Theoretical Basis of Advanced Nursing Practice

The term “paradigm” is defined as the development of knowledge within a specific field or discipline. In 1984, Dr. Jacqueline Fawcett evaluated existing nursing theories and identified four concepts common to the individual paradigms within each theory: Patient-Environment-Health-Nursing. Placing the nursing theories within one context enhanced the potential for the development of nursing knowledge. Dr. Fawcett’s work is commonly referred to as the “Meta-paradigm” of nursing (Fawcett, 1984). Nursing knowledge and knowledge development focuses on the “whole” and is directed at defining and understanding the inter-relationships among the four core concepts identified above (Smith & Liehr, 2014).

Grand Nursing Theory

Among the core beliefs of nursing is the idea that nursing should be founded on the best empirical evidence, incorporate the beliefs of patients and families, and be guided by disciplinary theory (Pipe, 2013). Beginning in the 1950’s multiple theories of nursing were developed; some scholars believe the first nursing theory was postulated by Florence Nightingale when she published her “Notes on Nursing” in 1860. As we discussed in an earlier Unit, concepts are the building blocks of theory. A theory defines the relationship between two or more concepts; conceptual models of nursing are typically called “Grand nursing theories”. Grand theories are quite abstract and usually do not provide specific instruction for nursing actions (Kenney, 2013).

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