A Quick Guide 

Nursing theory will probably always be excruciating so why talk about it? Because nursing theory includes how philosophy and thoughts can profoundly affect your patient care and practice.  Theory is not difficult but it includes some serious barriers:

• Lack of enthusiasm
• People not aware of theory or anything after Florence Nightingale
• Little or no institutional and hospital support
• The historical bad image of nursing i.e. who just give shots

However, nursing theory consists of a perception that can be influenced for better or worse. If a person is considered a “bad nurse”, the background sometimes has a huge influence. A nursing foundation will always follow you throughout your career and that impact should be positive. This is a simple guide that helped me in the course or if you need a little refresher, just bear with me 🙂

The Structure for Contemporary Nursing Theory

Understanding the Nursing Knowledge Chart

The First Component

• A metaparadigm is a “global concept”: ask yourself or anybody you talk to, what is health (or any “concept”) and you’ll get billions of definitions. Hence, a metaparadigm or a global concept is the most abstract or the first component in the hierarchy chart.
• Now you must know that the “metaparadigm of nursing“ is made up of 4 GLOBAL CONCEPTS and (non) relational propositions, which are human beings, environment, health, and nursing.
• As previously mentioned, these 4 global concepts can have many different definitions or meanings depending on the conceptual model i.e. you have to pay attention to what the conceptual model considers “human”, which can be called a client, -self, patient…etc.

Second Component

Philosophy is the second component of nursing theory because it attempts to answer why these 4 GLOBAL CONCEPTS are important by utilizing different assumptions or propositions:

1. Ontological: all the nature or the reality of the world or being.
2. Epistemic: how did we develop the knowledge. 3 methods (empiricism -received view: objective-deductive, post/positivism: objective & subjective-deductive, or perceived view–subjective inductive).
   • Deductive: to take information from everywhere and then develop a hypothesis. “Top-down” logic
   • Inductive: to make generalizations based upon a few statements. “Bottom-up” logic
3. Ethical: the character of nursing actions and the individuals of nursing.

Ontological & Epistemic Claims Determine One of the 3 Worldviews (Paradigms)

Third Component

• Nursing conceptual models are synonymous with a conceptual framework, conceptual system, paradigm, and disciplinary matrix.
• This is because the conceptual model functions to provide a framework or a system to organize the phenomena or the relationship between ALL 4 global concepts. If all 4 global concepts; health, nursing, human, and environment are NOT present, then it’s NOT a conceptual model. 
• They are abstract and not directly observed or tested in hospitals, but nursing theories come from conceptual frameworks, therefore theories are the next component from the chart.

Fourth Component or Grand & Middle-Range Theories

• Grand: are broad in scope but do NOT have all the 4 global concepts like the conceptual model. Grand theories have propositions such as expanding consciousness, improving cognition, or mindfulness.
• Middle-Range: consists of less than two concepts and the narrowest. It has 3 categories; descriptive, explanatory, or predictive i.e. a nurse’s activity. The DESCRIPTIVE Middle-Range theory is the most basic such as just describing the concept whereas the other theories (explanatory or predictive) need at least 2 concepts.

Fifth Component

• Empirical indicators are how concepts are viewed in reality i.e. blood sugar level: monitoring the fasting blood sugar, healthy eating: the number of fruits and vegetables per meal.
• Empirical indicators use clinical tools to record observations and determine interventions.

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All 7 conceptual frameworks include the 4 metaparadigm concepts and reflect different paradigms “worldviews”

1. Levine’s Conservation
2. Johnson’s Behavioral Systems
3. Neuman’s System
4. Roy’s Adaptation Model
5. King’s General Systems
6. Orem’s Self-Care Framework
7. Rogers’ Science of Unitary Human Beings

Theories –not all metaparadigm concepts (3 concepts or less)

Grand Theories

1. Orem’s 3 theories:
   • Theory of Self-Care
   • Theory of Self-Care Deficit
   • Theory of Nursing Systems
2. Parse’s Theory of Human Becoming
3. Newman’s Theory of Health as Expanding Consciousness

Mid-Range Theories

1. King’s Theory of Goal Attainment
2. Mishel’s Theory of Uncertainty

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Why is Theory Important? or a formal reason to impress people 🙂

• It’s the hallmark of a profession
• Theory defines boundaries and promotes knowledge that’s unique to the profession
• It provides a structure to identify the focus, purpose, and goals of the practice
• Articulate to the public and other professions what we know, not just what we do

Also, when reading nursing articles, try to notice how theories are being used to get a better understanding of the context and also note the metaparadigm of nursing or its 4 GLOBAL CONCEPTS (if available):

Also, note future research and implications…

Read more about theories at PHMNP Topics! I also outlined the most important conceptual models in nursing: King’s, Neuman, Orem, & Roy. Thanks for reading!