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In this guide for nursing theories, we aim to help you understand what comprises a nursing
theory and its importance, purpose, history, types, or classifications, and give you an overview
through summaries of selected nursing theories.
Defining Terms
The development of nursing theory demands an understanding of selected terminologies,
definitions, and assumptions.
Philosophy. These are beliefs and values that define a way of thinking and are
generally known and understood by a group or discipline.
Theory. A belief, policy, or procedure proposed or followed as the basis of action. It
refers to a logical group of general propositions used as principles of explanation.
Theories are also used to describe, predict, or control phenomena.
Concept. Concepts are often called the building blocks of theories. They are primarily
the vehicles of thought that involve images.
Models. Models are representations of the interaction among and between the
concepts showing patterns. They present an overview of the theory’s thinking and may
demonstrate how theory can be introduced into practice.
Conceptual framework. A conceptual framework is a group of related ideas,
statements, or concepts. It is often used interchangeably with the conceptual
model and with grand theories.
Proposition. Propositions are statements that describe the relationship between the
concepts.
Domain. The domain is the perspective or territory of a profession or discipline.
Process. Processes are organized steps, changes, or functions intended to bring about
the desired result.
Paradigm. A paradigm refers to a pattern of shared understanding and assumptions
about reality and the world, worldview, or widely accepted value system.
Metaparadigm. A metaparadigm is the most general statement of discipline and
functions as a framework in which the more restricted structures of conceptual models
develop. Much of the theoretical work in nursing focused on articulating relationships
among four major concepts: person, environment, health, and nursing.
Environment
Environment (or situation) is defined as the internal and external surroundings that affect the
client. It includes all positive or negative conditions that affect the patient, the physical
environment, such as families, friends, and significant others, and the setting for where they
go for their healthcare.
Health
Health is defined as the degree of wellness or well-being that the client experiences. It may
have different meanings for each patient, the clinical setting, and the health care provider.
Nursing
The nurse’s attributes, characteristics, and actions provide care on behalf of or in conjunction
with the client. There are numerous definitions of nursing, though nursing scholars may have
difficulty agreeing on its exact definition. The ultimate goal of nursing theories is to improve
patient care.
You’ll find that these four concepts are used frequently and defined differently throughout
different nursing theories. Each nurse theorist’s definition varies by their orientation, nursing
experience, and different factors that affect the theorist’s nursing view. The person is the main
focus, but how each theorist defines the nursing metaparadigm gives a unique take specific to
a particular theory. To give you an example, below are the different definitions of various
theorists on the nursing metaparadigm:
Components of Nursing Theories
For a theory to be a theory, it has to contain concepts, definitions, relational statements, and
assumptions that explain a phenomenon. It should also explain how these components relate
to each other.
Phenomenon
A term given to describe an idea or response about an event, a situation, a process, a group of
events, or a group of situations. Phenomena may be temporary or permanent. Nursing
theories focus on the phenomena of nursing.
Concepts
Interrelated concepts define a theory. Concepts are used to help describe or label a
phenomenon. They are words or phrases that identify, define, and establish structure and
boundaries for ideas generated about a particular phenomenon. Concepts may be abstract or
concrete.
Definitions
Definitions are used to convey the general meaning of the concepts of the theory. Definitions
can be theoretical or operational.
Relational Statements
Relational statements define the relationships between two or more concepts. They are the
chains that link concepts to one another.
Assumptions
Assumptions are accepted as truths and are based on values and beliefs. These statements
explain the nature of concepts, definitions, purpose, relationships, and structure of a theory.
Nursing theories help recognize what should set the foundation of practice by explicitly
describing nursing.
By defining nursing, a nursing theory also helps nurses understand their purpose and
role in the healthcare setting.
Theories serve as a rationale or scientific reasons for nursing interventions and give
nurses the knowledge base necessary for acting and responding appropriately in
nursing care situations.
Nursing theories provide the foundations of nursing practice, generate further
knowledge, and indicate which direction nursing should develop in the future (Brown,
1964).
By providing nurses a sense of identity, nursing theory can help patients, managers, and
other healthcare professionals to acknowledge and understand the unique contribution
that nurses make to the healthcare service (Draper, 1990).
Nursing theories prepare the nurses to reflect on the assumptions and question the
nursing values, thus further defining nursing and increasing the knowledge base.
Nursing theories aim to define, predict, and demonstrate nursing phenomenon (Chinn
and Jacobs, 1978).
It can be regarded as an attempt by the nursing profession to maintain and preserve its
professional limits and boundaries.
In many cases, nursing theories guide knowledge development and directs education,
research, and practice, although each influences the others. (Fitzpatrick and Whall,
2005).
Purposes of Nursing Theories
The primary purpose of theory in nursing is to improve practice by positively influencing the
health and quality of life of patients. Nursing theories are also developed to define and
describe nursing care, guide nursing practice, and provide a basis for clinical decision-making.
In the past, the accomplishments of nursing led to the recognition of nursing in an academic
discipline, research, and profession.
In Academic Discipline
Much of the earlier nursing programs identified the major concepts in one or two nursing
models, organized the concepts, and build an entire nursing curriculum around the created
framework. These models’ unique language was typically introduced into program objectives,
course objectives, course descriptions, and clinical performance criteria. The purpose was to
explain the fundamental implications of the profession and enhance the profession’s status.
In Research
The development of theory is fundamental to the research process, where it is necessary to
use theory as a framework to provide perspective and guidance to the research study. Theory
can also be used to guide the research process by creating and testing phenomena of
interest. To improve the nursing profession’s ability to meet societal duties and
responsibilities, there needs to be a continuous reciprocal and cyclical connection with theory,
practice, and research. This will help connect the perceived “gap” between theory and practice
and promote the theory-guided practice.
In Profession
Clinical practice generates research questions and knowledge for theory. In a clinical setting,
its primary contribution has been the facilitation of reflecting, questioning, and thinking about
what nurses do. Because nurses and nursing practice are often subordinate to powerful
institutional forces and traditions, introducing any framework that encourages nurses to
reflect on, question, and think about what they do provide an invaluable service.
Classification of Nursing Theories
There are different ways to categorize nursing theories. They are classified depending on their
function, levels of abstraction, or goal orientation.
By Abstraction
There are three major categories when classifying nursing theories based on their level of
abstraction: grand theory, middle-range theory, and practice-level theory.
Grand theories are abstract, broad in scope, and complex, therefore requiring further
research for clarification.
Grand nursing theories do not guide specific nursing interventions but rather provide a
general framework and nursing ideas.
Grand nursing theorists develop their works based on their own experiences and their
time, explaining why there is so much variation among theories.
Address the nursing metaparadigm components of person, nursing, health, and
environment.
Middle-Range Nursing Theories
More limited in scope (compared to grand theories) and present concepts and
propositions at a lower level of abstraction. They address a specific phenomenon in
nursing.
Due to the difficulty of testing grand theories, nursing scholars proposed using this
level of theory.
Most middle-range theories are based on a grand theorist’s works, but they can be
conceived from research, nursing practice, or the theories of other disciplines.
Practice-Level Nursing Theories
Practice nursing theories are situation-specific theories that are narrow in scope and
focuses on a specific patient population at a specific time.
Practice-level nursing theories provide frameworks for nursing interventions and
suggest outcomes or the effect of nursing practice.
Theories developed at this level have a more direct effect on nursing practice than more
abstract theories.
These theories are interrelated with concepts from middle-range theories or grand
theories.
By Goal Orientation
Theories can also be classified based on their goals. They can be descriptive or prescriptive.
Descriptive Theories
Descriptive theories are the first level of theory development. They describe the
phenomena and identify its properties and components in which it occurs.
Descriptive theories are not action-oriented or attempt to produce or change a
situation.
There are two types of descriptive theories: factor-isolating theory and explanatory theory.
Factor-Isolating Theory
Address the nursing interventions for a phenomenon, guide practice change, and
predict consequences.
Includes propositions that call for change.
In nursing, prescriptive theories are used to anticipate the outcomes of nursing
interventions.
Afaf Ibrahim Meleis (2011), in her book Theoretical Nursing: Development and Progress, organizes
the major nurse theories and models using the following headings: needs theories, interaction
theories, and outcome theories. These categories indicate the basic philosophical
underpinnings of the theories.
Needs-Based Theories. The needs theorists were the first group of nurses who thought
of giving nursing care a conceptual order. Theories under this group are based on
helping individuals to fulfill their physical and mental needs. Theories of Orem,
Henderson, and Abdella are categorized under this group. Need theories are criticized
for relying too much on the medical model of health and placing the patient in an
overtly dependent position.
Interaction Theories. These theories emphasized nursing on the establishment and
maintenance of relationships. They highlighted the impact of nursing on patients and
how they interact with the environment, people, and situations. Theories of King,
Orlando, and Travelbee are grouped under this category.
Outcome Theories. These theories describe the nurse as controlling and directing
patient care using their knowledge of the human physiological and behavioral systems.
The nursing theories of Johnson, Levine, Rogers, and Roy belong to this group.
In her book, Nursing Theorists and Their Work, Raile Alligood (2017) categorized nursing theories
into four headings: nursing philosophy, nursing conceptual models, nursing theories and
grand theories, and middle-range nursing theories.
Nursing Philosophy. It is the most abstract type and sets forth the meaning of nursing
phenomena through analysis, reasoning, and logical presentation. Works of
Nightingale, Watson, Ray, and Benner are categorized under this group.
Nursing Conceptual Models. These are comprehensive nursing theories that are
regarded by some as pioneers in nursing. These theories address the nursing
metaparadigm and explain the relationship between them. Conceptual models of
Levine, Rogers, Roy, King, and Orem are under this group.
Grand Nursing Theories. Are works derived from nursing philosophies, conceptual
models, and other grand theories that are generally not as specific as middle-range
theories. Works of Levine, Rogers, Orem, and King are some of the theories under this
category.
Middle-Range Theories. Are precise and answer specific nursing practice questions.
They address the specifics of nursing situations within the model’s perspective or theory
from which they are derived. Examples of Middle-Range theories are that of Mercer,
Reed, Mishel, and Barker.
Florence Nightingale
See Also: Florence Nightingale: Environmental Theory and Biography
Virginia Henderson
See Also: Virginia Henderson: Nursing Need Theory
Lydia E. Hall
See Also: Lydia Hall: Care, Cure, Core Theory
Developed the Care, Cure, Core Theory is also known as the “Three Cs of Lydia
Hall.“
Hall defined Nursing as the “participation in care, core and cure aspects of patient care,
where CARE is the sole function of nurses, whereas the CORE and CURE are shared with
other members of the health team.”
The major purpose of care is to achieve an interpersonal relationship with the individual
to facilitate the development of the core.
The “care” circle defines a professional nurse’s primary role, such as providing bodily
care for the patient. The “core” is the patient receiving nursing care. The “cure” is the
aspect of nursing that involves the administration of medications and treatments.
Joyce Travelbee
States in her Human-to-Human Relationship Model that the purpose of nursing was
to help and support an individual, family, or community to prevent or cope with the
struggles of illness and suffering and, if necessary, to find significance in these
occurrences, with the ultimate goal being the presence of hope.
Nursing was accomplished through human-to-human relationships.
Extended the interpersonal relationship theories of Peplau and Orlando.
Kathryn E. Barnard
Developed the Child Health Assessment Model.
Concerns improving the health of infants and their families.
Her findings on parent-child interaction as an important predictor of cognitive
development helped shape public policy.
She is the founder of the Nursing Child Assessment Satellite Training Project (NCAST),
which produces and develops research-based products, assessment, and training
programs to teach professionals, parents, and other caregivers the skills to provide
nurturing environments for young children.
Borrows from psychology and human development and focuses on mother-infant
interaction with the environment.
Contributed a close link to practice that has modified the way health care providers
assess children in light of the parent-child relationship.
Evelyn Adam
Focuses on the development of models and theories on the concept of nursing.
Includes the profession’s goal, the beneficiary of the professional service, the role of the
professional, the source of the beneficiary’s difficulty, the intervention of the
professional, and the consequences.
A good example of using a unique basis of nursing for further expansion.
Jean Watson
She pioneered the Philosophy and Theory of Transpersonal Caring.
“Nursing is concerned with promoting health, preventing illness, caring for the sick, and
restoring health.”
Mainly concerns with how nurses care for their patients and how that caring progresses
into better plans to promote health and wellness, prevent illness and restore health.
Focuses on health promotion, as well as the treatment of diseases.
Caring is central to nursing practice and promotes health better than a simple medical
cure.
Kari Martinsen
Philosophy of Caring
“Nursing is founded on caring for life, on neighborly love, […]At the same time, the
nurse must be professionally educated.”
Human beings are created and are beings for whom we may have administrative
responsibility.
Caring, solidarity, and moral practice are unavoidable realities.
Katie Eriksson
Theory of Carative Caring
“Caritative nursing means that we take ‘caritas’ into use when caring for the human
being in health and suffering […] Caritative caring is a manifestation of the love that
‘just exists’ […] Caring communion, true caring, occurs when the one caring in a spirit of
caritas alleviates the suffering of the patient.”
The ultimate goal of caring is to lighten suffering and serve life and health.
Inspired many in the Nordic countries and used it as the basis of research, education,
and clinical practice.
Dorothea E. Orem
In her Self-Care Theory, she defined Nursing as “The act of assisting others in the
provision and management of self-care to maintain or improve human functioning at
the home level of effectiveness.”
Focuses on each individual’s ability to perform self-care.
Composed of three interrelated theories: (1) the theory of self-care, (2) the self-care
deficit theory, and (3) the theory of nursing systems, which is further classified into
wholly compensatory, partially compensatory, and supportive-educative.
Imogene M. King
See Also: Imogene M. King: Theory of Goal Attainment
Dorothy E. Johnson
See Also: Dorothy E. Johnson: Behavioral Systems Model
Nola J. Pender
See Also: Nola Pender: Health Promotion Model
Margaret A. Newman
Health as Expanding Consciousness
“Nursing is the process of recognizing the patient in relation to the environment, and it
is the process of the understanding of consciousness.”
“The theory of health as expanding consciousness was stimulated by concern for those
for whom health as the absence of disease or disability is not possible . . . “
Nursing is regarded as a connection between the nurse and patient, and both grow in
the sense of higher levels of consciousness.
Ramona T. Mercer
Maternal Role Attainment—Becoming a Mother
“Nursing is a dynamic profession with three major foci: health promotion and
prevention of illness, providing care for those who need professional assistance to
achieve their optimal level of health and functioning, and research to enhance the
knowledge base for providing excellent nursing care.”
“Nurses are the health professionals having the most sustained and intense interaction
with women in the maternity cycle.”
Maternal role attainment is an interactional and developmental process occurring over
time. The mother becomes attached to her infant, acquires competence in the
caretaking tasks involved in the role, and expresses pleasure and gratification. (Mercer,
1986).
Provides proper health care interventions for nontraditional mothers for them to
favorably adopt a strong maternal identity.
Merle H. Mishel
Uncertainty in Illness Theory
Presents a comprehensive structure to view the experience of acute and chronic illness
and organize nursing interventions to promote optimal adjustment.
Describes how individuals form meaning from illness-related situations.
The original theory’s concepts were organized in a linear model around the following
three major themes: Antecedents of uncertainty, Process of uncertainty appraisal, and
Coping with uncertainty.
Pamela G. Reed
Self-Transcendence Theory
Self-transcendence refers to the fluctuation of perceived boundaries that extend the
person (or self) beyond the immediate and constricted views of self and the world
(Reed, 1997).
Has three basic concepts: vulnerability, self-transcendence, and well-being.
Gives insight into the developmental nature of humans associated with health
circumstances connected to nursing care.
Phil Barker
Barker’s Tidal Model of Mental Health Recovery is widely used in mental health
nursing.
It focuses on nursing’s fundamental care processes, is universally applicable, and is a
practical guide for psychiatry and mental health nursing.
Draws on values about relating to people and help others in their moments of distress.
The values of the Tidal Model are revealed in the Ten Commitments: Value the voice,
Respect the language, Develop genuine curiosity, Become the apprentice, Use the
available toolkit, Craft the step beyond, Give the gift of time, Reveal personal wisdom,
Know that change is constant, and Be transparent.
Katharine Kolcaba
Theory of Comfort
“Comfort is an antidote to the stressors inherent in health care situations today, and
when comfort is enhanced, patients and families are strengthened for the tasks ahead.
Also, nurses feel more satisfied with the care they are giving.”
Patient comfort exists in three forms: relief, ease, and transcendence. These comforts
can occur in four contexts: physical, psychospiritual, environmental, and sociocultural.
As a patient’s comfort needs change, the nurse’s interventions change, as well.
Cheryl Tatano Beck
Postpartum Depression Theory
“The birth of a baby is an occasion for joy—or so the saying goes […] But for some
women, joy is not an option.”
Described nursing as a caring profession with caring obligations to persons we care for,
students, and each other.
Provides evidence to understand and prevent postpartum depression.
Kristen M. Swanson
Theory of Caring
“Caring is a nurturing way of relating to a valued other toward whom one feels a
personal sense of commitment and responsibility.”
Defines nursing as informed caring for the well-being of others.
Offers a structure for improving up-to-date nursing practice, education, and research
while bringing the discipline to its traditional values and caring-healing roots.
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