Foundation of nursing theories

Assumptions, beliefs, and values are terminology used when describing the foundation of nursing theories. Theories are used to describe, explain, and predict nursing phenomena, that is, the nursing metaparadigm concepts. Nursing theory is the theorist’s worldview or personal perspective of how the nursing world works.

Understanding the theorist’s assumptions, beliefs, and values is important to understanding the purpose of their theory as a whole. Knowing where the theorist is “coming from” helps you understand how the theory is constructed and why the pieces fit together.

Understanding your own assumptions, beliefs, and values will help you devise your own personal philosophy of nursing and help you choose a nursing theory or theories from which to base your own professional practice. More on those topics in future posts. Foundation of nursing theories.

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This post will define the terms assumptions, beliefs, and values that underlie nursing theory and provide examples related to the four nursing metaparadigm concepts.

All these theory and philosophy terms confusing? I can help you! Download my free 8-page resource guide of nursing theory and philosophy terms and concepts.

Definitions

Let’s start with identifying what I mean by assumptions, beliefs, and values as they relate to nursing theory and the metaparadigm concepts of person, health, environment, and/or nursing.

Worldview (from Thompson, 2016): An individual’s perspective of their reality that guides their thinking and being.

Each theorist (nursing or otherwise) has their own perspective that has then shaped their beliefs, assumptions, and values and therefore their definitions of the paradigms/metaparadigms of their discipline.

These views underlie their behaviors and decisions.

Let me acknowledge again that there is overlap between these constructs – they are related. So read the definitions and then review the examples provided in the next section. Foundation of nursing theories.

Assumptions can be thought of “givens” or a notion or fact that we take for granted, things we believe to be true, or the ways things are without us questioning the premise (Hernandez, 2009). An assumption is something that — is usually unspoken — you believe to be the TRUTH, but there is no hard proof.

Assumptions denote beliefs and values (Masters, 2015). Beliefs and values are things that ground your practice – these are things that are fundamentally important to you.

Merriam-Webster defines belief as “a state or habit of mind … something that is accepted, considered to be true, or held as an opinion.” Belief is a synonym for the term assumption, though there may be evidence for one’s beliefs. Beliefs regarding the metaparadigm concepts can be defined as the definitions and descriptions of each of the metaparadigm concepts from a personal viewpoint (i.e., your belief about each metaparadigm concept) (Hernandez, 2009). Individual belief statements about the metaparadigm concepts can also be made.

Values are defined as “a person’s principles or standards of behavior; one’s judgment of what is important in life.”

Core values are generally global, that is, related to humankind as a whole (Denehy, 2001). Personal values are the result of your unique life and circumstances. Your personal values are impacted by many factors including family dynamics, how you grew up (e.g., expectations of parents, friends, neighbors), education, employment, culture, the type of relationships you had, your religion, your experiences, etc. Professional valuesare influenced by professional nursing associations, ethics, nursing roles, and other expectations of professional nursing. Foundation of nursing theories.

Values guide and direct behavior, as well as decision-making.

Examples of Assumptions, Beliefs, and Values Related to the Nursing Metaparadigm Concepts

The four metaparadigm concepts reflect a general understanding of the discipline or the concepts that identify the phenomena of central interest to a discipline. In nursing, these phenomena are identified as the nurse, person, environment, and health.

In these examples, I’ll present examples of statements of assumptions, beliefs, and values related to each of the nursing metaparadigm concepts. Foundation of nursing theories. I won’t link the statements to any specific theorist, I just want you to get an idea of how to recognize assumptions, beliefs, and values.

Person: Definition and Description: The recipient of care and others important to person

Assumptions (A): What does one assume or take for granted about Persons?

Beliefs (B): What does one believe about Persons? (with or without evidence)

Values (V): What is desirable, good, worthy, or honorable about Persons?

Since assumptions contain beliefs and/or values, I’ll identify these aspects of the assumption statements.

A: “Persons are social beings.”

A value associated with this statement is that it is good to be around other people.
A belief associated with this statement is that people like to be around, and need, other people.

A: “Persons are biopsychosocial beings.”

A value associated with this statement is that it is good for persons to pay attention to all aspects of their lives.
A belief associated with this statement is that persons are multidimensional and influenced by physical, psychological, and social aspects of their being. The nurse would need to think about what constitutes the identified components (biological, psychological, and the social components in this assumption) so you can assess and plan care accordingly.

A: “Persons are worthy of respect.”

A value associated with this statement is that all people should be respected.
A belief associated with this statement is that persons have inherent worth.

A: “Persons have worth, value, and should be honored.“

A value associated with this statement is that it is good to treat people with dignity.
A belief associated with this statement is that all persons have inherent worth and should be treated accordingly.

A: “People have a right to make decisions about their medical care.”

A value associated with this statement is that people are autonomous individuals with inalienable rights.
A belief associated with this statement is that persons should be able to make their own decisions.

A: “People want to be a part of healthcare planning.”

A value associated with this statement is that people should participate in their own care planning.
A belief associated with this statement is that people desire to be included in planning regarding their healthcare.

B: Persons seek treatment when they are ill.

B: People should be involved in decisions about their health.

B: Patients should be emotionally and mentally stable before discharge. Foundation of nursing theories.

B: Health promotion education provides patients with knowledge to stay healthy.

V: People should be involved in decisions about their health.

V: A person’s definition of health should be respected.

V: Persons have the right to refuse care.

Health: Definition and Description: The continuum of health/wellness to illness; access to care.

Assumptions (A): What does one assume or take for granted about Health?

Beliefs (B): What does one believe about Health? (with or without evidence)

Values (V): What is desirable, good, worthy, or honorable about Health?

A: Health is defined by the Person.

A value associated with this statement is that the determination of what is healthy or quality of life should be made by the person.
A belief associated with this statement is that healthy vs. not healthy is subjective and that only the person can define what health means for them.

A: Health is dynamic.

A value associated with this statement is that it is good that health status is not static.
A belief associated with this statement is that one’s health status is constantly changing; multiple internal and external factors that interact and influence health status and therefore health can be improved.

A: Health promotion will prevent disease.

A value associated with this statement is that people should do what they can to promote health and prevent disease.
A belief associated with this statement is that educating patients with health-promoting information will make people choose healthier lifestyles and therefore prevent disease. Foundation of nursing theories.

B: Health is a state of complete wellbeing.

B: Personal values influence and determine health behaviors.

B: Pregnant women should get prenatal care.

B: Patients should feel taken care of by the healthcare team.

B: Health is what the person says it is.

V: Access to health care providers should be available to all people.

V: Health should not be taken for granted.

V: Cultural values and beliefs about health should be respected.

V: People value a healthy lifestyle.

Environment: Definition and Description: Internal, external, and social factors that influence the patient and their health status.

Assumptions (A): What does one assume or take for granted about Environment?

Beliefs (B): What does one believe about Environment? (with or without evidence)

Values (V): What is desirable, good, worthy, or honorable about Environment?

A: The environment can be modified to improve health status.

A value associated with this statement is that the environment should be conducive to health.
A belief associated with this statement is that environmental factors can be modified.

A: Interactions with family and friends are good for personal health.

A value associated with this statement is that the personal relationships (part of the external environment) are good for one’s health; they contribute to wellness.
A belief associated with this statement is that environmental factors affect health status.

A: Information found in a patient’s chart is valid.

A value associated with this statement is that information recorded in the patient’s chart should be accurate.
A belief associated with this statement is that hospital charts contain accurate information about the patient.

B: The nurse-patient relationship creates a trusting environment.

B: Nurses should provide comfort to patients and families.

B: A quiet environment is conducive to good patient care.

B: Patient experiences impact their views of health.

B: Supportive relationships positively affect health.

V: Cultural views should be respected.

V: The environment should be quiet and comfortable.

V: The environment should be kept clean and free of clutter.

V: Physical, mental, and spiritual health are valued equally.

Nursing: Definition and Description: Remember that the Nursing metaparadigm is all about what nurses DO; their characteristics and how he/she applies knowledge and skills to patient care. Foundation of nursing theories.

Assumptions (A): What does one assume or take for granted about Nurses/Nursing?

Beliefs (B): What does one believe about Nurses/Nursing? (with or without evidence)

Values (V): What is desirable, good, worthy, or honorable about Nurses/Nursing?

A: “Nurses want to help people.”

A value associated with this statement is that it is good to help others.
A belief associated with this statement is that, fundamentally, nurses are nurses because they want to help people.

A: “Nurses care about the well-being of their patients”

A value associated with this statement is that it is good or desirable to be caring. Foundation of nursing theories.
The belief or view of nurses, in general, is that because they want to help people they obviously care about their patients.

A: “Nurses can reliably assess a patient.” Foundation of nursing theories.

Values associated with this statement are that reliability/consistency and competence are desirable. Nurses should be reliable and competent.
A belief associated with this statement is that nurses are technically competent. Their skills in assessment are assumed because of what is known about nursing education and training.

A: “Nurses are skilled in physical and psychological assessment.”

A value associated with this statement is that of skill or competence. Nurses should be skilled in nursing procedures such as assessment.
A belief associated with this statement is that nurses need to be competent in certain skills (in this case technical/intellectual/communication skills) to be nurses. Their skills in assessment include interpreting the physical and psychological data they’ve gathered through history, review of systems, and physical/psychological assessment procedures and exams.

B: Nurses administer medications accurately.

B: Nurses follow physician orders.

B: Nurses treat patients the way they would want to be treated.

B: Nurses are good patient advocates.

V: Nurses should be competent.

V: Nurses should use best practices and evidence to inform their nursing care.

V: Nurses should develop a treatment plan with the patient’s involvement.

V: Nurses are trustworthy.

How to Identify Your Assumptions, Beliefs, and Values

Critical thinking and reflective clinical practice are hallmarks of advanced nursing practice and nurse experts. By critically examining your practice, you’ll have a deeper understanding of how theorists develop theories (Hernandez, 2009). Foundation of nursing theories. When you critically examine your personal practice, the abstract world of philosophy and theory becomes more concrete – more understandable. Foundation of nursing theories.

So if you want to identify your beliefs, assumptions, and values (BAVs), critically reflect on your clinical practice (Hernandez, 2009). Think about patient care experiences that you’ve had. If you can write a few of them out, with as much detail as possible, it may help you to specifically identify your BAVs.

These narratives should be a detailed description of interactions between you and a client/client and family. Try to be as comprehensive about the separate interactions as your memory will allow — add in details about the client situation, the gist of conversations, what you did, what they did, what happened, etc.

Then examine each clinical story you wrote, sentence by sentence. As you reflect on your stories, identify which phenomena are being discussed (i.e., metaparadigm concepts of nursing, person, environment, or health) and then identify if each sentence is a belief, assumption, or value.

To identify assumptions, it might help to say, I assume that nurses …. I assume that health is …. I assume that environment …. I assume that persons are ….

To identify beliefs, it might help to say, I believe that nurses are …. I believe that health is …. I believe that environment is …. I believe that persons are ….

To identify values, it might help to say, it is good for nurses to …. or nurses should/ought to …. It is good for persons to …. or persons should/ought to …. Environment should/ought to be …. Health should/ought to ….

When you collate your BAVs under each metaparadigm concept, you’ll become clear on what you believe in and value because the way you practice nursing is what you believe is important (i.e., your beliefs and values).

Explicating your own assumptions, beliefs, and values will help you become more self-aware of what really underlies your professional practice. It will also help you to have a deeper understanding of how theorists develop theories: they look at the way nursing practice is or should be, identify their assumptions, explain the concepts of the nursing metaparadigm according to their worldview, and ultimately propose the relationships between the concepts in their theories or models.

You will be one step closer to articulating your own personal philosophy of nursing!

In the previous post, I gave you examples of how selected theorists define each of the metaparadigm concepts. Go back to that post and see if you can identify the assumption, belief, and/or value being represented in the theorist statements.

How to Cite this Blogpost in APA*:

Thompson, C. J. (2017, October 10). What are assumptions, beliefs, and values in nursing theory? *Citation should have hanging indent

References

Denehy, J. (2001). Articulating your philosophy of nursing. The Journal of School Nursing, 17(1), 1-2.

Hernandez, C. A. (2009). Student articulation of a nursing philosophical statement: An assignment to enhance critical thinking skills and promote learning. Journal of Nursing Education, 48(6), 343-349. Foundation of nursing theories.

Masters, K. (2015). Nursing theories: A framework for professional practice (2nd ed.). Burlington, MA: Jones & Bartlett Learning.

Thompson, C. J. (2016). Nursing theory and philosophy: Terms & concepts guide! [eGuide]. Retrieved from Free Nursing Theory Guide.