Chapter 4
Theoretical Foundations of
Nursing Practice
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
The Domain of Nursing
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Domain
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Is the perspective of a profession
Provides the subject, central concepts, values and
beliefs, phenomena of interest, and central
problems of a discipline
Domain of nursing provides both practical
and theoretical aspects of the discipline.
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Paradigm
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Paradigm
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Links science, philosophy, and theories accepted
and applied by a discipline
Nursing paradigm
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Links person, health, environment/situation, and
nursing
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Terminology
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Person
Health
Environment/situation
Nursing
Nursing process: Method of applying the
theory or knowledge
Integration of theory and nursing process is
the basis for professional nursing.
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Theory
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A theory contains a set of concepts,
definitions, and assumptions or propositions
that explain a phenomenon.
Theories guide the design of nursing
interventions.
Nursing theory
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Is a conceptualization of some aspect of nursing
Describes, explains, predicts, and/or prescribes
nursing care
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Components of a Theory
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Types of Theory
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Grand
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Middle-range
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More limited in scope and less abstract
Descriptive
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Broad in scope, complex, require specification
Describe phenomena, speculate on why
phenomena occur, and describe the
consequences of phenomena.
Prescriptive
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Address nursing interventions for a phenomenon,
and predict the consequence of a specific nursing
intervention.
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Theory-Based Nursing Practice
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Theories
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Generate nursing knowledge for use in practice
Can direct how to use nursing process
Are adaptable to different patients and all care
settings
The goal of nursing knowledge is to explain
the practice of nursing as different and
distinct from the practice of medicine,
psychology, and other health care disciplines.
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Interdisciplinary Theories
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Explain systematic views of phenomena
specific to the discipline of inquiry:
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Basic human needs
Developmental
Psychosocial
Systems
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Quick Quiz!
1. Nursing theories provide nurses with
perspectives from which to
A. Analyze patient data.
B. Predict phenomena.
C. Formulate legislation.
D. Link science to nursing.
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Systems Theories
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Case Study
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Susan is a new nurse who tutors a nursing
student, Bill, who has difficulty mastering
good study habits and prioritizing school
assignments. Susan is helping Bill learn the
theoretical foundations of nursing practice.
After Susan and Bill review interdisciplinary
theories such as Maslow’s hierarchy of needs
and the developmental theories, they move
on to the topic of nursing theories.
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Selected Nursing Theories
Nightingale
Peplau
Henderson
Orem
Leininger
Neuman
Roy
Watson
Benner and
Wrubel
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Selected Nursing Theories (cont’d)
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Nightingale (mid-1800s)
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Peplau (1952)
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Environment as the focus of nursing care
Descriptive theory
Focus on interpersonal relations between nurse,
patient, and patient’s family
Development of nurse-patient relationship
Henderson (1955, 1966)
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14 basic needs of the whole person
Framing nursing care are the needs of the
individual.
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Selected Nursing Theories (cont’d)
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Orem (2001)
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Leininger (2010)
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Focuses on patient’s self-care needs
Goal is for patient to manage his or her health
problems.
Theory of cultural care diversity and universality
Considers social structure factors
Neuman (2010)
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Based on stress and the patient’s reaction to the
stressor
Role of nursing is to stabilize the patient or
situation.
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Case Study (cont’d)
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Susan and Bill review the history of nursing
theories. Rank the following nursing theories
in chronological order of their acceptance into
nursing practice.
Leininger’s theory
Henderson’s theory
Peplau’s theory
Nightingale’s theory
Orem’s theory
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Selected Nursing Theories (cont’d)
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Roy (1989)
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Watson (1996)
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Views the patient as an adaptive system
When patient cannot adapt to stressors, nursing is
needed.
Defines the outcome of nursing activity with regard
to the humanistic aspects of life
Purpose is to understand the interrelationships
among health, illness, and human behavior.
Benner and Wrubel (1989)
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Caring is central.
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Case Study (cont’d)

Bill reads about the concept of people’s
responses and adaptation to change. The
theory that views the patient as an adaptive
system is ______________.
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The Link Between Theory
and Knowledge Development
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Nursing knowledge is theoretical and
practical.
The goals of theoretical knowledge are to
stimulate thinking and create a broad
understanding of the “science” and practices
of the nursing discipline.
Experiential knowledge, or the “art” of
nursing, is based on nurses’ experiences in
providing care to patients.
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Quick Quiz!
2. Nursing process is central to nursing
practice. Nursing practice
A. Is a theory.
B. Is derived from a theory.
C. Is not adaptable to all patients.
D. Generates knowledge for use in practice.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Susan quizzes Bill about the core concept of
Benner and Wrubel’s theory. Benner and
Wrubel’s theory is based on the premise that
persons, events, projects, and things matter
to people.
True
False
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The Link Between Theory
and Knowledge Development
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Theories provide direction for nursing
research.
Nursing theory and nursing research build the
knowledge base for nursing, which is then
applied to practice.
Theory-generating or theory-testing research
refines the knowledge base of nursing.
Nurses incorporate research-based
interventions into theory-based practice.
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