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Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 2
Overview of Theory in Nursing

Theory
• It is the unique theories and perspectives used by a
discipline that distinguishes it from other disciplines.
• Theories of a discipline
– Clarify basic assumptions and values
– Define the nature and purpose of
practice

Theory—Definitions
• A systematic explanation of an event in which constructs
and concepts are identified and relationships are
proposed and predictions made
• A system of interrelated propositions used to predict,
explain, understand, and control a part of the empirical
world

Theories
• Are composed of concepts, propositions, and laws; they
can be communicated
• Vary according to the number of elements,
characteristics and complexity of the elements, and type
of relationships among the elements
• Are invented rather than discovered

Question
“A tentative suggestion that a specific relationship exists
between two concepts or propositions” is a definition of:
A.Assumptions
B.Epistemology
C.Hypothesis
D.Ontology

Answer
C. Hypothesis
Rationale: A hypothesis is a tentative suggestion that a
specific relationship exists between two concepts or
propositions.

“Well, ya see Normmy, it’s like this . . . a herd of buffalo can only
move as fast as the slowest buffalo. And when the herd is
hunted, it is the slowest and weakest ones at the back that are
killed first. This natural selection is good for the herd as a
whole, because the general speed and health of the whole
group keeps improving by the regular killing of the weakest
members. In much the same way, the human brain can only
operate as fast as the slowest brain cells. Excessive intake of
alcohol, as we all know, kills brain cells, but naturally it attacks
the slowest and weakest brain cells first. In this way, regular
consumption of beer eliminates the weaker brain cells, making
the brain a faster and more efficient machine. That’s why you
always feel smarter after a few beers.”
—Cliff Claven (Cheers)
An Example of “Theory”

Theory in Nursing
• Theory provides structure and organization for nursing
knowledge.
• Theory provides systematic means of collecting data to
describe, explain, and predict phenomena of importance
to nursing.
• Theories define and clarify nursing and distinguish it from
other caring professions.

Uses of Theory in Nursing
• Identify standards of practice
• Identify settings for practice
• Identify distinctive nursing processes to be used
• Direct the delivery of nursing interventions
• Serve as the basis for clinical information systems
• Direct quality improvement programs

Terms Used in Theory
• Assumptions—beliefs about phenomena that are
accepted as true
• Concept—abstract elements of a phenomenon necessary
to understand it
• Construct—complex concepts; comprises more than one
concept and built or “constructed” to fit a purpose

Terms Used in Theory—(cont.)
• Empirical indicator—specific and concrete identifiers of
concepts; method used to observe or measure the
concept(s)
• Hypotheses—tentative suggestions that a specific
relationship exists between two concepts or propositions

• Model—graphic or symbolic representation of a
phenomenon
• Paradigm—organizing framework that contains concepts,
theories, assumptions, beliefs, values, and principles that
form the way a discipline interprets the subject matter
with which it is concerned

• Philosophy—a statement of beliefs and values about
human beings and their world
• Relationship statements—indicate specific relationships
between two or more concepts; may be propositions,
hypotheses, laws, or theorems

Stages of Theory Development in Nursing
• Silent knowledge
• Received knowledge
• Subjective knowledge
• Procedural knowledge
• Constructed knowledge
• Integrated knowledge

Stages of Theory Development in
Nursing—(cont.)
• Silent knowledge stage (1870s–1940s)
– Nurses were trained in hospitals.
– Education was controlled by the hospital
and doctors.
– Education and practice were based on
tradition, rules, and principles and focused
on technical skills.
– Apprentice form of education

Question
Tell whether the following statement is true or false:
In the “silent knowledge” stage, emphasis on nursing
education grew following publication of the report Nursing
for the Future by Esther Brown.

Answer
False
Rationale: Esther Brown’s report was part of the “received
knowledge” stage. The silent knowledge stage applies to
the very early years of nursing education.

Nursing—(cont.)
• Received knowledge stage (1945–1960)
– Serious nursing shortage
– Hill-Burton Act increased the need for nurses.
– Nursing for the Future published—promoted
nursing education in universities

Nursing—(cont.)
• Received knowledge stage (1945–1960)—(cont.)
– Testing for registration began.
– Nursing Research first published
– Books on nursing research and theory were
published.
– Slow growth of graduate education—nurses
questioning practice

Nursing—(cont.)
• Subjective knowledge stage (1960–1970)
– Dickoff et al. published articles on theory
development and theory for a practice
discipline.
– Number of nursing theorists grew.

Nursing—(cont.)
• Procedural knowledge stage (1970–1985)
– Nursing viewed as an academic discipline
– Theories became the framework for nursing
education.
– More nursing theories were published.

Nursing—(cont.)
• Procedural knowledge stage (1970–1985)—(cont.)
– Consensus developed regarding the common
elements of nursing
• Person or client (man)
• Health
• Nursing
• Environment

Nursing—(cont.)
• Procedural knowledge stage (1970–1985)—(cont.)
– Books published on
• Theory evaluation/critique
• Theory application
• Theory construction
– Graduate courses on nursing theory
implemented

Nursing—(cont.)
• Constructed knowledge stage (1985–2010+)
– Incorporation of philosophy of science courses into
graduate programs
– Development of middle range and practice
theories

Nursing—(cont.)
• Integrated knowledge stage (2010–???)
– Increasing focus on “evidence-based practice”
– Continued development of middle range and
situation-specific theories
– Attention to “translation” of research in practice

Scope of Theory
• Metatheory
• Grand theory
• Middle range theory
• Practice theory

Scope of theory—(cont.)
• Metatheory—theory about theory
• In nursing, metatheory focuses on broad issues.
– Philosophical issues
• Philosophical worldviews (perceived view vs.
received view)
• Nature of health and man; purpose of nursing
• Appropriate level of nursing theory
– Methodological issues
• Processes of theory evaluation
• Processes of knowledge development

Scope of Theory—(cont.)
• Grand theories
– Most complex and broad theories
– Attempt to explain broad areas within a discipline
– Characteristics
• Nonspecific
• Composed of relatively abstract concepts and
propositions
• Are not generally amenable to testing
• May incorporate other theories

• Middle range theories
– More circumscribed than grand theories
– Contain a limited number of concepts that are
operationally defined
– Focus on a limited aspect of reality
– Propositions may be tested through research.

• Middle range theory may be:
– A description of a particular phenomenon
– An explanation of the relationship between
phenomena
– Prediction of the effects of one phenomenon or
another

• Practice theories
– Called microtheories, prescriptive theories, situation-
specific theories
– Least complex; contain fewest concepts
– Refer to specific, easily defined phenomena
– Limited to specific populations or fields of practice
– Often use knowledge from other disciplines

Comparison of the scope of nursing theories.

Types of Theory
• Descriptive theory
• Explanatory theory
• Predictive theory
• Prescriptive theory

Descriptive Theories
• Describe, observe, and name concepts
• Do not explain how or why concepts are related
• Provide observation and meaning regarding phenomena
• Generated and tested through descriptive research

Explanatory Theories
• Relate concepts or propositions to one another
• Attempt to explain how or why concepts are related
• Focus on correlations or rules that regulate interactions
• Developed through correlational research

Predictive Theories
• Explicate conditions under which concepts are related
and relational statements are able to describe future
outcomes consistently
• Experimental research is used to generate and test them.

Prescriptive Theories
• Prescribe activities necessary to reach defined goals
• Address actions and predict consequences of
interventions
• Describe the prescription (action or intervention),
consequence, type of client, and condition

Nursing’s Metaparadigm
• Metaparadigm—the most global perspective of a
discipline
• The primary phenomena that are of interest to a
discipline
• Explains how the discipline deals with phenomena in a
unique manner

Nursing’s Metaparadigm—(cont.)
• Characteristics of a metaparadigm
– Domain is distinctive from other disciplines.
– Encompass all phenomena of interest to the
discipline
– Are perspective-neutral (concepts and propositions
do not represent a specific perspective or worldview)
– Must be international in scope and substance (do not
reflect national, cultural, or ethnic beliefs and values)

• Most scholars and theorists consider that nursing’s
metaparadigm consists of the concepts of:
– Person (man or client)
– Health
– Environment
– Nursing
• Some scholars/theories add “caring.”

• Person can refer to a(n):
– Being consisting of physical, intellectual, biochemical
and psychosocial needs
– Human energy field
– Holistic being
– Open system
– Integrated whole
– Being who is greater than the sum of his
parts

• Health
– The ability to function independently
– Successful adaptation to life’s stressors
– Achievement of one’s full life potential
– Unity of mind, body, and soul
• Health is the concept reflecting greatest diversity in
nursing theory.

Nursing’s Metaparadigm (Continued)
• Environment refers to:
– External elements that affect the person
– Internal and external conditions that influence the
organism
– Significant others with whom the person interacts
– An open system with boundaries that permit the
exchange of matter, energy, and information

• Nursing is a science, art, and practice discipline.
• Goals of nursing include:
– Care of the well
– Care of the sick
– Assisting with self-care
– Helping individuals attain their human
potential

Question
Which of the following is not considered to be one of the
major concepts of nursing’s metaparadigm?
A.Environment
B.Health
C.Nursing
D.Person/recipient of care
E.Professionalism

Answer
E. Professionalism
Rationale: The other four concepts are considered to be
concepts of the nursing metaparadigm.

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