Do you have what we call “TAS”, otherwise known as Theory Aversion Syndrome? If you are not sure, let’s do a quick assessment. Do you experience nausea when you hear the word theory, dizziness and vomiting when you have to read the stuff, and do you fall out when asked to apply it?

If you are afflicted with this rather common nursing disorder, it may comfort you to know that you are not alone! Many nurses shudder at the mere thought of nursing theory, shaking their head in disbelief at the “pie in the sky” folks and sneering, “Don’t they know that nursing is a PRACTICE profession!” “Why don’t they climb down from their ivory tower and get in touch with reality!” Sound familiar? Cross (as cited in Cody, 2013) claims that without the dynamic interface between practice and theory, practice is “empty” and theory is “blind” (p. 7). Yet, if theory and practice are dependent on one another, why is there a continued disconnect between practitioners and theorists? In this unit we will explore the theoretical underpinnings for nursing practice. Students of advanced/doctorate nursing practice, are you open to the journey?
We invite you to begin your trip by recalling how your personal vision of nursing evolved. Weren’t you socialized through formal education and clinical practice to think like and act as a nurse? Wasn’t the socialization process so insidious that, today, what you have come to understand as the essence of nursing seems rather intuitive? Intuition is defined as “the direct knowing or learning without the conscious use of reasoning” (Webster’s New World College Dictionary, p. 750). But, without rational thought, how does one articulate what one knows? And, with the “what is nursing” unconsciously ingrained, how does one envision “what could be” (Rogers, 1989 as cited in Cody, 2013)? These philosophical queries, among others, continue to be the quest of many nursing scholars.
To satisfy the specifications of a profession, nursing has the responsibility to differentiate work provided by its members from that of others and to base that work on a substantive body of scientific knowledge. So, can the unique work (not to be confused with roles) of nursing be identified? Would distinguishing our work help to define the scientific body of knowledge required for nursing practice? Can the use of theory improve nursing outcomes?
Theory is defined by Chinn and Kramer (2008) as “a creative and rigorous structure of ideas that projects a tentative purposeful and systematic view of phenomena” (p. 219). Theorists use philosophical inquiry to explore the knowledge, value, meaning, and ethical factors related to a question of interest. So what theories serve as the basis for nursing practice? Many of the practices of nurses/nursing are grounded in theory from other disciplines, such as family theory, developmental theories, theories of learning, change theory, system theory, so don’t forget to consider these theories when contemplating practice change. However, as a discipline, nursing continues to establish a unique body of knowledge, therefore proposing nursing theories that distinguish the practice of our profession when those of other disciplines do not completely answer practice issues. For instance, learning theories provide the backbone for teaching our patients, yet learning theories alone do not adequately reflect the process of learning applicable to a person acutely ill, or ethical dilemmas when providing sensitive information to a patient. In the views of some, nursing theory development began in the 1800s with the vision of
Florence Nightingale. However, it was not until the last half of the 20th century that theoretical work proliferated. Theory development emerged when nurse leaders identified the need for a knowledge base to move nursing from a vocation to a profession and when scholars recognized that theories from other disciplines were inadequate to describe, explain, or predict nursing outcomes (Alligood & Toomey, 2010).
A prerequisite to using a theory in practice is an understanding of the theory. USA College of Nursing has an excellent library of nursing theorist videos available on mediasite. Most of the videos consist of interviews of prominent nursing theorists. The interviews are conducted by Dr. Jacqueline Fawcett, an internationally recognized authority on conceptual models of nursing and nursing theory development.

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Dr. Fawcett is credited with a major breakthrough in nursing knowledge development for her suggestion of a paradigm perspective for nursing (Alligood & Toomey, 2010). Fawcett recognized four salient concepts (person, environment, health, and nursing) used by individual theorists as foundational tenets of their respective paradigms. Placing the work of individual theorists in a larger context (metaparadigm) strengthened the understanding of the knowledge development process (Alligood & Toomey, 2010).
Walker and Avant (2011) describe four levels of theory:
– Metatheory
– Grand Nursing Theory
– Middle-Range Theory
– Practice Theory
Metatheory –the focus is broad and seeks answers to philosophical questions about the purpose and kind of theory needed in nursing, proposed methodologies to evaluate nursing, and suggests how to best critique theories. Many of the classic works included in Cody’s text are examples of metatheory. A specific example is Carper’s 1978 paper on the Fundamental Pattern of Knowing.
Grand Nursing Theory – is abstract (at varying degrees) and consists of “conceptual frameworks defining broad perspectives for practice and ways of looking at nursing phenomena based on these perspectives” (Walker & Avant, 2010, p. 6). Grand theories offer distinct nursing perspectives which have helped to distinguish the profession of nursing from medicine. Examples of grand nursing theories include the work of Neuman, Roy, Parse, Leininger, Watson, and many others. Be sure to view the videotapes of these and other theorists. If you could use a mental break right now, check out this youtube ion nursing theorists:
The following are a couple of ways that grand theories influence practice:
When applying Parse’s “humanbecoming theory” to a patient situation, nurses do not follow a problem-solving process, such as the nursing process. Nurses who use Parse’s theory as guidance seek to understand the person’s own concerns, hopes, and plans about their health. Therefore the desired outcome is set by the patient not the nurse (Parse, 1992). Her theory has been used in various clinical settings and nursing programs throughout the world.
Jean Watson’s “human caring theory,” can be applied not only to clinical nursing practice, but also to other roles in nursing, such as the nurse leader or administrator. Watson’s theory can be linked to evidence based practice, patient satisfaction, outcomes, and length of stay. Therefore, Watson patterned her theory to inform our nursing practice in a variety of ways (Zaccagnini & White, 2011, pg. 26).
Middle-Range Theory – is a more workable level of theory. Midrange theories have limited variables and scope and elucidate specific relationships between concepts. Therefore, midrange theories are more useful to research and practice. Examples of middle range theories in nursing include Meleis’ transition theory, Pender’s health promotion model, and Swanson’s theory of caring practice. Swanson’s theory of caring is a specific illustration of how a midrange theory evolves from research. The theory is founded on the results of three phenomenological studies that identified five caring processes (knowing, being with, doing for, enabling, and maintaining belief).

Practice Theory – is theory that leads to nursing modalities. We see the application of practice theory in the growing number of evidenced-based measures to manage nurse sensitive quality issues.
Now let’s connect the dots. Take a moment to reflect on the relationship of concepts and theory. Remember from previous course discussions that a concept is “a complex mental formulation of experience” (Chinn & Kramer, 2008, p. 187). In essence, concepts are the building blocks of theories and provide contextual meaning to thoughts and ideas.
Please note that there is a class discussion in this unit for you to participate in.
We hope that you have enjoyed the beginning of your trip to understanding the theoretical underpinnings of nursing. Be patient, knowledge discovery is a lifelong process. Happy journey!
(If you would like to end the keynote discussion on a funny note, check out this youtube regarding the fun theory…not a nursing theory, but don’t you love working in a fun environment? Wouldn’t it be great if we could make our work fun???
Alligood, M. R., & Tomey. A. M. (2010). Nursing Theorists and Their Work (7th ed.). Maryland Heights, MO: Mosby Elsevier.
Chinn, P. L., & Kramer, M. K. (2008). Integrated Theory Knowledge Development in Nursing (8th ed.). St. Louis, MO: Mosby Elsevier.
Cody, W. K. (2013). Philosophical and Theoretical Perspectives for Advanced Nursing Practice (5th ed.). Sudsbury, MA: Jones and Bartlett.
Walker, L.O., & Avant K. C. (2011). Strategies for Theory Construction in Nursing (5th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Webster’s new world college dictionary (4th ed.). (2010). Cleveland, OH: Wiley.
Zaccagnini, M.E., & White K. (2010). The Doctor of Nursing Practice Essential: A New Model for Advanced Practice Nursing. Sudbury, MA: Jones and Barlett.