Week 5 discussion trans to baccalaureate nursing

A theory, as a general term, is a notion or an idea that explains experience, interprets 
observation, describes relationships, and projects outcomes. Theories help to organize 
these ideas. Many describe theories as lenses because they color and shape what is seen. 
The same phenomena will be seen differently depending on the theoretical perspective 
assumed. For these reasons, theory and related terms have been defined and described in 
a number of ways according to individual experience and what is useful at the time. 
Theories, as reflections of understanding, guide our actions, help us set forth desired 
outcomes, and give evidence of what has been achieved. 

Based on strongly held values and beliefs about nursing, and within contexts of various 
worldviews, theories are patterns that guide the thinking about, being, and doing of 
nursing. The primary purpose of nursing theories is to further the development and 
understanding of nursing practice. 

There remains conflict for nurses between propositional knowledge (theoretical 
knowledge) and practical experiential knowledge (practice knowledge), sometimes 
referred to as the ‘know‐that’ and the ‘know‐ how’

Know‐how’ knowledge is often gained through personal experience. It is usually not 
explained but is learned during practice, which equates with the art of nursing. ‘Know that’ 
is knowledge that usually comes from theory and research. It is generally more easily 
communicated verbally and could be described as the science of nursing. These are both 


important to nursing, but unfortunately nursing theorists and nurses in practice continue to 
debate – is nursing a science or is it an art? Why can’t it be both?
It is not enough to only have knowledge ‐ nurses also need the ability to apply it in their 
practice and need to be ‘knowledgeable doers’. Nurses should value knowledge gained from 
practice perhaps even if it was arrived at by intuition just as much as if it was arrived at by 
theoretical or scientific means ‐ but only when they are confident that it is of benefit to their 


Theories are part of the knowledge structure of any discipline. The domain of inquiry, 
metaparadigm, or focus nursing as a discipline is the foundation of the structure. The 4 
concepts of nursing were – the person, the environment, health, and nursing. This is 
sometimes referred to as the metaparadigm of nursing. When the metaparadigm is put 
together in an organized fashion, usually by a nurse scientist, this knowledge structure 
becomes nursing theory. Although nursing models, theories vary according to philosophical 
world views at the time of their development, all flow from metaparadigm of nursing.

Other levels of the knowledge structure include paradigms, conceptual models or grand 
theories, middle‐range theories, practice theories, and research and practice traditions. 
These levels of nursing knowledge are interrelated; each level of development is influenced 
by work at other levels. Theoretical work in nursing must be dynamic; that is, it must be 
continually in process and useful for the purposes and work of the discipline.

This is where things can get a little confusing, as still happens to me. Now we are going to 
discuss knowledge and how concepts, theories, and frameworks are the foundation of 
nursing knowledge. For this presentation, please think of knowing as a verb – the action of 
how one might obtain information. Knowledge, on the other hand for our purposes today is 
taking information that has been synthesized so that relations and interactions are defined 
and formalized – and in this case, what nursing is based upon…

Instead of explaining what all of the different types of theories mean, we’ll discuss them in 


terms of examples of theories, frameworks, and models. With each keep the metaparadigm 
of nursing ‐ person, environment, health, and nursing – in mind.


A Model Provides way to visualize reality to simplify thinking. A Conceptual model Gives 
structure to something, and shows how various concepts are interrelated.

Conceptual model
Gives structure to something, and shows how various concepts

are interrelated.

Growth Model of Change
Focuses on helping human beings grow to realize, attain full

human potential.

Uses caring theory or complexity theory as underlying


Complexity Theory as Framework
Emphasizes change over time, long-term unpredictability,

openness to environment with mutual simultaneous


Seeks to understand patterns of phenomena as wholes within

their contexts.


Orem’s initial purpose in developing what expanded into the theory was to define 
nursing’s concern and nursing’s goal as a part of curriculum development. Her 
definition of nursing’s concern included “man’s need for self‐care action and the 
provision and management of it on a continuous basis in order to sustain life and 
health, recover from disease or injury, and cope with their effects. Her definition of 
nursing’s goal comprised, more simply, “overcoming human limitations”.


King to select four universal ideas that included social systems, health, perception, 
and interpersonal relations and to explore the relevance of these ideas to nursing. 
Because all systems include the essential elements of structure, function, resources, 
goal(s), and decision making, King attempted to provide a structure for nursing as a 
discipline and profession by using a systems framework as a basis for the 
development of her conceptual framework. In the conceptual framework, the 
structure of a system is viewed as an open system with semipermeable boundaries 
between individuals, groups, and society, all of which interact with the 
environment. The functions of these three systems are identified in the reciprocal 
relations of individuals as they interact in groups. Resources are essential to 
perform functions within a structure and attain goals. The allocation of human and 
material resources involves choice or decision making within the system. Decisions 
at one level of func‐ tion influence the behavior at all levels and are reflected in 
outcomes. The goal is to keep the system in harmony or health.


The Neuman Systems Model is a unique, systems‐based perspective that provides a 
unifying focus for approaching a wide range of nursing concerns. The Neuman
systems model is a wellness model based on general systems theory in which the 
client system is exposed to environmental stressors from within and without the 
system. In the model, the focus is on the client system in relationship to 
environmental stressors. The client system is protected by a circular series of buffers 
known as lines of defense that minimize the effects of stressors. Progressing inward, 
three lines of defense are encountered: the flexible line of defense, the normal line 
of defense, and lines of resistance. The greater the quality of the client system’s 
health, the greater the levels of protection provided by the various lines of defense


The Roy adaptation model presents the person as a holistic adaptive system in 
constant interaction with the internal and external environments. The main task of 
the human system is to maintain integrity in the face of environmental stimuli. The 
goal of nursing is to foster successful adaptation. Adaptation leads to optimal health 
and well‐being, to quality of life, and to death with dignity. The adaptation level 
represents the con‐ dition of the life processes. Three levels are described by Roy: 
integrated, compensatory, and compromised life processes. An integrated life 
process may change to a compensatory process, which attempts to reestablish 
adaptation. If the compensatory processes are not adequate, compromised 
processes result.


Caring is not unique to the discipline of nursing. Nevertheless, as a discipline, 
nursing uniquely focuses on caring as its central value, its primary interest, and the 
direct intention of practice. According to Watson, caring is an expression of nursing 
and is the “intentional and authentic presence of the nurse with another who is 
recognized as living in caring and growing in caring” The general intention of 
nursing is to know persons as caring and to support and sustain them as they live 
caring. This intention is expressed when the nurse enters into a relationship with 
the person with the intention of knowing the other as a caring person, and 
affirming and celebrating the person as caring.


Rogers’ theory asserts that human beings are dynamic energy fields, which are 
integrated with environmental energy fields. She asserts that a person and his or 
her environment form a single unit. As such, the human does not adapt to the 
environment and the environment does not cause anything to happen to the 
individual; rather, the person and the environment change together. Once change 
occurs, neither the person nor the environment can return to the former state . 
Both human energy fields and environmental fields are open systems, 
pandimensional in nature and in a constant state of change. Pattern is the 
identifying characteristic of energy fields.


The central concept of her theory is human‐becoming, which refers to the human 
being’s living health. As part of a learned discipline, the nurse uses true presence to 
help human beings move toward becoming through choosing ways of co‐creating 
their own health and finding meaning in situations. Nursing is practiced in 
relationship with humans in their processes of becoming.


From the early development of her theory, the major concepts specific to 
Newman’s theory have been consciousness, pattern, movement, space, and time. 
Movement, space, and time have been viewed as dimensions of pattern and 
consciousness. Newman’s health as expanding consciousness theory proposes a 
view of health that is a unidirectional, unitary process of development —an 
expansion of consciousness that is seen as the ability of the person to interact with 
the environment. Newman considers health and illness to be components of a 
unitary process that she refers to as a pattern of wholeness.


What nursing models/frameworks exist where you currently work,

previously attended school, or did clinical rotations?

Are there features of a nursing model that support how you deliver


Which model or framework would you like see used in your future

practice as a nurse?


Over time, many have developed nursing theories that has helped the profession 
evolve.   Each of these theorists have had a slightly different view on nursing yet 
add to our collective understanding, as well in assisting nurses to describe, explain 
and predict phenomena while providing the foundation of our knowledge.  Because 
of nursing theory, we having improved interdisciplinary communication, better 
patient care and enhanced professional status.  Theories also guide our research 
and education.  To each of us, nursing theory guides our practice.  


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