NCM 100 (Theoretical Foundation of Nursing)

Lesson 1
Prepared by: Apple Pie Soccoro Buenaflor-Renacido, RN (Clinical Instructor)

Nursing as a Profession
 In the past, there has been considerable discussion about whether nursing is a profession or an
occupation. This is important for nurses to consider for several reasons.
 An occupation is a job or a career, whereas a profession is a learned vocation or occupation that has a
status of superiority and precedence within a division of work

Characteristics of a Profession
 defined and specialized knowledge base
 control and authority over training and education
 credentialing system or registration to ensure competence
 altruistic service to society
 a code of ethics
 formal training within institutions of higher education
 lengthy socialization to the profession
 autonomy (control of professional activities)

 Until near the end of the 20th century, nursing was viewed as an occupation rather than a profession.
Nursing has had difficulty being deemed a profession because many of the services provided by nurses
have been perceived as an extension of those offered by wives and mothers. Additionally, historically,
nursing has been seen as subservient to medicine, and nurses have delayed in identifying and
organizing professional knowledge.
 Furthermore, education for nurses is not yet standardized, and the three-tier entry-level system
(diploma, associate degree, and bachelor’s degree) into practice that persists has hindered
professionalization because a college education is not yet a requirement. Finally, autonomy in practice
is incomplete because nursing is still dependent on medicine to direct much of its practice.

Nursing as an Academic Discipline

 Disciplines are distinctions between bodies of knowledge found in academic settings. A discipline is
“a branch of knowledge ordered through the theories and methods evolving from more than one
worldview of the phenomenon of concern”
 a discipline is a branch of educational instruction or a department of learning or knowledge.
Institutions of higher education are organized around disciplines into colleges, schools, and
departments
 Disciplines are organized by structure and tradition. The structure of the discipline provides
organization and determines the amount, relationship, and ratio of each type of knowledge that
comprises the discipline.
Characteristics of disciplines
(1) a distinct perspective and syntax,
(2) determination of what phenomena are of interest,
(3) determination of the context in which the phenomena are viewed,
(4) determination of what questions to ask
(5) determination of what methods of study are used
(6) determination of what evidence is proof

 Knowledge development within a discipline proceeds from several philosophical and scientific
perspectives or worldviews. In some cases, these worldviews may serve to divide or segregate
members of a discipline. For example, in psychology, practitioners might consider themselves
behaviorists, Freudians, or any one of a number of other divisions.

 Several ways of classifying academic disciplines have been proposed. For instance, they may be divided
into the basic sciences (physics, biology, chemistry, sociology, anthropology) and the humanities
(philosophy, ethics, history, fine arts).

 In this classification scheme, it is arguable that nursing has characteristics of both.

 Nursing’s knowledge base draws from many disciplines. In the past, nursing depended heavily on
physiology, sociology, psychology, and medicine to provide academic standing and to inform practice. In
recent decades, however, nursing has been seeking what is unique to nursing and developing those
aspects into an academic discipline.

Areas that identify nursing as a distinct discipline are as follows:

 An identifiable philosophy
 At least one conceptual framework (perspective) for delineation of what can be defined as nursing
 Acceptable methodologic approaches for the pursuit and development of knowledge

Introduction to Science and Philosophy

Science
 is concerned with causality (cause and effect). The scientific approach to understanding reality is
characterized by observation, verifiability, and experience; hypothesis testing and experimentation are
considered scientific methods.
Philosophy
 is concerned with the purpose of human life, the nature of being and reality, and the theory and limits
of knowledge.
History and Philosophy of Science

SCIENCE AND PHILOSOPHICAL SCHOOLS OF THOUGHTS

 In the period of modern science, three philosophies of science dominate: rationalism, empiricism, and
human science/phenomenology.
 Rationalism and empiricism are often termed received view and human science/phenomenology and
related worldviews (i.e., historicism) are considered perceived view

Empiricism
 roots in the writings of Francis Bacon, John Locke, and David Hume, who valued observation,
perception by senses, and experience as sources of knowledge
 founded on the belief that what is experienced is what exists, and its knowledge base requires that
these experiences be verified through scientific methodology
 holds that truth corresponds to observable, reduction, verification, control, and bias-free science. It
emphasizes mathematic formulas to explain phenomena and prefers simple dichotomies and
classification of concepts.
 focuses on understanding the parts of the whole in an attempt to understand the whole. It strives to
explain nature through testing of hypotheses and development of theories. Theories are made to
describe, explain, and predict phenomena in nature and to provide understanding of relationships
between phenomena.

Positivism
 often equated with empiricism. Like empiricism, positivism supports mechanistic, reductionist
principles, where the complex can be best understood in terms of its basic components.
 Logical positivism was the dominant empirical philosophy of science between the 1880s and 1950s.
Logical positivists recognized only the logical and empirical bases of science and stressed that there is
no room for metaphysics, understanding, or meaning within the realm of
 Logical positivism maintained that science is value free, independent of the scientist, and obtained
using objective methods. The goal of science is to explain, predict, and control. Theories are either true
or false, subject to empirical observation, and capable of being reduced to existing scientific theories

What are Nursing Theories?

 organized bodies of knowledge to define what nursing is, what nurses do, and why do they do it
 provide a way to define nursing as a unique discipline that is separate from other disciplines (e.g.,
medicine). It is a framework of concepts and purposes intended to guide the practice of nursing at a
more concrete and specific level.
Defining Terms
 Philosophy
Beliefs and values that define a way of thinking and are generally known and understood by a group or
discipline.
 Theory
A belief, policy, or procedure proposed or followed as the basis of action. It refers to a logical group of
general propositions used as principles of explanation. Theories are also used to describe, predict, or control
phenomena.
 Concept
Often called the building blocks of theories. They are primarily the vehicles of thought that involve
images.
 Models
representations of the interaction among and between the concepts showing patterns. They present an
overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice.
 Conceptual framework
a group of related ideas, statements, or concepts. It is often used interchangeably with the conceptual
model and with grand theories.
 Proposition
statements that describe the relationship between the concepts.
 Domain
perspective or territory of a profession or discipline.
 Process
series of organized steps, changes or functions intended to bring about the desired result.
 Paradigm
a pattern of shared understanding and assumptions about reality and the world; worldview or widely
accepted value system.
 Metaparadigm
most general statement of discipline and functions as a framework in which the more restricted
structures of conceptual models develop. Much of the theoretical work in nursing focused on articulating
relationships among four major concepts: person, environment, health, and nursing.
History of Nursing Theories
 In 1860, Florence Nightingale defined nursing in her “Environmental Theory”
 In 1952, Hildegard Peplau introduced her “Theory of Interpersonal”
 In 1955, Virginia Henderson developed Nursing Need Theory.
 In 1960, Faye Abdellah published her work “Typology of 21 Nursing Problems”
 In 1962, Ida Jean Orlando emphasized the reciprocal relationship between patient and nurse and
viewed the professional function of nursing as finding out and meeting the patient’s immediate need
for help.
 In 1968, Dorothy Johnson pioneered the Behavioral System Model
 In 1970, Martha Rogers viewed nursing as both a science and an art
 In 1971, Dorothea Orem states in her theory that nursing care is required if the client is unable to fulfill
biological, psychological, developmental, or social needs.
 In 1971, Imogene King developed Theory of Goal attainment
 In 1972, Betty Neuman in her theory states that many needs exist, and each may disrupt client balance
or stability.
 In 1979, Sr. Callista Roy viewed the individual as a set of interrelated systems who strives to maintain
the balance between these various stimuli.
 In 1979, Jean Watson developed the philosophy of caring

Components of Nursing Theories

1. Phenomenon
 A term given to describe an idea or responses about an event, a situation, a process, a group of
events, or a group of situations. Phenomena may be temporary or permanent. Nursing theories
focus on the phenomena of nursing.

2. Concepts
 Interrelated concepts define a theory. Concepts are used to help describe or label a
phenomenon. They are words or phrases that identify, define, and establish structure and
boundaries for ideas generated about a particular phenomenon. Concepts may be abstract or
concrete.
a. Abstract Concepts - defined as mentally constructed independent of a specific time or place.
b. Concrete Concepts - are directly experienced and related to a particular time or place.

3. Definitions
 used to convey the general meaning of the concepts of the theory. Definitions can be
theoretical or operational.
a) Theoretical Definitions - define a particular concept based on the theorist’s perspective.
b) Operational Definitions - states how concepts are measured.
4. Relational Statements
 defines the relationships between two or more concepts. They are the chains that link concepts
to one another.

5. Assumptions
 accepted as truths and are based on values and beliefs. These are statements that explain the
nature of concepts, definitions, purpose, relationships, and structure of a theory.