source or Discipline:
Theories and concepts used from behavioral sciences,
biologic sciences, and sociologic sciences as well as
learning theories, organization and management theories.
CATEGORISATION OF GRAND NURSING THEORIESCATEGORISATION OF GRAND NURSING THEORIES
MODELS & THEORIES
PROCESS MODELS &
MODELS & THEORIES
Abdellah Artinian and
Johnson King Rogers
1. MetatheoryGrand Theory
Middle range theory
RANGE OF THEORIES
Metatheory is the highest level of
theory (The fourth level of theory)
Is defined by the prefix META,
meaning “change in position”, “beyond”,
“on a higher level”, or “transcending,”
Refers to the body of knowledge or
about a field of study such as meta
GRAND THEORYGRAND THEORY
Macro level theory
Composed of abstract concepts in
This facilitates description but is not
capable of research verification.
MIDDLE RANGE THEORYMIDDLE RANGE THEORY
Composed of less abstract conceptual frame
works, closely aligned to observable reality,
thus capable of research verification.
It has categorization as:
1.High Middle Range Theory.
2.Middle Middle Range Theory.
3.Low Middle Range Theory.
32. Sociological TheorySociological TheoryComes in a
variety of shapes
High-Level TheoriesHigh-Level Theories
Mid-Range TheoriesMid-Range Theories
Low-Level TheoriesLow-Level Theories
Focus on trying to explain how
and why society is ordered
Focus on trying to explain
some general aspect of
Focus on trying to explain a
specific aspect of social
Why do I always fall
asleep in Psychology
Why do girls
PRACTICE THEORY:PRACTICE THEORY:
Practice theories, the first level of nursing theory, describe
prescriptions or modalities for practice.
Four steps are involved to determine practice theories, which include:
• Factor isolating: to identify and describe a phenomenon;
• Factor relating: to identify and describe possible explanations or
causes of the phenomenon;
• Situation relating: to predict occurrence of a phenomenon when
the cause is present.
• Situation producing control: to prevent occurrence of the
phenomenon by controlling or eliminating possible causes.
34. Basic processes in the development
of nursing theories:
Nursing theories are often based on and
influenced by broadly applicable processes and
theories. Following theories are basic to many nursing
General system theory:
-It describes how to break whole things into parts and
then to learn how the parts work together in system.
- These concepts may be applied to different kinds of
systems, eg molecules in chemistry, cultures in
sociology, organs in anatomy and health in nursing.
35. Adaptation theory:
- It defines adaptation as the adjustment of
living matter to other living things and to
- Adaptation is a continuously occurring
process that effects change and involves
interaction and response.
- Human adaptation occurs on three levels:
1.The internal( self)
2.The social( others)
3.The physical( biochemical reactions)
36. Developmental theory:
- It outlines the process of growth and
development of humans as orderly and
predictable, beginning with conception and
ending with death.
- The progress and behaviors of an
individual within each stage are unique.
- The growth and development of an
individual are influenced by heredity,
temperament, emotional and physical
environment, life experience and health
A well developed and articulated
theoretical basis gives a nursing program
the perspective that shapes the content
and the methods that guide students’
learning; eventually these methods have
an impact on nursing practice.
Mawn & Reece, 2000
“Theoretical principles drawn from a
number of sources directly after a
curriculum whether faculty members
recognize it or not.”
APPLICATION OF NURSING THEORIES INAPPLICATION OF NURSING THEORIES IN
NURSING EDUCATION:NURSING EDUCATION:
 For decades, nursing educators have invested heavily in
developing a philosophy and conceptual framework
specific to a given school of nursing, regardless of the
level of nursing education.
 This missing theoretical piece is of critical importance
for the student seeking nursing education at a variety of
colleges and universities and through multiple programs
such as practical nurse, associate degree nurse,
baccalaureate degree nurse, masters degree nurse and
even as a doctorate prepared nurse.
A theoretical basis provides a framework that helps
nursing students define their professional philosophies
It identifies and describes essential concepts and
significant problems and suggests approaches to structure
and methods that the student may use in continuing to
develop her or his knowledge.
Theoretical basis of the nursing program influences the
means by which material is presented and the methods by
which learning is evaluated.
APPLICATION OF NURSING THEORIES INAPPLICATION OF NURSING THEORIES IN
NURSING EDUCATION:NURSING EDUCATION:
APPLICATION OF NURSINGAPPLICATION OF NURSING
THEORIES IN NURSING EDUCATION:THEORIES IN NURSING EDUCATION:
The theoretical principles, concepts and
models are used in two major ways in
• They are used to determine the content and
structure of a program’s curriculum.
• They are used to determine the instructional
processes and strategies used by faculty to
APPLICATION OF THEORY INAPPLICATION OF THEORY IN
NURSING EDUCATIONNURSING EDUCATION
• Problem based learning
• Lifelong learning.
NEW MODELS FOR CURRICULANEW MODELS FOR CURRICULA
“Humanistic” approaches to teaching
Highlight caring relationships
Student faculty shared responsibilities for
Multiple ways of knowing.
THEORETICAL ISSUES IN NURSING CURRICULATHEORETICAL ISSUES IN NURSING CURRICULA
The issues incorporation of theoretical principles
and frameworks into nursing curricula are:
Basic curriculum design.
The impact of regulating organizations on nursing
Components of curricular conceptual or
organizational frameworks and
The process involved in designing and organizing
CURRICULUM DESIGN IN NURSING EDUCATION:CURRICULUM DESIGN IN NURSING EDUCATION:
The curricula of most nursing programs are based on the Tyler
Curriculum Development Model which was published in 1949.
According to Bevis (1989), introduction of Tyler’s concepts in the
1950s along with her first book on curriculum development, and Mager’s
(1962) publication of Preparing Instructional Objectives, led to the
development of Tyler type curricula throughout nursing education.
Eventually, the Tyler Model became the only model used in
developing nursing curricula for all levels of nursing education – Diploma,
Associate Degree, and Baccalaureate.
TYLER MODELTYLER MODEL
1. It begins with Identification of the educational purposes
or objectives for the program.
2. Then differentiates what learning experiences should be
selected to attain the objectives.
3. Third issue is how to organize learning experiences for
4. Finally, the model focuses on evaluation of behaviors to
determine if objectives have been met.
NURSING CURRICULA AND REGULATING BODIESNURSING CURRICULA AND REGULATING BODIES
The Tyler –Based Curriculum development process has been
translated into essential curricular components, and without evidence of
these components, state boards will not grant program approval.
The rules and regulations set by state boards of nursing typically
specify content areas that must be covered minimum hours that must be
spent by all students in clinical settings and competencies or skills that
all students must possess at completion of the nursing program.
Boland & Finke, (2005)
Stated or defined conceptual framework is required for program
approval by many state boards of nursing
CONCEPTUAL / ORGANISATIONALCONCEPTUAL / ORGANISATIONAL
FRAMEWORKS FOR NURSING CURRICULAFRAMEWORKS FOR NURSING CURRICULA
The conceptual or organizational framework of
nursing program must be an outgrowth of the philosophy of
the faculty, which typically reflects the faculty’s
philosophical beliefs about the metaparadigm concepts.
- Boland, (2005); Keating, (2006)
A curriculum conceptual framework is an
“interrelated system of premises that provides guidelines or
ground rules for making all curricular decisions- objectives,
content, implementation, and evaluation”
THEORETICAL ISSUES IN NURSING INSTRUCTIONINSTRUCTION
According to Barnum (1998), what is taught
in nursing programs can be divided in 3
1. Cognitive Content
2. Psychomotor tasks
3. Application of content and skills in nursing
1. Cognitive Content:1. Cognitive Content:
 Refers to all the information the nurse learns as background for
 Eg: Anatomy, Physiology, Pathology, Psychology, Medical procedures,
 Cognitive content can be easily transmitted through a variety of
means: lectures, discussions, programmed learning, or reading
 Acquisition of cognitive content can be achieved in the absence of
skilled teaching if another source of information (i.e a textbook) is
2. Psychomotor tasks2. Psychomotor tasks
 Are the acts or skills nurses perform according to a given rationale by
applying accepted techniques.
 Eg: Administering medication, Changing dressings, Inserting I.V lines.
 Requires demonstration, return demonstration, with corrective
feedback, and skill development through practice.
 Most complex task to learn to application.
 Takes time as learning accumulates from multiple clinical experiences
in varied setting
3. Application of content and skills in3. Application of content and skills in
nursing practicenursing practice
 Involves recognizing and
interpreting phenomena in the clinical
setting and adapting care based on the
THEORY BASED TEACHING STRATEGIESTHEORY BASED TEACHING STRATEGIES
To best meet the learning needs of students
at the beginning of the 21st
educators are encouraged to move beyond
reliance on traditional techniques of lecture and
reading assignments to incorporate other
teaching strategies which are based on sound
SOME THEORIES SUGGESTED BY BARNUM (1998)SOME THEORIES SUGGESTED BY BARNUM (1998)
Problem Based Learning Strategies
Operational Teaching Strategies
Logistic Teaching Strategies
DIALECTIC LEARNINGDIALECTIC LEARNING
 Leads students to develop and expand their own thoughts on a
given subject, primarily through the use of well constructed questions.
 Shown to be effective, as Ironside (1999) described how questioning
and dialogue techniques used by nursing faculty, promote critical
thinking in nursing students.
 Questioning can lead to demonstration of inconsistencies in, or
contradictions to, the student's position.
 The student moves from a narrow conception of the subject matter
to a broader and more comprehensive understanding that
encompasses more events and more complexities.
 Eg: It is commonly used in clinical situations and postclinical
 Online discussions provide an environment for dialectic learning.
PROBLEM BASED LEARNING STRATEGIESPROBLEM BASED LEARNING STRATEGIES
• Involves the use of predefined clinical situations and case studies to enhance
or stimulate students to acquire specific skills, knowledge and abilities
(Rowles & Brigham, 2006)
• The objective of Problem based learning is to determine how to manage the
• Stimulated clients may be used, or the student might be given real problem in
an actual clinical case.
• Allow the instructor to manipulate the multiple variables to add increasingly
complex issues or circumstances that must be considered in problem
• Problem based learning is innovative and encourages self direction,
interpersonal communication, and use of information technology.
• Typically small groups of students work together in self directed teams, the
case studies challenge them to improve their critical thinking capabilities,
learn self evaluation strategies and promote communication among peers
(Bently, 2004; Rowles & Brigham, 2006)
• Focus on presenting various perspectives regarding an agent or issue.
• Eg: A symposium that uses speakers with different perspectives on the
same subject matter or a debate.
• Other Operational strategies focus on providing different or atypical
activities for the learner.
• Using educational games or viewing nonmedical videos for illustration
are considered to be operational teaching activities (Barnum, 1998)
• Many nursing faculty use operational teaching techniques to make
learning more interesting and enjoyable and to provide a different
perspective on a particular topic (Rhorer, 2000)
• Use of games to enhance students understanding of ethical situations
was described by (Metcalf and Yankou, 2003)
OPERATIONAL TEACHING STRATEGIESOPERATIONAL TEACHING STRATEGIES
LOGISTIC TEACHING STRATEGIESLOGISTIC TEACHING STRATEGIES
• Based on the concept of mastery of sequential learning
• Logistic teaching techniques generally divide the material to be
learned into learning sequences, where acquisition of one section
of the material is a necessary prerequisite to acquisition of another
• Teach the student clearly defined components and provide for
reinforcement and testing of each component as the program
• As the sections of the material are added and related to each other,
knowledge accumulates (Barnum, 1998)
• Some of the strategies include use of Self instructional modules
and portfolios; these are typically logistic in nature because they
follow a pattern of assembling information that is built on
previously explained material (Rowles & Brigham, 2005)
The Theory of Nursing Knowledge
and Nursing Practice presents a global
perspective of the science and art of
nursing and accounts for the past,
present, and future impacts on nursing
knowledge and nursing practice.
61. APPLICATION OF NURSINGAPPLICATION OF NURSING
THEORIES IN TO NURSINGTHEORIES IN TO NURSING
Theory helps provide knowledge to
improve practice by describing,
explaining, predicting, and controlling
phenomena. Nurses' power is increased
through theoretical knowledge because
systematically developed methods are
more likely to be successful. In
addition, nurses will know why they
are doing what they are doing if
challenged. Theory provides
professional autonomy by guiding the
practice, education, and research
functions of the profession. The study
of theory helps develop 'analytical
skills, challenge thinking, clarify
SCIENCE IS “THE OBSERVATION,
AND OBSERVAON AND
THEORETICAL EXPLANATION OF
NATURAL PHENOMENA. IT IS A
BODY OF KNOWLEDGE.
65. KNOWLEDGE IS AN
PERCEPTION OF REALITY
Phenomena comprise the
subject matter of a
discipline. A phenomenon
is defined as an object or
aspect known through the
senses rather than by
thought or intuition a fact
or event of scientific
interest susceptible to
scientific description and
Philosophy is the
science comprising logic,
epistemology. It is the
“investigation of causes
and laws underlying
realty” and is “inquiry
into the nature of things
based on logical reasoning
rather than empirical
A theory is a set of
assumptions that project a
systematic view of
70. • Nursing Theory helps in building
knowledge and Establishing Nursing as a
• Nursing Theory is a Source of Professional
Autonomy and Power.
71.  The development of nursing theory
will help in strengthening nursing
 It helps in provide systematic
structure and rationale for nursing
72.  Theory is important because it
helps us to decide what we know
and what we need to know.
It helps to Develop curriculum
plans for nursing education.
 A formal definition of nursing
theory also provides nurses with
an understanding of their purpose
and role in health care.
73. • It helps to Guide development of nursing
care delivery system.
• It helps to formulate legislation governing
nursing practice, research and education
• It guides nursing education, research and
practice and differentiate nursing practice.
74. • Nursing theory aims to
describe, predict and explain
the phenomenon of nursing.
It should provide the
foundations of nursing
practice, help to generate
further knowledge and
indicate in which direction
nursing should develop in
75.  Theory Provides knowledge to
improve nursing administration,
practice, education, and research.
 It Identify nature of contribution that
research will make to advancement of
 Theories serves as a springboard for
76.  It helps to guide research to
establish empirical knowledge
base for nursing.
 It helps to Identify research
techniques and tools that will be
used to validate nursing
77.  Nursing is a learned profession,
a science, and an art. Nurses need a
theoretical base to exemplify the
science and art of the profession
when they promote health and
wellness for their clients, whether
the client is an individual, a family,
or a community.
78.  Theories constitute much
of the knowledge of a
discipline, and theory and
inquiry are vital linkages to
each other. Nursing theories
provide nurses with a
perspective to view client
situations, a way to organize
data, and a method to analyze
and interpret information.
79.  Nursing Theory is used to: Define
commonalities of the variables in a
stated field of inquiry; guide nursing
research and actions; predict practice
outcomes; and predict client
response. A nursing theory is a
conceptualization of some aspect of
nursing communicated for the
purpose of describing, explaining,
predicting, and/or prescribing
80.  Theory is useful. Nursing practice settings
are complex and the amount of data available
to nurses is virtually endless. Nurses must
analyze a tremendous amount of information
about each patient and decide what to do. If a
theory helps practicing nurses categorize and
understand what is going on in nursing
practice, it is helps them predict patient
responses to nursing care, and it is helpful in
clinical decision making it is useful as a guide
81.  Commitment to practice based
on sound, reliable; knowledge is
intrinsically valuable to nursing.
That is to say, knowledge is
desirable by its very nature. The
growth and enrichment of theory in
and of itself is an important goal for
nursing, as a scholarly discipline to
82. WHY DO WE NEED
THEORIES IN NURSING
83.  Theories can interrelate concepts in
such a way as to create a different way
of looking at a particular phenomenon.
 Theories can be the basis for
hypotheses that can be tested.
 Theories contribute to and assist in
increasing the general body of
knowledge within the discipline
through the research implemented to
84.  Theories can be utilized by the
profession to guide and improve
 Theories must be consistent with
other validated theories, laws, and
principles but will leave open,
unanswered questions that need to be
 Theory supports professional
autonomy by guiding practice, education
Nurses should actively support the development
of nursing theory because it offers them a sense
of identity and can help patient, managers and
other healthcare professionals to recognize the
unique contribution nurses make to the
healthcare service. The definition of nursing
theory also provides nurses with an
understanding of their purpose and role in the