N U R S I N G T H E O R Y A N D C O N C E P T D E V E L O P M E N T O R A N A LY S I S

The meaning of models of nursing to practising nurses

Peter Wimpenny BSc PhD RGN RNT
Lecturer, Centre for Nurse Practice Research and Development, School of Nursing and Midwifery, The Robert Gordon
University, Aberdeen, UK

Submitted for publication 27 November 2001

Accepted for publication 30 July 2002

Correspondence: W I M P E N N Y P . ( 2 0 0 2 ) Journal of Advanced Nursing 40(3), 346–354

Peter Wimpenny, The meaning of models of nursing to practising nurses
Centre for Nurse Practice Research and Background. It is contended that models of nursing have lost the momentum and
Development,
challenge that they promised the profession. Their use, value and purpose have been
School of Nursing and Midwifery,
seriously questioned and new perspectives on their use and implementation in
The Robert Gordon University,
Garthdee Road,
practice, education and research are required. In addition, limited evidence exists on
Aberdeen AB10 7QG, the implementation of models into clinical areas.
UK. Aim. To explore the meaning of models of nursing to practising nurses.
E-mail: p.wimpenny@rgu.ac.uk Methods. Serial interviews with qualified nurses who were undertaking an educa-
tional programme or module that explored and examined models of nursing.
Findings. The outcome reveals that the use of the terms, models of nursing or
nursing model, are limited and confusing as the terms can encompass a range of
meanings. It is suggested that a three-model typology exists that clarifies more fully
the present position of nursing models. The three models are Theoretical Model,
Mental Model and Surrogate Model.
Limitations. The focus on data collection through serial interviews with qualified
practitioners could have been broadened to include a range of data sources such as
teachers and clinical areas, which could have enriched the phenomenon of models of
nursing.
Conclusions. There is a greater need to understand nursing models within the
framework of the three-model typology and to reconsider their introduction and use
in this context.

Keywords: nursing models, theoretical models, conceptual models, qualitative

research, grounded theory, serial interviews

(1998), (Roper et al. 2000) sets out to defend models from

Introduction and background to nursing models
Since the mid 1970s considerable writing and discussion has
occurred about models of nursing. In the 21st century the
impact and relevance of nursing models to the practising
nurse is characterized by divergent and often ambivalent
views. The almost evangelical adoption of a model of nursing
in the 1970s to 1990s has changed and made way for a more
critical and sceptical view of their purpose and value. Many
nurses in clinical practice, education and research may view
this as wholly appropriate as the uncritical acceptance of
these ‘early’ years resulted in decisions and usage of models,
which have had a lasting legacy. More recently Tierney
such critics, for example, Cash (1990) and Biley (1992), who
argue that models are too general in nature and probably
now redundant in the evolution of nursing.
From the outset, the plethora of model related books and
articles indicated that nursing models were to move nursing
away from medical/disease orientation. It was essential to be
seen to be using a model as it was believed to confer credence
on nursing in its attempt to delineate a clear distinction
between itself and medicine (Holmes 1990). It was as
Newton (1991) highlights in relation to the intention of the
12 Activities of Living (Roper et al. 1980, 1985) intended to
reflect the image of nursing by providing ‘a clear structure for

346
2002 Blackwell Science Ltd

Nursing theory and concept development or analysis
nurses to carry out their care for patients and a rationale for
this care’ (p. 13), an intention that may be applicable to all
nursing models. Such strength of involvement must surely
have had an impact on practitioners, and yet Biley (1992),
was stating that nursing models (at least some) were now
redundant in practice. So why had they moved from a central
role where they, in conjunction with the nursing process,
were expected to change and enhance nursing practice to a
point where they were no longer required?
Scant research evidence exists about implementation of
models into clinical areas, despite an extensive introduction
across the world. Archibald (2000) describes development and
implementation of a model in a Nursing Development Unit.
Wright (1986) describes this implementation process in con-
junction with building the model from the ground. Pearson
(1992) also details this process at Burford Hospital in the
1980s. The adoption of models within these first Nursing
Development Units (NDUs) highlights how it was intended to
clarify thinking, create shared understanding, focus on patients
and allow nurses to identify more clearly their contribution to
care. The suggestion in the literature at that time was that a
model was an essential requirement for practitioners otherwise
anarchy might ensue. The foundation for such a claim was the
perceived differences of perspective that exist within any health
care organization (Pearson et al. 1996).
Griffiths (1998) found little differentiation in the way
nursing care was delivered or recorded in practice within two
wards where different models had been adopted. Although
matching particular models to particular specialities may
have some advantage in that the models themselves have
usually been developed from a particular experiential per-
spective. However, as McKenna’s work (1989) shows, the
determinants of choice may have little to do with suitability
but be based instead on previous training and experience. The
psychiatric ward managers he questioned showed a major
preference for three behavioural/needs models reflecting, it is
contended, their physically orientated biomedical model
education. It could be suggested that irrespective of model
these ward managers would continue to promote care based
on their prior experience and training.
To prevent this Botha (1989) is adamant that it is the
responsibility of education to expose students to as many
models as can possibly be fitted into a curriculum. This
possibility may, for preregistration students, serve only to
foster the concept that nursing models are merely idealistic
and are not for use in practice. However, McKenna (1994a)
does highlight the value of models as seen by student nurses,
and it may be reasonable to support the view that models are
useful structures for such neophytes (Heath 1998). For those
already in practice models may remain at an academic or

2002 Blackwell Science Ltd, Journal of Advanced Nursing, 40(3), 346–354
The meaning of models of nursing
abstract level that has little to do with the world of nursing
practice, or it may be the case that experienced nurses have
already moved beyond the model and it is therefore not an
end but a means to an end (Thorne et al. 1998).
McFarlane (1977) in an earlier paper describes how, when
considering nursing degree programmes and which sciences
were relevant for nursing practice, she was ‘overwhelmed
with a feeling of frustration and powerlessness as we
floundered in the uncharted seas of nursing’ (p. 261). (She
echoes some of this frustration again in an article in the
British Medical Journal in 1985). She went on to explore the
relationship of theory and practice and presents a view that it
is the systematic organization of nursing practice based on
theory (not specifically nursing theory) that is needed to chart
the seas of nursing (McFarlane 1977). It is interesting to note
that even at this stage she is finding evidence that such an
approach is viewed as antithetical to the views of practition-
ers who consider any theoretical work as of lesser value in
comparison to practical activity.
Ten years later Aggleton and Chalmers (1987) are still
opting for a view that requires nurses to reject practice based
on intuition and to seek practice based on ‘...systematically
derived sets of understandings about people and their nursing
needs’ (p. 573). There is within their work a change to
acknowledge a knowledge base that is specific to nursing
concerns, a factor not evident in McFarlane’s discussion.
Models in Aggleton and Chalmers view are identified as
providing the vehicle that will assist the nurse to reject
practice based on personal preconceptions and preferences or
routines and rituals. The emphasis has now moved to making
the right choice from the available range of nursing models, a
choice that Aggleton and Chalmers (1987) identify should be
as systematic as the model itself. Walker and Neuman (1996),
for example, provide a blueprint for undertaking such a
choice. Aggleton and Chalmers (1987) believe that wider use
of models would help toward building a professional know-
ledge base and also provide a more integrated set of
experiences for students. Little evidence exists as to the
impact of such major change and development. In later work,
Aggleton and Chalmers (2000) acknowledge the problems
that have accompanied models of nursing but still view them
as having the potential to unify nursing’s development.
The inclusive approach to adoption of a model in practice
taken by Pearson (1992) and Johns (1994) at Burford and
Wright (1986) at Tameside was not mirrored in most other
health care settings with implementation happening without
practitioner involvement. The result was, as Ormerod (1994)
identifies that when models did not work it was the
practitioner who was getting the blame. So after nearly
30 years of model based practices what meaning do models
347
P. Wimpenny
have for the practitioner? Are they as influential and
necessary for practice as originally suggested? Have they
moved or are they moving from being extant to being extinct?
The study
Research questions
Two central questions provided the focus for this study:
• What is the experience of nursing models amongst qualified
nurses?
• What meaning and understanding do they take from an
educational programme about nursing models?
The intention of these questions at the outset of the study
was to maintain the focus on nursing models as they were
experienced by the participants. Detailed investigation of the
curriculum and how participants had been taught was outwith
the scope of this study but the impact of the course structure
and the quality of the teaching is duly acknowledged.
Methodology
The original work of Glaser and Strauss (1967) provided the
methodological underpinning that gave structure to this
research. However, this did not negate influence from other
qualitative fields such as phenomenology. Grounded theory
has appeal when setting out to find out ‘what’s going on here?’
It has three key aspects that assist the researcher: First, it has a
step-by-step process that can be helpful when the process of
data generation and management is complex; second, it
supports the researcher who is attempting to generate theory
where a dearth exists; and third, it can be a facilitator, so that
the research process can be modified and creatively adapted as
the research progresses (Christensen 1993).
Methods
Data collection
Data collection was carried out using serial interviews
(Seidman 1991) with qualified nurses who were undertaking
educational programmes on nursing models. Data collection
commenced in 1994 and was completed in 1997. A constant
comparative analytical approach was used between inter-
views with coding and categorizing the main tools for data
analysis and reduction (Glaser & Strauss 1967).
The first interview occurred at the start of, or prior to, any
educational input and was focused on establishing the
context of the participants’ experience and meanings of
models. It also enabled the researcher to build rapport and set
the scene for future interviews. Opening questions that
348
2002 Blackwell Science Ltd, Journal of Advanced Nursing, 40(3), 346–354
related to the professional background of the nurse were
used to develop rapport. Entry into the field of models was
initiated using an open question such as, ‘Can you describe
your present experience of models?’ The interview usually
took place in available office or classroom space at the
institution in which the student was studying.
The second interview occurred at the end of, or soon after,
the educational programme. This interview concentrated on
the experience of models as encountered in the programme,
which also included making connections to the social context
of clinical practice in addition to that of the educational
context. ‘Can you describe your experience of models from
the educational programme you have just completed?’
usually commenced the interview. Questions were also raised
from the first interview data at an appropriate place, for
example when new perspectives about a model or models in
general were being described or previous views were being
restated or reinforced. Again these interviews usually took
place in available office or classroom space at the institution
in which the student was studying.
The third interview occurred within 1–2 years of the
second interview. Within this interview participants were
encouraged to reflect on the meaning of their experiences and
also to consider the future for models. The opening for the
interview centred on the previous two interviews, as this
helped to re-contextualize the study. Following this the
researcher asked a broad question, such as ‘Can you now tell
me your story of models?’ Ensuing questions emerged from
travelling (Kvale 1996) with the participant and also as a
reflection of previous interviews and analysis. These inter-
views took place in the person’s workplace or home.
Tape recorded interview time varied from 15 to 45 minutes,
although this did not include time spent in initial general
discussion and discussion that often occurred after the tape
recorder was switched off. First interviews were shorter as
participants were often interviewed at convenient times in
their educational programmes. All interviews were transcribed
verbatim by the researcher so that he could know the
interviews better (Seidman 1991) and also minimize acontex-
tualization of the data from the whole picture (Mischler 1986).
Sample
The sample was drawn from four educational institutions
across Scotland who were offering programmes on nursing
models to postregistration students. Not all institutions
commenced in the study at the same time. Three were Higher
Education institutions (HEI) one was, at that commencement
of the study, a stand alone School of Nursing and Midwifery
(SNM). The programmes and numbers of participants are
summarized below in Table 1.
Nursing theory and concept development or analysis The meaning of models of nursing

Table 1 Institutions, programmes of study and sample numbers

No. of cohorts No. of participants

Institution Programme of study approached in each cohort

HE1 Models were incorporated into a module, which examined One Three
the professional development of nursing. Block attendance
of 2 weeks was required in conjunction with distance learning
materials.
HE2 Specific module which related to nursing theory and models. Two Four
One day per week attendance pattern for one semester. Module Four
was only part of input for each day.

HE3 Specific module which was solely related to nursing theory and One Four
models. One day per week attendance across academic year Module
was only part of input for each day.
SNM Stand alone module run over a period of 10 weeks with 1 Two Five
day/week attendance. Three
Total 6 23

Due to a variety of factors, it was impossible to interview
all participants three times. At second interview 20 partici-
pants were interviewed, at the third interview 14 participants
were interviewed. The greatest reduction in numbers of
participants (see Table 2) can be seen in the School of
Nursing and Midwifery group. It is contended that this may
have been due to the short modular programmes, which at
that time, were taken as stand alone modules. Participants
undertaking these modules were possibly more transient than
those who were undertaking a part-time degree of which the
module was only one component in a longer programme.
No attempt was made to reflect demographic variations in
the student or nursing populations (Morse 1991). It is also
acknowledged that the educational programmes varied and
this was of initial concern. However, the intention from the
outset was that the programme was to act as a conduit to
facilitate discussion about models, rather than a structure to
be investigated.
Ethical issues
A formal ethical procedure was required from two institu-
tions; the other institutions requested that discussions took
place between the researcher and the teacher/lecturer
Table 2 Number of interviewees at each stage of interviewing
Institution First interviews Second interviews Third interviews
responsible for the programme to negotiate access to stu-
dents. A consent form was attached to the letter introducing
the researcher and the study. The sample was obtained from
volunteers within each student cohort. Consideration was
given to issues of intrusion, harm and exploitation and
addressed through emphasizing right of withdrawal from the
study and wherever possible choice of place and time for
interview. Consent was implied through volunteering. Con-
fidentiality was assured and data handling and storage con-
fined to the researcher.
Analysis of data
Analysis of data occurred using the constant comparative
approach described by Glaser and Strauss (1967). Analysis
was therefore undertaken throughout the data collection
process and hence informed each interview stage. Interview
transcripts and any field notes were open-coded and themes
developed. These themes were then taken back to the original
transcripts and data recorded under each theme. Thus the
researcher moved backwards and forwards through the
analysis and data collection until a pattern or structure
emerged around a core category. On completion and reduc-
tion of the third interviews a further abstraction of meaning
was arrived at from the displayed data (Huberman & Miles
1998) and represented as the emerging theory.

HE1 3 2 1 Findings
HE2 8 8 7
Considerable data are generated in qualitative research, which
HE3 4 4 3
SNM 8 6 3 is often difficult to summarize and convey to the reader in a
short paper. Therefore summaries of the data are limited to an
Total 23 20 14
overview of the main categories that emerged at each stage of

2002 Blackwell Science Ltd, Journal of Advanced Nursing, 40(3), 346–354 349
P. Wimpenny
the interview process. Cresswell (1994) indicates that no
definitive way of presenting data in qualitative research is
described, the important factor being the creation of a vision or
picture as the essential factor. Data from the three interviews
are presented separately to provide such a picture and the
subsequent emerging theory is then described and discussed.
First interviews
The major or core category from the first interviews is
described as Operationalizing the model. It reflected the
experience of models as something to be put into practice in
the clinical area, often through some form of paperwork. Six
subcategories contributed to this: Indoctrination/Condition-
ing, which arose from participants’ views that models were
chosen by others and given to them to use ‘it just appeared
(Jo)’ or as Amanda stated ‘…all of a sudden the placement
teacher from the college said to us the students weren’t
learning Roper, Logan and Tierney, they were learning
Minschull’s therefore we had to implement Minschulls from
then on’. Purpose and Value, whereby the systematic nature
of the assessment process was identified, like ‘headings to
remind yourself’ (Marion). Adapting models to the situation
and clinical area in which you worked, although uncertainty
existed as to the appropriateness of doing this. Models were
identified strongly with the Care Plan, particularly the
written record, as Amanda stated ‘we kind of have the
paperwork but we don’t have the understanding’. There was
also a Searching, for the right model, a model with a name on
it ‘that will give another way of looking at it (nursing)’
(Martin). It was as though having the named model, in itself,
was of value. Other models were also apparent at this stage
although not overtly stated, for example biomedical models.
Second interviews
At the end of the educational programmes some of the
categories from the first interviews still appeared. However,
the core category at this stage was now Contextualizing the
model. This resonated with the first interviews major
category of Operationalizing the model but moved it more
into the individual practitioner and their clinical environ-
ment. Through the educational programme the participants
had been attempting to Envision the model in action, often
through a case study. There was also a Validating component
where practitioners were able to link into the model and
validate their own ideas and perspectives although, con-
versely, the educational programmes had also diminished this
by suggesting that you had to be Doing it right. That is, the
model was potentially viewed as having a right and wrong
350
2002 Blackwell Science Ltd, Journal of Advanced Nursing, 40(3), 346–354
way to be used. As Margaret stated ‘…as far as my nurse
education is concerned Roper, Logan and Tierney was the be
all and end all and then to find out that you hadn’t even been
doing that right made me feel really bad’. Thus models could
potentially diminish the practice of the nurse. Other subcat-
egories continued to develop and reflect the view that the
Paperwork and a Care Plan was an important part of being
able to see a model working and put it into practice: ‘…it
(book) showed the structure of the care plan which was quite
good because you could actually see it working’ (Belinda).
Third interviews
These interviews occurred up to 2 years after the end of the
educational programme. They were characterized by the
feature of models moving into the background and returning
to an external position in the mind of the participants.
Participants quickly moved any questions back to their own
reality and the major theme reflected a tenuous relationship
between Models and the Reality of Practice. The model was
incidental to practice although participants indicated an All
or Nothing whereby you either used a model or you didn’t.
As Marion indicated ‘In my opinion we use a systematic
approach and they’ve stuck Roper, Logan and Tierney on’,
that is, it was all and nothing. Uncertainty still existed as to
the whether you could have an adapted version of a model.
The Assessment and Documentation remained a key feature,
although this did not necessarily arise from or influence
nursing practice. It appeared to be an organizational or
communication tool: ‘when I see models, I see documenta-
tion’ (Alice). Therefore, being able to see Relevance at this
stage often meant relevance to others such as students,
neophytes or transient nurses rather than relevance to the
practitioner who was using it. Differences were noted
between Thinking and Doing. Whilst the overwhelming view
was that models were tools for use there was a tentative
acknowledgement that they could also be tools for thought.
‘…it’s (the model) got to fit in with the way you see
nursing…It makes the doing part easier because it comes
naturally’(Jane). The relationship between these two elements
would seem to be crucial but they were rarely considered in
conjunction. It is the linkage between the conceptual map of
the nurse and the model that often appeared to be missing.
Emerging theory – a typology of models
The summary of data described above indicates that the
phenomenon of nursing models often remained tangential
and external to the participant and their nursing practice.
Therefore, it is proposed that the use of the term nursing
Nursing theory and concept development or analysis
MENTAL
MODEL
TYPE
SURROGATE
MODEL TYPE
THEORETICAL
MODEL TYPE
Figure 1 Model typology.
model or model of nursing is insufficient to describe the
perspectives and varieties of model that exist. The data
supports a linked, three model typology (Figure 1). That is, a
Theoretical model (theorists conceptualization), a Surrogate
model (functional representation) and a Mental model
(personal pattern). It is the relationships between these three
types that is of particular importance from the results of this
study.
Theoretical model
The theoretical model is that which could be defined as
abstract, general and developed, usually by one person,
through inductive and deductive approaches and presented as
a potential picture of the reality of nursing. There are then
competing models, depending on the theorists standpoint.
This accords with Kuhn’s (1970) use of the term model,
which he indicates provides a permissible analogy or meta-
phor. Models are potential aids to problem solving within a
paradigm, rather than the paradigm itself (see also Robinson
1993). They are there to challenge nurses’ ideas and concepts
rather than as tools to be used directly in practice.
Mental model
The mental model is the personal pattern or schema of the
individual nurse, built through personal experience and
knowledge and represented in the way nursing is described by
the individual. There are many factors that relate to the
development of the mental model. However, it is axiomatic
and imperative to the development of model based practice.
Polanyi’s (1958) seminal work perhaps best characterizes the
central place of the person in knowledge development and
use. However, there often exists an uncertainty as to the

2002 Blackwell Science Ltd, Journal of Advanced Nursing, 40(3), 346–354
The meaning of models of nursing
completeness or correctness of such personal knowledge
(Norman 1983) and it is duly acknowledged that the mental
model of the nurse may be influenced by knowledge and
experience which could be detrimental to patient care. It is
also influenced by the occupational socialization that occurs
through exposure to clinical practice (Melia 1987).
Surrogate model
The surrogate model is a functional version of the theoretical
model. It is used as a guide in the clinical area and represents
a framework or structure around which nurses can collect
data, communicate and through which the organization can
standardize and audit practice(s). The use of a model could
then be identified solely with this functional type irrespective
of its involvement with the mental or theoretical model types.
Many such ‘usages’ can be seen in case studies and care plans
(for example in Fraser 1996, Alligood & Marriner-Tomey
1997) where the documentation is central, acting as a guide, a
systematic way of gathering relevant information. The wri-
ting that accompanies many case studies may not be con-
gruent with the theoretical model but more of a reflection of
the mental model of the author.
Discussion
The results of the study must be considered carefully as
changes in nursing education and practice may have super-
seded the results obtained in mid-1990s Scotland. The delay
is inexcusable in research terms but the commitment of part-
time PhD work can militate against early publication. It is
also contended that the work remains relevant as models are
still a feature of education and practice, although the level of
overt activity has, it is acknowledged, reduced in the United
Kingdom (UK).
The results from this research strongly suggest nevertheless,
that in many cases the theoretical model is put into use
through a surrogate version. The mental model of the nurse is
incidental. For many nurses the discovery that the theoretical
model is more than the surrogate model may actually
diminish, rather than strengthen their mental model. Discus-
sion and writings on nursing models fail to distinguish
between model types and so when, for example, the term
‘model use’ is raised it is difficult to know to which type it is
referring. For example, McKenna (1994b) might be accepting
a surrogate version when he wanted to see practitioners using
models in practice through examining documentation.
Whereas his investigation would appear to be seeking to
address all three model types although it may be impossible
to see all three types in ward documentation, a factor also
highlighted by Murphy et al. (2000).
351
P. Wimpenny
Other factors are of concern. Model tenacity (based on
the work of Loehle 1987) where the outcome of model
choice may be due to the vigorousness of the proposers/
debaters as opposed to the validity of the model, even if
major flaws are evident in their arguments. This might be
seen in the many papers that present case studies using a
model of nursing, the result is invariably positive in nature.
Such model tenacity may have influenced the adoption of a
theoretical model into a surrogate version by ‘managers’ and
yet nurses will still not think or practice through the model.
Berger and Luckmann (1967) may view this as reification
and the potential outcome is that nurses and nursing models
may become divorced from each other. Nursing is pre-
scribed by others, it is an externally identified process rather
than an internally derived praxis.
If one nursing model is used to assist the practitioner to
think about and practise nursing, then a ‘mental set’ may
develop which closes off possible alternatives, Kristjanson
et al. (1987) call this conceptual closure. This may have the
effect of blinkering the nurse to believe that no other models
are appropriate, despite the possibility that other models may
enhance the nurse’s ability to deal with changes in particular
contexts of practice. However, this may also have a positive
result whereby the thinking and doing are connected and
co-ordinated within the clinical area. It is the relationship of
thinking and doing that is a central issue here as these are
often not aligned with the ‘model used in practice’, that is, the
surrogate version.
An additional concern is that raised by writers such as
Hardy (1986, 1988), who criticise models for their complex-
ity of language, formality and lack of rigorous testing. Luker
(1988, p. 158) adds to this when she states that ‘nursing
models as espoused by theorists and educators have made
little or no positive impact on the clinical practice of nurses’s.
This is not surprising if the theoretical model is introduced
solely through the surrogate version. Littlejohn (2002)
highlights, for this author, the type of confusion that then
ensues.
It is considered that testing nursing models in practice to
seek impact is unachievable. For example, if the theoretical
model is to be tested in practice and only the surrogate
version is considered, it is probably of little value. If the
testing is to be undertaken through the mental model of the
nurse how will this be confined to the constructs of one
theoretical model? Will testing be of the model or the
underpinning theoretical constructs on which it is based?
Nursing models may thus have more in common with
theories such as Freud, Marx and Adler, which Popper
(1972) argues cannot be tested, or refuted in any scientific
way.
352
2002 Blackwell Science Ltd, Journal of Advanced Nursing, 40(3), 346–354
Theoretical models may be more valuable as tools for
thought rather than tools for use. Walsh (1998) would appear
to accord with this view, when he contends that models offer ‘a
way of thinking about nursing’ (p. 26). If they were tools for
thought they could, in Giddens (1987) terms, be useful in
innovating and opening up new areas of thought and activity
but could not be tested to the extent that one theoretical model
may achieve greater empirical validation over another. Unfor-
tunately as Kaplan (1964) notes, models are often presented as
some final truth and defended as such with the result that they
attract pros and cons without examination of their worth or
limitations. Heath (1998), from a nursing perspective, high-
lights the dogma that surrounds models and practice.
Black (1962) also provides support to the views on models
being expressed in this paper. He associates strongly with the
view that models can be metaphors with the result that they
can become a ‘systematic repertoire of ideas’ (p. 142), as if
rather than as being. They can then be seen as heuristic
devices which contribute to the development of the nurse’s
mental model. Such development does not negate the need for
collective understandings in nursing, but does allow theoret-
ical models to act as fertile source for ideas and inventiveness
(Kaplan 1964). However, it must also be considered that such
collective understanding based on a theroretical model of
nursing may also limit a broader understanding of factors
that affect health (Pierson 1999).
Aggleton and Chalmers (2000) acknowledge that the
context for health and health care is now significantly
different and models are seen in a less restrictive way as
nurses are now more confident ‘to work creatively and
questioningly with the ideas embodied in a particular model’
(p. 10). Such creativity and questionning is essential if all
three model types are to move closer together. However,
there is still little evidence of this happening, for example,
Mason (1999) highlights the lack of connection between care
planning, theoretical models and nurses’ cognitive schemas.
Adoption or adaptation of theoretical models requires
better selection (Walker & Neuman 1996) and greater
facilitation and organizational input in the work place
(Archibald 2000). In addition, if nursing theory is to develop
greater integration with all domains of nursing (Parker 2001)
from the more general and abstract nursing model, then
considerably more attention needs to be placed on the
development of the nurse’s mental model. I contend that
considerable reorientation to nursing models needs to occur
to bring about such change, as they have become overly
associated with a surrogate model version. This version, if
introduced or implemented on its own, will lead nurses to use
it as a functional tool rather than as a means to develop
nursing (Thorne et al. 1998).
Nursing theory and concept development or analysis
Conclusion
Despite the limitations of this research it does identify
problems with the relationship between theoretical models
and practitioners’ practice. However, it is proposed that if the
theoretical, surrogate and mental models can be made explicit,
acknowledged and appropriately aligned then model-based
practice has a future and models of nursing will remain extant
and contribute to nursing’s development. If there is a continu-
ation of the assumption that theoretical models can be
introduced solely through a surrogate version, or are the
surrogate version, then they may already be considered extinct.
Acknowledgement
An earlier version of this paper was presented at the Second
European Nursing Theory Conference in Stockholm, Sweden,
May 2000.
References
Aggleton P. & Chalmers H. (1987) Models of nursing, nursing
practice and nurse education. Journal of Advanced Nursing 12,
573–581.
Aggleton P. & Chalmers H. (2000) Nursing Models and Nursing
Practice, 2nd edn. MacMilllan Press, Basingstoke, Hampshire.
Alligood M.R. & Marriner-Tomey A. (1997) Nursing Theory: Uti-
lization and Application. Mosby, St Louis, MO.
Archibald G. (2000) A post-modern nursing model. Nursing Stan-
dard 14, 40–42.
Berger P. & Luckman T. (1967) The Social Construction of Reality.
Penguin Books, London.
Biley F. (1992) Nursing models redundant in practice? British Journal
of Nursing 1, 219.
Black M. (1962) Models and Metaphors. Cornell University Press,
Ithaca, NY.
Botha M.E. (1989) Theory development in perspective: the role of
conceptual frameworks and models in theory development. Journal
of Advanced Nursing 14, 49–55.
Cash K. (1990) Nursing models and the idea of nursing. International
Journal of Nursing Studies 27, 249–256.
Christensen J. (1993) Nursing Partnership, a Model for Nursing
Practice. Churchill Livingstone, Edinburgh.
Creswell J. (1994) Research Design. Qualitative and Quantitative
Approaches. Sage, Thousand Oaks, California.
Fraser M. (1996) Conceptual Nursing in Practice, 2nd edn.
Chapman & Hall, London.
Giddens A. (1987) Social Theory and Modern Sociology. Polity Press,
Cambridge.
Glaser B.G. & Strauss A.L. (1967) The Discovery of Grounded
Theory: Strategies for Qualitative Research, Weidenfeld and
Nicolson, London.
Griffiths P. (1998) An investigation into the description of patients’
problems by nurses using two different needs-based nursing mod-
els. Journal of Advanced Nursing 28, 969–977.

2002 Blackwell Science Ltd, Journal of Advanced Nursing, 40(3), 346–354
The meaning of models of nursing
Hardy L.K. (1986) Identifying the place of theoretical frameworks
in an evolving discipline. Journal of Advanced Nursing 11, 103–
107.
Hardy L.K. (1988) Excellence in nursing through debate: the case of
nursing theory. Recent Advances in Nursing 21, 1–13.
Heath H. (1998) Paradigm dialogues and dogma: finding a place for
research, nursing models and reflective practice. Journal of
Advanced Nursing 28, 288–294.
Holmes C.A. (1990) Alternatives to natural science foundations for
nursing. International Journal of Nursing Studies 27, 187–198.
Huberman A.B. & Miles M.B. (1998) Data management and analysis
methods. In Collecting and Interpreting Qualitative Materials
(Denzin N.K. & Lincoln Y.S., eds). Sage, Thousand Oaks,
California.
Johns C. (ed.) (1994) The Burford NDU Model: Caring in Practice.
Blackwell Science, Oxford.
Kaplan A. (1964) The Conduct of Inquiry, Methodology for Beha-
vioural Science. Chandler, San Francisco.
Kristjanson L.J., Tamblyn R. & Kuypers J.A. (1987) A model to
guide development and application of multiple nursing theories.
Journal of Advanced Nursing 12, 523–529.
Kuhn T.S. (1970) The Structure of Scientific Revolutions, 2nd edn.
University of Chicago Press, Chicago.
Kvale S. (1996) Interviews: An Introduction to Qualitative Research
Interviewing. Sage, Thousand Oaks, California.
Littlejohn C. (2002) Are nursing models to blame for low morale?
Nursing Standard 16, 39–41.
Loehle C. (1987) Hypothesis testing in ecology: psychological aspects
and the importance of theory maturation. Quarterly Review of
Biology 62, 397–409.
Luker K. (1988) Debate 1: This house believes that nursing models
provide a useful tool in the management of patient care. In Cancer
Nursing: a Revolution in Care (Pritchard P. ed.) Proceedings of the
5th International Conference on Cancer Nursing. MacMillan,
London, pp. 154–159.
Mason C. (1999) Guide to practice or ‘load of rubbish’? The
influence of care plans on nursing practice in five clinical
areas in Northern Ireland. Journal of Advanced Nursing 29,
380–387.
McFarlane J.K. (1977) Developing a theory of nursing: the rela-
tionship of theory to practice, education and research. Journal of
Advanced Nursing 2, 261–270.
McFarlane J.K. (1985) Contemporary challenges in education for the
caring professions: education for nursing, midwifery and health
visiting. British Medical Journal 291, 268–271.
McKenna H.P. (1989) The selection by ward managers of an
appropriate nursing model for long-stay psychiatric care. Journal
of Advanced Nursing 14, 762–775.
McKenna H.P. (1994a) The attitudes of traditional and undergra-
duate student nurses towards nursing models: a comparative sur-
vey. Journal of Advanced Nursing 19, 527–536.
McKenna H.P. (1994b) Nursing Theories and Quality of Care.
Avebury, Aldershot.
Melia K.M. (1987) Learning and Working: the Occupational Soci-
alisation of Nurses. Tavistock, London.
Mischler E. (1986) Research Interviewing. Harvard University Press,
Cambridge, MA.
353
P. Wimpenny
Morse J. (1991) Qualitative Research: A Contemporary Dialogue.
Sage, Newbury Park, California.
Murphy K., Cooney A., Casey D., Conner M., O’Conner J. & Dineen
B. (2000) The Roper, Logan and Tierney (1996) model: percep-
tions and operationalization of the model in psychiatric nursing
within a Health Board in Ireland. Journal of Advanced Nursing 31,
1333–1341.
Newton C. (1991) The Roper-Logan-Tierney Model in Action.
MacMillan, Houndmills, Basingstoke.
Norman D.A. (1983) Some observations on mental models. In
Mental Models (Gentner D. & Stevens A.L., eds). Lawrence
Erlbaum Associates, Hillsdale, New Jersey.
Ormerod J.A. (1994) An Exploration of the Roper, Logan and
Tierney Model of Nursing in Practice in an Acute Medical Ward:
An Action Research Approach. Unpublished BA Dissertation. The
Robert Gordon University, Aberdeen.
Parker M. (2001) Nursing Theories and Nursing Practice. FA Davis,
Philadelphia.
Pearson A. (1992) Nursing at Burford: a Story of Change. Scutari
Press, Harrow, Middlesex.
Pearson A., Vaughan B. & Fitzgerald M. (1996) Nursing Models for
Practice, 2nd edn. Butterworth-Heinemann, Oxford.
Pierson W. (1999) Considering the nature of intersubjectivity within
professional nursing. Journal of Advanced Nursing 30, 294–302.
Polanyi M. (1958) Personal Knowledge. Towards a Post-critical
Philosophy. Routledge and Kegan Paul, London.
354
2002 Blackwell Science Ltd, Journal of Advanced Nursing, 40(3), 346–354
Popper K.R. (1972) Conjecture and Refutations: the Growth of
Scientific Knowledge, 4th edn. Routledge and Kegan Paul, London.
Robinson J. (1993) Problems with paradigms in a caring profession.
In Nursing Art and Science (Kitson A ed.), Chapman & Hall,
London, pp. 72–84.
Roper N., Logan W. & Tierney A. (1980) The Elements of Nursing.
Churchill Livingstone, Edinburgh.
Roper N., Logan W. & Tierney A. (1985) The Elements of Nursing,
2nd edn. Churchill Livingstone, Edinburgh.
Roper N., Logan W. & Tierney A. (2000) The Roper Logan and
Tierney Model of Nursing. Churchill Livingstone, Edinburgh.
Seidman I.E. (1991) Interviewing as Qualitative Research. Teachers
College Press, New York.
Thorne S., Canam C., Dahinten S., Hall W., Henderson A. &
Kirkham S.R. (1998) Nursing’s metaparadigm concepts: disim-
pacting the debates. Journal of Advanced Nursing 27, 1257–1268.
Tierney A. (1998) Nursing models: extant or extinct? Journal of
Advanced Nursing 28, 77–86.
Walker P.H. & Neuman B. (eds) (1996) Blueprint Fo Use of Nursing
Models: Education, Research, Practice and Administration. NLN,
New York.
Walsh M. (1998) Models and Critical Pathways in Clinical Nursing,
Conceptual Frameworks for Care Planning, 2nd edn. Bailliere
Tindall, London.
Wright S. (1986) Building and Using a Model of Nursing. Edward
Arnold, London.