Well, good morning everyone. So, now that we've explored the importance of nursing theory in education, research, and clinical practice, let's take a step back and look at how these theories are actually developed. To fully understand to fully appreciate nursing theory, we need to understand its topical needs, the thinking and reasoning behind its formation. So this brings us to our next topic, the developmental process of theory, including key philosophical foundations like rationalism and empiricism. These perspectives influence how knowledge is built in nursing, how theories emerge, and how they evolve over time. So let's dive into the origins of theory development, and see how deep thinking shapes the science and art of nursing. As we begin this new section, it's important to remember that theories are the foundation of all scientific knowledge, including nursing. But before we can fully apply them in practice, we need to understand where they came from. Learning about the origins and development of gives us a deeper appreciation of how nursing knowledge is built, tested, and applied in real world care. Two major philosophical schools of thought have strongly influenced theory development. The rationalism which emphasizes reasoning and logic and empiricism which focuses on observation and experience. In addition to these other philosophical perspectives such as phenomenology, constructivism, realism, and post-positivism have also shaped how we view knowledge, truth, and evidence in nursing. So in this section we will explore each of these briefly to understand how different ways of thinking contribute to the evolution of nursing theory and eventually to better patient care. So let's talk about rationalism. Rationalism is the belief that knowledge mainly comes from thinking and reasoning not just from what we see or experience with our senses. In simple terms, rationalism tells us that we can figure out the truth just by using our minds, even if we haven't seen or experienced something yet. Here's a quick example. Imagine you're sitting inside a room with no windows. You can't see outside, but you think it's rainy season, so it's probably raining right now. So, you didn't see the rain, but you used logic to guess what's happening. So that's rational thinking in action. A key point in rationalism is that theory comes first. Here people start by coming up with an idea or theory first and then they check later if it works in the real world. This is called a top down approach. They start with a general idea and then apply it to specific situations. Some famous Russian instincters includes Plato and Renee Dearts. They believe the mind can discover the truth all by itself even without experiencing everything directly. Decarts even said I think therefore I am meaning if I can think I know I exist. An an example of rationalism in nursing is Florence Nightingale's theory. So before she had actual proof or data, Nightingale already used her reasoning to form ideas like that patients need fresh air and that hospital should be clean or proper hygiene helps with healing. She thought of these ideas first and then later proved them with actual data. So again thinking came before observe. So let's try another uh everyday example. A teacher believes students learn better when they are not hungry. She hadn't done a study yet, but she uses logic to think this is true. So, she starts a feeding program. Then later on, the students perform better and it supports her idea. So, that is rationalism at work. Now let's talk about empiricism which is basically the opposite of rationalism. So what is empiricism? Empiricism is the belief that we gain knowledge through experience through what we see, hear, touch, smell or observe in the real world. In short, empiricism says we learn by using our senses, not just by thinking or guessing. So how does this work? Empiricism follows a see first then explain process. Unlike rationalism, we don't begin with a theory. Instead, we observe what's happening, gather information or data, and only then form a conclusion or theory based on what we found. So, this method is called a bottom up approach. It starts with specific experiences and then develop a general idea. Example of empiricist thinkers are philosophers like Aristo, John Lock and David Hume. They are all known as empiricist thinkers. So John Lock even said that the human mind is that is like a blank slate when we were born. Meaning everything we know comes from our experiences. An example of empiricism in nursing is the evidencebased practice. So in nursing we use evidence-based practice which is a perfect example of empiricism in action. So we don't just guess or assume what works. We rely on research studies, real patient outcomes and clinical trials and then we use that data to make decisions about patient care. Example, if research show that turning every p uh turning patients every two hours helps prevent bed source, nurses follow that not because it sounds right, but because evidence proves it work. Another everyday example is that let's say you want to know whether rice or bread keeps you full longer. You try eating rice one day and then bread the next day. Then you observe your body reacts. So based on your experience you make a conclusion. That is empiricism. Learning through direct observation and experience. Now let's talk about phenomenology. a way of thinking that plays a big role in nursing research especially when we want to understand how people truly feel and experience certain events. So what is phenomenology? Phenomenology is the study of real life experiences from the person's own point of view. It asks deep and emotional questions like, "What does it feel to have to uh what does it feel like to have cancer?" Or, "How does it feel to lose someone you love?" "What is it like to live with a long-term pain?" Phenomenology isn't about love, love test, or numbers. Instead, it focuses on thoughts, emotions, and meaning behind those experiences. So how is this different from other approaches? Most research methods like empiricism rely on measurements, statistics, and objective data. But phenomenology says that's not enough. We need to understand how people actually feel. So instead of just checking blood pressure or vital signs, it also asks how do you feel about your illness or what's the hardest part of your healing journey? It's about understanding the human side of health. So an example in nursing practice, let's say you're caring for a patient with terminal illness. A medical approach might focus on symptoms, medications, and vital signs. But phenomenology helps you ask deeper, more personal questions like what is it like to know you're nearing the end of life? Or what are your fears? what matters most to you right now. By listening to the patient's story, we offer care that's not only physical but also emotional, spiritual, and meaning. So, how do nurses use phenomenology in research? Phenomenology is often used in qualitative research, which means research based on words, stories, and experiences, not numbers. Okay. Nurses might conduct interviews, collect personal stories, or read journals written by patients. So, from these we learn what our patients are truly going through beyond just symptoms or diagnosis. And here's an everyday example. Imagine your friend just failed an exam. You don't just look at their score and move on. Instead, you ask, "How do you feel about it?" What were you thinking during the test or what does this mean to you? So that is phenomenology in action. Trying to understand what the experience meant to that person. Now let's talk about constructivism. This is a powerful way of thinking that helps us understand how people learn and how they make sense of the world around them. Okay. So, what is constructivism? Constructivism says that learning isn't just about absorbing facts like a sponge. Instead, each of us builds our own understanding based on our life's experiences, what we believe, or the culture we grew up in and how we see and feel about things. So learning is personal and active, not just copying what someone else says. Example of contra constructivism. Imagine two patients with the exact same condition, a broken leg. One says, "I can handle the pain. I've been through worst." And the other one says, "This is the worst thing that ever happened to me." Okay. So, same medical condition, same medical situation, but completely different reactions. Why? Because each person is bringing their own background, belief, and past experiences into the situation. That's constructivism in action. People make sense of things in their own unique. So, let's apply constructivism in nursing practice. Constructivism reminds us that every patient is different. We can't treat everyone the same way. We need to ask, listen, and understand each person's story. For example, a child from one culture may not cry when in pain because they were taught to be strong. Another child might might cry loudly even with mild pain. So a nurse using a constructivist approach would ask why is this patient reacting this way and what does this mean for them personally? So this mindset helps us deliver patient centered care that respects the individual's unique experiences. So let's apply constructivism in nursing education. Okay. So constructivism also shapes how nursing students learn. So instead of just memorizing facts, new students reflect on what you're learning. Dis you discuss with your classmates, you practice during clinical clinical duties and apply what you've learned in real life situations. Example, reading about vital signs in a book is one thing, but actually checking a patient's blood pressure and seeing it change over time, that's when learning becomes real. That's constructivism. Understanding grows through real experience. So, let's have another everyday example. Okay? You and your best friend watch the same movie, but you both walk away feeling something totally different. Why? Because each of you brings your own life experience into the way you interpret that movie. Okay, so that's constructivism. We all construct meaning in our own way. Okay, to summarize this, constructivism means people build their own understanding through experience. Knowledge is not the same for everyone. It is shaped by beliefs, culture, and background. In nursing, this helps us give care that fit each patient's personal needs. In nursing education, it helps students learn better through practice. reflection and teamwork. Constructivism reminds us that everyone learns and sees the world differently and that's not only okay. It's something we need to respect and understand. Okay. So, let's now explore two important ideas in nursing research. Realism and post-positivism. These concepts help us understand how we search for the truth in health, illness and patient care. So what is realism? Realism is the belief that a real world exists independent of our thoughts or feelings. Even if we can't see, hear, or feel something right away, it can still be real. Simple terms, something can be true even if no one notices yet. Well, let's have an example. A patient has an infection in their wound. They may not feel pain yet and the nurse may not have seen any signs, but the infection still exists. It's real. Even if it it hasn't been detected yet, realism reminds us that science looks for objective truth. things that are there whether we believe in them or not. So what is postpositivism? Post-positivism agrees with realism that truth exists but it adds a layer of cion and humility. It says humans can make mistakes when they observe things. So we all have biases, limits or blind spots. We may never know the whole truth but we try to get as close as possible. That's why post-p positivism values careful research method like experiments, surveys, interviews and this helps us check our observations and reduce human error. So let's have an example in research. Let's say you're doing a study on why patients don't take their medications properly. A post-positivist approach would collect quantitative data like how many patients skip doses. Also collect qualitative data like patient interviews to understand their feelings or reasons. So you're combining numbers and statistics with stories and personal experiences. So this gives you a fuller more accurate picture of the situation. Okay, let's have an example of realism and post-positivism in nursing practice. In everyday nursing, both ideas are very useful. Okay, realism helps us remember that a patient might have internal bleeding, even if all their vital signs look normal. Just because we don't see it yet, doesn't mean it's not real. While post-p positive positivism reminds us that our tools, senses and judgments judgments are perfect. We need to listen carefully, look at all the data and keep an open mind. Another everyday example is uh your friend says I think there's a gas leak in the kitchen. You can't smell anything but the leak could still be real. That is real. Now imagine you have a cold and your sense of smell isn't working well. That's a limitation of your observation. And post positivism reminds us that we all have those limits. Okay. To summarize this, realism means truth exists even if we don't see it. While post-positivism means truth exists but we must work carefully to discover it because our observations can be flawed. So in nursing these ideas help us combine science with compassion, balance hard data with human experience and most importantly remind us to stay accurate, open-minded and careful in both research and patient care. Okay. So this summary table shows five philosophical foundations in n in theory development. So each philosophy has its own key idea and role. Rationalism values reason and uses deduction while empiricism relies on experiences and uses induction. Okay. Phenomenology focuses on subjective human experience through qualitative approaches. Constructivism sees knowledge as socially built and contextbased. And lastly, post-positivism believes in objective but imperfect truth using both qualitative and quantitative methods. Now let's bring everything together and see how these different philosophies actually work in real life nursing. In practice, nurses don't rely on just one way of thinking. Instead, we use a blend of different philosophies to give the best most holistic care possible. Okay. In nursing, we often combine rationalism or using critical thinking and logic and empiricism using observation and real life experience. So what does that do to me? It means we think through problems logically, form ideas and make clinical judgments and then we test those ideas using evidences like symptoms, lab results and research data. For example, you'd believe that clean surroundings help patients heal faster. That's rationalism at work. And then you observe if patients in cleaner rooms actually recover quicker. That is empiricism. Using both together leads to safe evidence-based care with strong. Okay. Okay. So a perfect example of this blend is Karper's four ways of knowing in nursing. Carper identified four types of knowledge which nurses views and these are empirical knowing based on science and facts. Okay. So example of this is knowing which medication lowers blood pressure. Next one is ethical knowing. This is based on what is right or wrong. An example of this is respecting a patient's wish not to be resuscitated or the DNR do not resuscitate form. Next one is personal knowing. This is based on self-awareness and connection. An example of this is sensing when a patient is scared and offering comfort even without words. Next one is aesthetic knowing. This is based on the art of nursing. Being intuitive, creative, and compassionate. An example of this is using a soft voice or picking the right time to deliver difficult news. These four ways help nurses see not just the illness, but the whole person. Another key example is Gene Watson's theory of human caring. So this theory focuses on the nurse patient relationship. This is being present with the patient or caring for the whole person not just the physical body but also their emotional mental and spiritual needs. So instead of asking what are the symptoms encourage us to encourages us to ask what is the patient feeling or what does healing mean to them? Okay, so this aligns with phenomenology which values the patient's personal experience. Another example, a cancer patient may not want more treatment. They may just want peace, comfort, and support. So Watson's theory helps the nurse focus on deep listening, presence, and emotional care, not just medication. Okay. So in real world nursing is not black and white. We don't stick to just one philosophy. We combine we combine logic and science, compassion and intuition, moral judgment and personal connection. Okay. So this blend gives us a well-rounded thoughtful and deeply human way to care for others. Okay. To sum this up, nurses use both thinking and rationalism and experience. Empiricism interpers four ways of knowing help us understand patience from many angles. Scientific, ethical, emotional, and artistic. And Gene Watson's theory reminds us that presence, empathy, and care are just as important as clinical treatments. Nursing draws from many philosophies to treat not just the illness but the whole person. Okay. So that's what makes nursing a science, an art and a calling at all at once. Okay. To conclude this session, it's important to remember that development of nursing theory is both dynamic and complex. Theories don't emerge from a single idea or method. They evolved through a combination of logic, experience, observation, and reflection. By understanding the philosophical roots behind theory like rationalism, empiricism, phenomenology, and constructivism, we gain deeper insight into how theories are formed, interpreted, and applied. So this understanding enhances our ability to use theory effectively in research, practice, and education. It allows us to choose or create frameworks that match the complexity of human health and nursing care. In the long run, taking a balanced view whether both rational reasoning and empirical evidence are valued leads to a more holistic approach to nursing. It reminds us that nursing is both a science and an art shaped not only by facts and data but also by meaning, experience and human connection. Okay. So as we've seen theories come from different ways of thinking rationalism, empiricism and others. Now it's equally important to understand how these theories are in or are organized by level and scope. In nursing we categorize theories into three main types. The micro range or practice theories, middle range theories and grand theories. Each play a different role in how we deliver care, conduct research and shape education. Now as we have seen theories come from different ways of thinking rationalism, empiricism and others. Now it's equally important to understand how these theories are organized by level and school. In nursing we categorize theories into three main types. The micro range or practice theories, middle range theories and grand theories. Each plays a different role in how we deliver care, conduct research, and shape education. So let's break this down in a simple way. Nursing theories are like tools in a toolbox. We don't use just one kind. We use different types depending on the situation. These are grouped into three main categories depending on how wide their scope is, how deep they go, and how we use them in practice. Micro range theories are the most specific. They help us with daily tasks at the bedside. For example, a theory that tells us how to reduce pain after surgery or how to manage anxiety before an operation. It's like a step-by-step guide, very practical and easy to use in real situations. Middle range theories are not too broad, not too narrow. They help us connect what we do in practice and what we learn in research. For example, a theory on how nurses and patients communicate can help improve both care and studies. They are helpful when we're doing clinical work and when we're growing uh when we're studying to improve it. While granties, these are the most general and abstract. They talk about the big picture of nursing. What nursing really is, what nursing should aim to do, and why our role matters in the world. They don't give exact steps but they shape how we think, teach and lead as nurses. Example, think of it like planning a trip. Micro range is your daily itinerary. What you'll do at 9:00 a.m., 10:00 a.m., etc. And middle range is the overall schedule, how long the trip is, which cities you'll visit. While grand theory is your reason for traveling maybe to explore to learn or experience something new. So in nursing knowing these categories helps us pick the right type of for the right purpose whether it's for patient care research or professional grow. Let's talk about micro range theories which are also known as practice theories. These are very specific types of theories that focus on sap problems or nursing actions. Usually the kind we deal with at uh usually the kind that we deal with at the bedside. Unlike broad or general theories, micro range theories gives us practical step-by-step guidance on what to do in a certain situation. Let me give you an example. Imagine a theory that explains how nurses should manage pain after surgery. This kind of theory might tell you how often to assess pain, what signs to look for, and what nursing actions help reduce the pain most effectively. It's like a helpful helpful guide made from real life experience or from focus research, things that nurses have seen and studied closely. So whenever you hear micro range theory just think just think uh these are useful tips for specific nursing situation. They are tools we can actually use during our hospital duties to care for patients better. Another simple example let's let's say you're caring for a patient after surgery. They are in pain. A micro range theory might say use a pain scale 0 to 10 every two hours. Offer comfort measures like positioning or a warm compress. Give prescribed medications on time and reassess pain 30 minutes after giving the meds. This is micro range theory at work. It tells you exactly what to do to help the patient in that moment. Okay, it's specific. Now let's talk about middle range theories. These theories are in the middle. They are not too broad like grand theories and not too specific like micro or practice theories. So think of it like this. Grand theories are like the big picture or general ideas. for example, what nursing is all about. And micro or practice theories give you exact steps at the bed bedside like how to take care for a patient in pain. And middle range theories fall in between. They focus on specific topics that are important in nursing but still leave room for different ways to apply them. What makes them useful is that they are evidence-based, back up by research, testable, you can use them in studies and they can and they help guide both nursing care and nursing research. A simple example, one good example of a middle range theory is Walcaba's theory of comfort. So this theory talks about how nurses can improve a patient's comfort. Not just physical comfort, but also emotional and spiritual comfort. It's not as general as saying nurses care for patients and not as detailed as saying give this medicine every 4 hours. Instead, it says ask the patient what makes them uncomfortable. Look at the environment. Is it noisy or too cold? Offer emotional support. Listen, talk, and be present. This kind of theory helps nurses think clearly about how to improve patient comfort, but also leaves room for different approaches depending on the situation. Okay. So whenever you hear middle range theory, think of it as a helpful guide that focuses on one important part of nursing care like communication, pain, stress, and comfort. It gives us direction without being too general or too detailed. And because it is based on research, it helps us give smart, safe, and caring nursing interventions. Let's now talk about grand nurse uh grand theories in nursing. These are the biggest and broadest type of nursing theories. I talk about the overall purpose of nursing. What we believe nurses should do and why the profession exists. Think of grand theories like the blueprint or the master plan of nursing. They don't tell you exactly what to do at the bed bedside like when to give medicine or how to dress a wound. Instead, they explain the general ideas and beliefs that guide the whole profession. Because they are so broad, brand theories are often used in nursing education which help students understand the role of nurses in society in leadership and research. It shapes how nursing schools, hospitals and research programs are built. Okay. Another simple simple example is one famous brand theory is Gene Watson's theory of human caring. Okay. So this theory says that nursing is not just about giving medicine or treating wounds. It's also about caring for the whole person including including their emotions, spirit and dignity. Watson believed that the nurse patient relationship is important and that kindness, empathy and presence can promote healing. So while her theory doesn't say do this step by step, it helps nurses understand the deeper purpose behind their actions. Another example is Florence Nightingale's environmental theory. She believed that things like clean air, clean water, and light could affect a person's health. That may sound simple today, but back then this idea helped shape modern nursing and its role in public health. Okay. So grand theories gives us the big picture of what nursing is all about. They help us answer deep questions like what is the true purpose of nursing? What values should guide us or how can nurses help improve society? They may not give direct instructions but they help us think, reflect and grow as future professionals. Okay. So let's look at this table to better understand the three types of nursing theories. Practice middle range and grand theories. As we move from B uh from the bottom up, micro to grand each theory becomes more broad and more abstract. Micro range theories are very specific. These are like how to guide you can use right away at the bedside. Okay. And middle range theories are in the middle. They are more general but still useful for solving specific problems or doing research. And grand theories, these are the most general. They help us understand the big picture of nursing like what it means to be a nurse and why our role matters. The important thing to remember here is pick the right theory for what you are doing. Okay? If you're taking care of a patient in real time, a practice theory might be useful. If you're working on a thesis or doing research, a middle range theory help gives you focus. If you're reflecting on your philosophy as a nurse or teaching future nurses, you may use a grand theory. Example, you imagine you are cooking. A practice theory is like the actual recipe you follow. Okay? And the middle range theory is like understanding how heat changes food or how flavor combinations work. And then a grand theory is like the idea of cooking as an art or culture. It helps you see the deeper meaning behind it. So this table simply shows that different types of theories serve different roles. And as nurses, we just need to know which one fits the situation. Okay. To wrap it all up, let's think of nursing theories like tools in a toolbox. As what I have mentioned earlier, each type of theory, whether it's brand, middle range or practice theory, has its own purpose. Some theories help us understand the big picture of nursing like what we stand for and why we care. Others guide us in specific situations like what to do when a patient is in pain or how to improve communication. So, just like how a carpenter picks the right tool depending on the job, we also choose the right theory depending on our goal. If you're planning a nursing curriculum, you might use a grand theory to guide your teaching philosophy. If you're doing research on patient comfort, a middle range theory can help you stay focused. And if you're at the bedside helping a patient after surgery, a practice theory can give you stepbystep guidance. Okay. Another example. Let's say you're caring for a patient with anxiety. A grand theory helps you understand the importance of treating the patient holistically, mind, body, and spirit. While a middle range theory can give you a framework for understanding how anxiety affects communication and a practice theory gives you exact steps like breathing exercises or therapeutic touch to help the patient feel better. Okay. So in short understanding the categories of nursing theories is like knowing which key fits which lock. Okay. Each theory type has its own use and together they help make us more effective, thoughtful and skilled nurses. Okay. So this is the end of this topic. Okay. Thank you and God bless.