EVOLUTION OF NURSING (THEORETICAL FOUNDATIONS OF NURSING)

EVOLUTION OF NURSING
(Theoretical Foundation of
Nursing)
By: ROMMEL LUIS C. ISRAEL III

INTRODUCTION
TO NURSING
THEORY
By: ROMMEL LUIS C. ISRAEL III 2

WHAT IS
THEORY?

A set of statements that tentatively describe, explain, or predict relationships among
concepts that have been systematically selected and organized as an abstract representation
of some phenomenon (Power and Knapp, 1995). These systematic organized perspectives
serve as guides for nursing action in administration, education, research, and practice.
A well - substantiated explanation of some aspect of the natural world; an organized system
of accepted knowledge that applies in a variety of situations/ hypotheses.

5
An expectation of what should happen,
barring unforeseen circumstances.
A coherent statement or set of
statements that attempts to explain
observed phenomena.
An explanation for some phenomena
that is based on observation,
experimentation, and reasoning.

A comprehensive explanation of a given set of data that has been repeatedly
confirmed by observation and experimentation and has gained general
acceptance within the scientific community but has not been yet decisively
proven.
A construct (the way to put together the "parts" of something) that accounts for
or organizes some phenomena (Barnum, 1998).

WHAT IS
NURSING
THEORY?

A body of knowledge that describes or explains nursing and is used to support nursing
practice.
An organized and systematic articulation of a set of statements related to questions in
the discipline of nursing.
Is a set of concepts, definitions, 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-relationships among
concepts for the purposes of describing. explaining, predicting and/or prescribing.

CHARACTERISTICS OF A
THEORY

A theory is interrelating concepts in
such a way as to create a different way
of looking at a particular phenomenon
A Theory islogical in nature
A theory is generalizable
A theory is basis for hypotheses that can
be tested

A theory is increasing the general body of
knowledge within the discipline through the
research implemented to validate them
A theory is used by the practitioners to
guide and improve their practice
A theory is consistent with other validated
theories, laws and principles but will leave
open unanswered questions that need to
be investigated.

COMPONENTS OF A
THEORY

By:
ROMMEL
LUIS
C.
ISRAEL
III
14

1. CONCEPTS
A theory is composed of interrelated concepts.
Concepts help to describe or label phenomena.
Using Levine's Conservation Model in Nursing Practice as an example, there are
concepts that affect the nursing practice - the "why's of nursing actions."
The three major concepts that form the basis of the model and its assumptions
are as follows: 1. conservation; 2. adaptation; 3, wholeness.

1. CONCEPTS
Another example is King's Theory of Goal Attainment in Nursing Practice.
According to this model, the concepts that are critical to goal attainment in
nursing practice are as follows: 1. personal systems;2. interpersonal systems;
3. social systems.

2. DEFINITIONS
The definitions within the description of a theory convey the general
meaning of the concepts in a manner that fits the theory.
These definitions also describe the activity necessary to measure the
constructs, relationships, or variables within a theory (Chinn and
Kramer 2004)

2. DEFINITIONS
For example, Levine's Conservation Model defines conservation as the
keeping together of the life system; those individuals continuously defend
their wholeness.
Accordingly, wholeness exists when the interactions or constant
adaptations to the environment permit the assurance of integrity.
In addition, the Model defines adaptation as the ongoing process of
change whereby individuals retain their integrity within the realities of
their environment

2. DEFINITIONS
Another example, King's Theory of Goal Attainment defines personal
systems as individuals; those individuals are open, total, unique systems in
constant interaction with the environment.
INTERPERSONAL SYSTEMS are defined as two or more individuals in
interaction.
SOCIAL SYSTEMS are defined as large groups with common interests or
goals

3. ASSUMPTIONS
Are statements that describe concepts or connect two concepts that
are factual.
Assumptions are the "taken for granted" statements that determine
the nature of the concepts, definitions, purpose, relationships and
structure of the theory.

3. ASSUMPTIONS
• The assumptions in Levine's Conservation Model are that: individuals continuously defend their
wholeness; adaptation is an ongoing process of change; nursing is human interaction; nurses
promote wholeness through the use of conservation principle.

4. PHENOMENON
A phenomenon is an aspect of reality that can be consciously sensed or experienced.
Nursing theories focus on the phenomena of nursing and nursing care.
Examples of phenomena in nursing include caring, self-care, and client responses to stress.
In Levine's Conservation Model, phenomena include: person, nursing, health and environment.
In King's Goal Attainment Theory, phenomena include: social systems, health, perception, and
interpersonal relationships.

TYPES OF THEORIES

1.
METATHEORIES
Are theories whose subject
matters are some other
theories.
These are theories about
theories.

2. GRAND
THEORIES
Are broad in scope and complex
and therefore require further
specification through research
before they can be fully tested
(Chinn and Kramer, 1999).
These are intended to provide
structural framework for broad,
abstract ideas about nursing
(Fawcett, 1995).

3. MIDDLE
RANGE
THEORIES
Have more limited scope, less
abstraction, address specific
phenomena or concepts and reflect
practice (administration, clinical or
teaching).
The phenomena or concepts tend to
cross different nursing fields, and reflect
a wide variety of nursing care situations,
e.g.: quality of life, uncertainty in illness,
social support, incontinence, caring.

4.
DESCRIPTIVE
THEORY
Are the first level of theory development.
They describe phenomena, speculate on
why phenomena occur, and describe the
consequences of phenomena.
They have the ability to explain, relate, and
in some situations predict nursing
phenomena (Meleis, 1997). Example:
Theories of Growth and Development. )

5.
PRESCRIPTIVE
THEORIES
Address nursing
interventions and predict the
consequence of a specific
nursing intervention.
Prescriptive theories are
action oriented, which test
the validity and predictability
of a nursing intervention.

NURSING: THE
DISCIPLINE
AND THE
PROFESSION

• DISCIPLINE is specific to academia
and refers to a branch of
education, a department of
learning, or a domain of
knowledge.
• PROFESSION refers to a
specialized field of practice,
founded upon the theoretical
structure of the science or
knowledge of that discipline and
accompanying practice abilities

SIGNIFICANCE
OF THEORY
FOR NURSING
AS A
DISCIPLINE

32
University baccalaureate programs proliferated, masters’
programs in nursing were developed, and the curricula
began to be standardized through the accreditation process.
Attention to the importance of nursing conceptualizations
for the research process and the role of a conceptual
framework in the purpose and design of research
production of science and nursing theoretical works also
began to publish.
Works began to be recognized for their theoretical nature,
such as Henderson, Nightingale and etc.

33
KEYNOTE ADDRESS, New nursing doctoral
programs were beginning to open and they
reopened the discussion of the nature of nursing
science. This becomes the first classic reference
for nursing as discipline and for distinguishing
between the discipline and profession.
Fawcett’s conceptualization of metaparadigm of
nursing and unifying conceptualtheoretical
structure of knowledge recognize works of major
nursing theorist as conceptual framework and
paradigms of nursing.

34
MAJOR SIGNIFICANCE IS; THE
DISCIPLINE IS DEPENDENT UPON
THEORY:
• Theoretical works have taken nursing to a
higher level;
• The emphasis has shifted from a focus on
knowledge about how nurses function,
which concentrated on the nursing process,
to focus on what nurses know and how they
use knowledge to guide their thinking and
decision making while concentrating on the
patient

SIGNIFICANCE OF
HISTORY FOR
NURSING AS A
PROFESSION

Bixler and Bixler published a set of criteria tailored to nursing in
the American Journal of Nursing in 1959. They stated that a
profession:
• Utilizes in its practice a well-defined and well-organized body of specialized
knowledge that is on the intellectual level of the higher learning.
• Constantly enlarges the body of knowledge it uses and improves its techniques of
education and service by the use of the scientific method.
• Entrusts the education of its practitioners to institution of higher education.
• Applies its body of knowledge in practical services that are vital to human and
social welfare.
• Functions autonomously in the formulation of professional policy and in the
control of professional activity thereby. F
• Attracts individuals of intellectual and personal qualities who exalt service above
personal gain and who recognizes their chosen occupation as a life work.
• Strives to compensate its practitioners by providing freedom of action, opportunity
for continuous professional growth and economic security.

Nursing theory is a useful tool for reasoning, critical thinking, and decision
making in nursing practice.
Nursing theoretical works provide a perspective of the patient.
Nursing theory provides more direction for nursing practice.
The conceptual models of nursing are comprehensive and the reader to the
specifics of the practice.
Middle range theories contain the specifics of nursing practice.

ANALYSIS QUESTIONS TO
DETERMINE THEORETICAL
ADEQUACY

CLARITY: How clear is this theory?
SIMPLICITY: How simple is this theory?
GENERALITY: How general is this theory?
ACCESSIBILITY: How accessible is this theory?
IMPORTANCE: How important is this theory?

HISTORY AND
PHILOSOPHY OF
SCIENCE

“Sometimes all that is
possible is to embrace
the mystery, the
unknown, of a
situation and allow it
to be beyond reach or
understanding it for a
while.”
The construction of
nursing theories is the
formalization of
attempts to describe,
explain, predict, or
control states of
affairs in nursing
(nursing phenomena).

HISTORICAL VIEWS OF THE NATURE OF
SCIENCE
The term EPISTEMOLOGY is concerned with the theory of
knowledge in philosophical inquiry.
The particular philosophical perspective selected to answer
these questions will influence how scientists perform scientific
activities, how they interpret outcomes, and even what they
regard as science and knowledge.

NURSING AS A
SCIENCE
44
Science is logical, systematic, & coherent way
to solve problems and answer questions.
It is a collection of facts known in area and the
process used to obtain that knowledge.
- Pure or basic
- Natural, human, or social
- Applied or practical

NURSING AND PHILOSOPHY
Philosophy studies concepts that
structure thought processes,
foundations, and presumptions.
It is an approach for thinking about
the nature of people, the methods
that should be used to create a
scientific knowledge and the ethics
involved. It denotes a perspective,
implying a certain broad, “taken for
granted” assumptions.
- Nature of existence
- Morality - Knowledge and reason - Human purpose

NURSING AND PHILOSOPHY
Nursing science has been characterized by two branching philosophies of
knowledge as the discipline developed.
Various terms are utilized to describe these two stances: empiricist and
interpretive, mechanistic and holistic, quantitative and qualitative, and
deductive and inductive forms of science.
Understanding the nature of these philosophical stances facilitates
appreciation for what each form contributes to nursing knowledge.

NURSING AND
PHILOSOPHY
•EPISTEMOLOGY a branch
of philosophy that is
concerned with the
nature and scope of
knowledge. It is referred
to as the ‘theory of
knowledge’. The power
of reason and power of
sensory experience
(Gale)

1. RATIONALISM:
THE POWER OF
REASON
• Rationalist epistemology (scope of
knowledge) emphasizes the importance of
a priori reasoning as the appropriate
method for advancing knowledge.
• A priori reasoning utilizes deductive logic by
reasoning from the cause to an effect or
from a generalization to a particular
instance.
• Reynolds (1971) labeled this approach the
theory-then-research strategy. In Reynolds’
view, “as the continuous interplay between
theory construction (invention) and testing
with empirical research progresses, the
theory becomes more precise and
complete as a description of nature and,
therefore, more useful for the goals of
science” (Reynolds, 1971, p. 145).
• Einstein made use of mathematical
equations in developing his theories.

2. EMPIRICISM: THE POWER OF SENSORY
EXPERIENCE
• The empiricist view is based on the central idea that scientific
knowledge can be derived only from sensory experience (i.e.,
seeing, feeling, hearing facts).
• Francis Bacon (Gale, 1979) received credit for popularizing the
basis for the empiricist approach to inquiry.
• Bacon believed that scientific truth was discovered through
generalizing observed facts in the natural world.
• This approach, called the inductive method, is based on the
idea that the collection of facts precedes attempts to
formulate generalizations, or as Reynolds (1971) called it, the
research-then-theory strategy Skinner’s work focuses on
collection of empirical data.
• In summary, deductive inquiry uses the theory then-research
approach, and inductive inquiry uses the research-then-
theory approach. Both approaches are utilized in the field of
nursing.

3. EARLY
TWENTHIETH
CENTURY VIEWS
OF SCIENCE AND
THEORY
• Philosophers focused on the analysis of theory
structure, whereas scientist focused on empirical
research.
• Positivism, a term first used by Comte, emerged as
the dominant view of modern science (Gale, 1979)
• Positivism (imposed on the mind by experience) is
the philosophy of science that information is
derived from logical and mathematical treatments
and reports of sensory experience is the exclusive
source of all authoritative knowledge.
• Modern logical positivists believed that empirical
research and logical analysis (deductive and
inductive) were two approaches that would produce
scientific knowledge (Brown, 1977).
• Logical empiricist argued that theoretical
propositions must be tested through observation
and experimentation.

4. EMERGENT
VIEWS OF SCIENCE
AND THEORY IN
THE LATE
TWENTIETH
CENTURY
• In The Phenomenology of the Social World,
Schutz (1967) argued that scientists seeking to
understand the social world could not
cognitively know an external world that is
independent of their own life experiences.
• A phenomenological approach reduces
observations or text to the meanings of
phenomena independent of their particular
context. Brown (1977), argued an intellectual
revolution in philosophy that emphasized the
history of science was replacing formal logic as
the major analytical tool in the philosophy of
science.
• Empiricists view phenomena objectively, collect
data, and analyze it to inductively proposed
theory (Brown, 1977).

4. EMERGENT
VIEWS OF SCIENCE
AND THEORY IN
THE LATE
TWENTIETH
CENTURY
52
Brown argues that the new
epistemology challenged the empiricist
view of perception by acknowledging
that theories play a significant role in
determining what the scientist will
observe and how it will be interpreted.
He identified the following three
different views of the relationship
between theories and observation:
• Scientists are merely passive observers of
occurrences in the empirical world. Observable
data are objective truth waiting to be discovered.
• Theories structure what the scientist perceives in
the empirical world
• Presupposed theories and observable data interact
in the process of scientific investigation

DATA-DRIVEN
OR BOTTOM-
UP THEORY
•Cognitive
expectation is used
to select input and
process of incoming
information from the
environment.

CONCEPTUALLY-
DRIVEN OR TOP-
DOWN THEORY
•Asserts that incoming
data are perceived as
unlabeled input and
analyzed as raw data
with increasing levels
of complex until all
data are classified

INTERDEPENDENCE
BETWEEN THEORY
AND RESEARCH
• A theory is accepted when
scientists agree that it provides a
description of reality that captures
the phenomenon based on current
research findings (Brown, 1977).
• A theory should be judged based
on the basis of scientific consensus.
• The acceptance of scientific
hypothesis through research
depends on the appraisal of the
coherence of theory

INTERDEPENDENCE
BETWEEN THEORY
AND RESEARCH
• Dubin identified when scientific
consensus is necessary:
1. Agreement on the boundaries of
the theory; that is, the
phenomenon it addresses and
the phenomena it excludes
(criterion of coherence).
2. Agreement on the logic used in
constructing the theory to further
understanding from a similar
perspective (criterion of
coherence).
3. Agreement that the theory fits
the data collected and analyzed
through research (criterion of
correspondence).

ISSUES IN NURSING
PHILOSOPHY AND
SCIENCE DEVELOPMENT

Meleis characterized
the years of progress
in nursing in four
stages:
1. Practice
2. Education and
Administration
3. Research
4. Development of
Nursing Theory

• Peplau developed the first
theory of nursing practice in
her book, Interpersonal
Relations in Nursing.
• Journal of Nursing Research
(1952)
• 1960s and 1970s – analysis
and debate on the
metatheoretical issues related
to theory development

Four fundamental patterns of
knowledge in Nursing (Carper, 1978)
1. Empirical knowledge (nursing
science)
2. Esthetic knowledge (nursing as an
art)
3. Moral knowledge (ethics in
nursing)
4. Personal knowledge (therapeutic
use of self)

•1980s further
acceptance of nursing
theory and its
incorporation in the
nursing curricula;
publication of several
nursing journals

PHENOMENOLOGY
•is a science that
describes how we
experience the objects
of the external world
and provides an
explanation of how we
construct objects of
experience.

ETHNOMETHODOLOGY
•focuses on the
world of “social
facts” as
accomplished or
cocreated through
people’s
interpretive work.

POSTPOSITIVISM
• Postpositivism focuses on
discovering patterns that may
describe, explain, and predict
phenomena.
• The postpositivist and
interpretive paradigms have
achieved a degree of
acceptance in nursing as
paradigms to guide knowledge
development.

POSTMODERNISM
• Postmodernism includes
the particular philosophies
that challenge the
“objectification of
knowledge,” such as
phenomenology,
hermeneutics, feminism,
critical theory, and
poststructuralism.

WHOLISM
•Wholism is
another
philosophy in
understanding
the patient.

WHOLISTIC NURSING
•Wholistic nursing views
the biophysical,
psychological, and
sociological subsystems
as related but separate,
thus the whole is equal
to the sum of the parts.

HOLISTIC NURSING
•Holistic nursing
recognizes that
multiple subsystems
are in continuous
interaction and that
mind-body
relationships do exist

INTERPRETIVE
PARADIGM
• Interpretive paradigm tends to
promote understanding by
addressing the meanings the
participants social interaction
that emphasize situation,
context and multiple cognitive
constructions that individuals
create on everyday events

CRITICAL PARADIGM
• Critical paradigm for
knowledge development in
nursing, provides framework
for inquiring about the
interaction between the social,
political, economic, gender and
cultural factors and
experiences of health and
illness.

SCIENCE AS A SOCIAL
ENTERPRISE
•The process of
scientific inquiry
may be viewed as a
social enterprise
(Mishler, 1979).

STRUCTURE OF
NURSING
KNOWLEDGE

1. Structure Level (Analysis
of theory, clarity,
simplicity, generality,
accessibility,
importance).
2. Metaparadigm (Person,
Health, Environment,
Nursing).
3. Philosophy
4. Conceptual models
5. Theory
6. Middle range theory

1. STRUCTURE
LEVEL

1. STRUCTURE
LEVEL
• Structure level presents the
structure and analysis of
specialized nursing knowledge.
• Structure of knowledge that was
used to organize the units of the
text and the definitions of the
analysis criteria used for the
review process of the theoretical
works

1. STRUCTURE LEVEL
A. ANALYSIS OF THEORY
1. Analysis, critique and evaluationn are
methods used to study nursing theoretical
works critically.
2. Analysis of theory is carried out to acquire
knowledge of theoretical adequacy.
3. It is an important process and the first step in
applying nursing theoretical works to
education research, administration or
practice.
4. Analysis process is useful for learning about
the works and is essential for nurse scientist
who intend to test, expand, or extend the
works.
5. Understanding theoretical framework is vital
to applying it in practice.

1. STRUCTURE LEVEL
B. CLARITY
1. It speaks to the meaning
of term used, and
definitional consistency
and structure speak to
the consistent structural
form of terms in the
theory.
2. Words have multiple
meanings within and
across disciplines;
therefore, a word should
be defined specifically
according to the
framework (Philosophy,
conceptual model, theory,
or middle range theory)

1. STRUCTURE LEVEL
C. SIMPLICITY
1. It is highly valued in nursing
theory development.
2. It discusses the degrees of
simplicity and call for simple
forms of theory, such as
middle range, to guide
practice.
3. Complex practice situation
may call for more complex
theory.
4. A theory should be sufficient,
comprehensive, presented at
a level of abstraction to
provide guidance, and have as
few concepts possible with a
simplistic relation as possible
to aid clarity.

1. STRUCTURE LEVEL
D. GENERALITY
1. It speaks to the scope of
application and the purpose within
the
theory (Chinn & Krammer, 2015).
2. Understanding the levels of
abstraction by doctors’ students and
nurse scientist has facilitated the
use of abstract frameworks and
the development of middle-
range theories

1. STRUCTURE LEVEL
E. ACCESSIBILITY
1. “Accessible 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”
2. It is vital to developing
nursing research to test
theory. It facilitates testing,
because the empirical
indicators provide linkage too
practice for test ability and
ultimate use of theory to
describe and test aspects of
practice
(Chinn&Krammer,2015).

1. STRUCTURE LEVEL
F. IMPORTANCE
1. “Does this theory
create understanding
that is important to
nursing?”. Because
research, theory, and
practice are closely
related, nursing theory
lends itself to research
testing and research
testing leads itself to
knowledge of practice.

2. METAPARADIGM
The broad conceptual boundaries of the discipline of
nursing, human beings, environment, and health

2. METAPARADIGM

3. PERSON
It is referred to the person as a patient.
Nurses performed task to and for the patient and controlled the patient’s
environment to enhance recovery.
Nightingale described a passive patient in this relationship. However, specific
references are made to the patient performing self-care when possible and,
in particular, being involved in the timing and substance of meals.

4. HEALTH
Health, a dynamic process, is the
synthesis of wellness and illness and is
defined by the perception of the client
across the life span.
This view focuses on the entire nature
of the client in physical, social,
aesthetic, and moral realms.
Health is contextual and relational.
Wellness, in this view, is the lived
experience of congruence between
one’s possibilities and one’s realities
and is based on caring and feeling
cared for. Illness is defined as the lived
experience of loss or dysfunction that
can be mediated by caring
relationships.
Inherent in this conceptualization is
each client’s approach to stress and
coping.
The degree or level of health is an
expression of the mutual interactive
process between human beings and
their environment.

5.
ENVIRONMENT
• Environment is the landscape and geography of
human social experience, the setting or context of
experience as everyday life and includes variations
in space, time and quality.
• This geography includes personal, social, national,
global, and beyond.
• Environment also includes societal beliefs, values,
mores, customs, and expectations.
• The environment is an energy field in mutual
process with the human energy field and is
conceptualized as the arena in which the nursing
client encounters aesthetic beauty, caring
relationships, threats to wellness and the lived
experiences of health.
• Dimensions that may affect health include
physical, psychosocial, cultural, historical and
developmental processes, as well as the political
and economic aspects of the social world

6. NURSING
Nursing is an academic discipline and a practice profession.
It is the art and science of holistic health care guided by the values of human freedom, choice, and responsibility.
Nursing science is a body of knowledge arrived at through theory development, research, and logical analysis.
Nursing and other supporting theories are essential to guide and advance nursing practice.
The art of nursing practice, actualized through therapeutic nursing interventions, is the creative use of this knowledge
in human care.
Nurses use critical thinking and clinical judgment to provide evidence-based care to individuals, families, aggregates,
and communities to achieve an optimal level of client wellness in diverse nursing settings/contexts.
Clinical judgment skills are therefore essential for professional nursing practice

2.
METAPARADIGM

FOUR
MAJOR
CONCEPTS
OF
NURSING
THEORIES
By:
ROMMEL
LUIS
C.
ISRAEL
III
91
PERSON. Refers to all human beings. People are the recipients of nursing care; they
include individuals, families, communities and groups.
ENVIRONMENT. Includes factors that affect individuals internally and externally. It
means not only everyday surroundings but also settings where nursing care is
provided.
HEALTH. Addresses the person's state of well-being.
NURSING. Is central to all nursing theories. Definitions of nursing describe what
nursing is, what nurses do, and how nurses interact with clients. It is the "diagnosis
and treatment of human responses to actual or potential health problems" (ANA,
1995). Example: the nurse establishes nursing diagnoses of fatigue, change in body
image, and altered coping based on the medical diagnosis of heart condition

3. PHILOSOPHY

Philosophy is the most abstract type and sets forth the
meaning of nursing phenomena through analysis, reasoning,
and logical presentation.
Early works that predate the nursing theory era, such as
Nightingale (1969/1859), contributed to knowledge
development by providing direction or a basis for subsequent
developments.

4. CONCEPTUAL MODELS

Nursing conceptual models, comprises nursing works by
theorists referred to by some as pioneers in nursing.
Fawcett (2005) explains, “A conceptual model provides a
distinct frame of reference for its adherents . . . that tells
them how to observe and interpret the phenomena of
interest to the discipline.”

5. THEORY

Theory comprises works derived from nursing philosophies, conceptual models, abstract
nursing theories, or works in other disciplines (Alligood, 2010a; Wood, 2010).
A work classified as a nursing theory is developed from some conceptual framework and is
generally not as specific as a middle-range theory. Although some use the terms model and
theory interchangeably, theories differ from models in that they propose a testable action.
An example of theory derived from a nursing model is in Roy’s work, where she derives a
theory of the person as an adaptive system from her Adaptation model.
Theories may be specific to a particular aspect or setting of nursing practice.

6. MIDDLE-
RANGE
THEORY

Middle-range theory, has the most specific focus and is concrete in its level of
abstraction.
Middle-range theories are precise and answer specific nursing practice questions.
They address the specifics of nursing situations within the perspective of the
model or theory from which they are derived.
The specifics are such things as the age group of the patient, the family situation,
the patient’s health condition, the location of the patient, and, most importantly,
the action of the nurse (Alligood, 2010a; Wood, 2010).
There are many examples of middle-range theories in the nursing literature that
have been developed inductively as well as deductively

REFERENCES
• Alligood, M. R. (2017). Nursing Theorists and Their Work (9th ed.).
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thesynchronicity-theory-application-of-the-nursing-engagement-
process/
• Antipuesto, D. J. (2014a, February 23). Carmencita M. Abaquin.
Nursing Crib. Retrieved August 8, 2022, from
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REFERENCES
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Retrieved August 8, 2022, from https://nursingcrib.com/nursing-notes-
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