Nursing Theorists

1. Florence Nightingale - Environment theory

2. Hildegard Peplau - Interpersonal theory
3. Virginia Henderson - Need Theory
4. Fay Abdella - Twenty One Nursing Problems
5. Ida Jean Orlando - Nursing Process theory
6. Dorothy Johnson - System model
7. Martha Rogers -Unitary Human beings
8. Dorothea Orem - Self-care theory
9. Imogene King - Goal Attainment theory
10. Betty Neuman - System model
11. Sister Calista Roy - Adaptation theory
12. Jean Watson - Philosophy and Caring Model
13. Madeleine Leininger -Transcultural nursing
14. Patricia Benner - From Novice to Expert
15. Lydia E. Hall - The Core, Care and Cure
16. Joyce Travelbee - Human-To-Human Relationship Model
17. Margaret Newman - Health As Expanding Consciousness
18. Katharine Kolcaba - Comfort Theory
19. Rosemarie Rizzo Parse - Human Becoming Theory
20. Ernestine Wiedenbach - The Helping Art of Clinical Nursing 

1. Florence Nightingale- Environmental Theory

 First nursing theorist

 Unsanitary conditions posed health hazard (Notes on Nursing, 1859)
 5 components of environment
o ventilation, light, warmth, effluvia, noise

 External influences can prevent, suppress or contribute to disease or death

Nightingale’s Concepts

1. Person

 Patient who is acted on by nurse

 Affected by environment
 Has reparative powers

2. Environment

 Foundation of theory. Included everything, physical, psychological, and social

3. Health

 Maintaining well-being by using a person’s powers

 Maintained by control of environment

4. Nursing

 Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate person’s reparative
process

2. Hildegard Peplau -Interpersonal Relations Model

 Based on psychodynamic nursing

 using an understanding of one’s own behavior to help others identify their difficulties
 Applies principles of human relations
 Patient has a felt need

Peplau’s Concepts

1. Person

 An individual; a developing organism who tries to reduce anxiety caused by needs

 Lives in instable equilibrium

2. Environment

 Not defined

3. Health

 Implies forward movement of the personality and human processes toward creative,
constructive, productive, personal, and community living
4. Nursing

 A significant, therapeutic, interpersonal process that functions cooperatively with others

to make health possible
 Involves problem-solving

3. Virginia Henderson -The Nature of Nursing

"The unique function of the nurse is to assist the individual, sick or well, in the performance of
those activities contributing to health or its recovery (or to peaceful death) that he would perform
unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to
help him gain independence as rapidly as possible. She must in a sense, get inside the skin of
each of her patients in order to know what he needs".

4. Fay Abdella- Topology of 21 Nursing Problems

 A list of 21 nursing problems

 Condition presented or faced by the patient or family.
 Problems are in 3 categories
o physical, social and emotional

 The nurse must be a good problem solver

Abdella’s Concepts

1. Nursing

 A helping profession
 A comprehensive service to meet patient’s needs
 Increases or restores self-help ability
 Uses 21 problems to guide nursing care

2. Health

 Excludes illness
 No unmet needs and no actual or anticipated impairments

3. Person

 One who has physical, emotional, or social needs

 The recipient of nursing care.

4. Environment
  Did not discuss much
 Includes room, home, and community

5. Ida Jean Orlando- Deliberative Nursing Process

 The deliberative nursing process is set in motion by the patient’s behavior

 All behavior may represent a cry for help. Patient’s behavior can be verbal or non-verbal.
 The nurse reacts to patient’s behavior and forms basis for determining nurse’s acts.
 Perception, thought, feeling
 Nurses’ actions should be deliberative, rather than automatic
 Deliberative actions explore the meaning and relevance of an action.

6. Dorothy Johnson-Behavioral Systems Model

 The person is a behavioral system comprised of a set of organized, interactive,

interdependent, and integrated subsystems
 Constancy is maintained through biological, psychological, and sociological factors.
 A steady state is maintained through adjusting and adapting to internal and external
forces.

Johnson’s 7 Subsystems

Affiliative subsystem

 social bonds

Dependency

 helping or nuturing

Ingestive

 food intake

Eliminative

 excretion

Sexual

 procreation and gratification

Aggressive
  self-protection and preservation

Achievement

 efforts to gain mastery and control

Johnson’s Concepts

1. Person

 A behavioral system comprised of subsystems constantly trying to maintain a steady state

2. Environment

 Not specifically defined but does say there is an internal and external environment

3. Health

 Balance and stability.

4. Nursing

 External regulatory force that is indicated only when there is instability.

7. Martha Rogers -Unitary Human Beings

 Energy fields
 Fundamental unity of things that are unique, dynamic, open, and infinite
 Unitary man and environmental field

Universe of open systems

 Energy fields are open, infinite, and interactive

Pattern

 Characteristic of energy field

 A wave that changes, becomes complex and diverse

Pandimensionality

 A nonlinear domain with out time or space

Roger’s Definitions
Integrality

 Continuous and mutual interaction between man and environment

Resonancy

 Continuous change longer to shorter wave patterns in human and environmental fields

Helicy

 Continuous, probabilistic, increasing diversity of the human and envrionmental fields.

 Characterized by nonrepeating rhymicities
 Change

8. Dorothea Orem- Self-Care Model

 Self-care comprises those activities performed independently by an individual to promote

and maintain person well-being
 Self care agency is the individual’s ability to perform self care activities
 Self- care deficit occurs when the person cannot carry out self-care
 The nurse then meets the self-care needs by acting or doing for; guiding, teaching,
supporting or providing the environment to promote patient’s ability
 Wholly compensatory nursing system-Patient dependent
 Partially compensatory- Patient can meet some needs but needs nursing assistance
 Supportive educative-Patient can meet self care requisites, but needs assistance with
decision making or knowledge

9. Imogene King-Goal Attainment Theory

 Open systems framework

 Human beings are open systems in constant interaction with the environment
 Personal System
o individual; perception, self, growth, development, time space, body image

o Interpersonal

o Society

 Personal System
o Individual; perception, self, growth, development, time space, body image
  Interpersonal
o Socialization; interaction, communication and transaction

 Society
o Family, religious groups, schools, work, peers

 The nurse and patient mutually communicate, establish goals and take action to attain
goals
 Each individual brings a different set of values, ideas, attitudes, perceptions to exchange

10. Betty Neuman - Health Care Systems Model

 The person is a complete system, with interrelated parts

 maintains balance and harmony between internal and external environment by adjusting
to stress and defending against tension-producing stimuli
 Focuses on stress and stress reduction
 Primarily concerned with effects of stress on health
 Stressors are any forces that alter the system’s stability
 Flexible lines of resistance - Surround basic core
 Internal factors that help defend against stressors
 Normal line of resistance -  Normal adaptation state
 Flexible line of defense - Protective barrier, changing, affected by variables
 Wellness is equilibrium

Nursing interventions are activates to:

 strengthen flexible lines of defense

 strengthen resistance to stressors
 maintain adaptation

11. Sister Calista Roy - Adaptation Model

Five Interrelated Essential Elements

1. Patiency- The person receiving care

2. Goal of nursing- Adapting to change
3. Health-Being and becoming a whole person
 4. Environment
5. Direction of nursing activities- Facilitating adaptation

 The person is an open adaptive system with input (stimuli), who adapts by processes or
control mechanisms (throughput)
 The output can be either adaptive responses or ineffective responses

12. Jean Watson - Philosophy and Science of Caring

 Caring can be demonstrated and practiced

 Caring consists of carative factors
 Caring promotes growth
 A caring environment accepts a person as he is and looks to what the person may become
 A caring environment offers development of potential
 Caring promotes health better than curing
 Caring is central to nursing

Watson’s 10 Carative Factors

 Forming humanistic-altruistic value system

 Instilling faith-hope
 Cultivating sensitivity to self and others
 Developing helping-trust relationship
 Promoting expression of feelings
 Using problem-solving for decision making
 Promoting teaching-learning
 Promoting supportive environment
 Assisting with gratification of human needs
 Allowing for existential-phenomenological forces

Watson’s Concepts

 Person
o Human being to be valued, cared for, respected, nurtured, understood and assisted

 Environment
 o Society

 Health
o Complete physical, mental and social well-being and functioning

 Nursing
o Concerned with promoting and restoring health, preventing illness

13. Rosemary Parse - Human Becoming Theory

 Human Becoming Theory includes Totality Paradigm

o Man is a combination of biological, psychological, sociological and spiritual
factors
 Simultaneity Paradigm
o Man is a unitary being in continuous, mutual interaction with environment

 Originally Man-Living-Health Theory

Parse’s Three Principles

 Meaning
o Man’s reality is given meaning through lived experiences

o Man and environment cocreate

 Rhythmicity
o Man and environment cocreate ( imaging, valuing, languaging) in rhythmical
patterns
 Cotranscendence
o Refers to reaching out and beyond the limits that a person sets

o One constantly transforms

 Person
o Open being who is more than and different from the sum of the parts

 Environment
o Everything in the person and his experiences

o Inseparable, complimentary to and evolving with

 Health
 o Open process of being and becoming. Involves synthesis of values

 Nursing
o A human science and art that uses an abstract body of knowledge to serve people

14. Madeleine Leininger - Culture Care Diversity and Universality

 According to transcultural nursing, the goal of nursing care is to provide care congruent
with cultural values, beliefs, and practices
 Sunrise model consists of 4 levels that provide a base of knowledge for delivering
cultural congruent care.
 Cultural care preservation
o help maintain or preserve health, recover from illness, or face death

 Cultural care accommodation

o help adapt to or negotiate for a beneficial health status, or face death

 Cultural care re-patterning

o help restructure or change lifestyles that are culturally meaningful

15. Patricia Benner - From Novice to Expert

 Described 5 levels of nursing experience and developed exemplars and paradigm cases to
illustrate each level

1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert

 Levels reflect:
o movement from reliance on past abstract principles to the use of past concrete
experience as paradigms
o change in perception of situation as a complete whole in which certain parts are
relevant

16. Lydia E. Hall - The Core, Care and Cure

  The theory contains of three independent but interconnected circles:
1. the core,
2. the care and
3. the cure
 The core is the person or patient to whom nursing care is directed and needed. The core
has goals set by himself and not by any other person. The core behaved according to his
feelings, and value system.
 The care circle explains the role of nurse
 The cure is the attention given to patients by the medical professionals.

Reference

1. Bordage, G. Conceptual frameworks to illuminate and magnify. Medical

Education. 2009;43;312-319.
2. Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby, 
Philadelphia, 2002.
3. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.).  Mosby, 
Philadelphia, 2002.
4. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed.
Norwalk, Appleton and Lange.
5. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia.
Lippincott Williamsand wilkins.
6. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development and Progress 3rd ed.
Philadelphia, Lippincott.
7. Taylor Carol,Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed.
Philadelphia, Lippincott.
8. Potter A Patricia, Perry G Anne (1992)Fundamentals Of Nursing –Concepts Process and
Practice 3rd ed. London Mosby Year Book.

Introduction to Nursing Theories

This page was last updated on October 14, 2011

INTRODUCTION
  Nursing theory is the term given to the body of knowledge that is used to support nursing
practice.
 Nursing theory is a framework designed to organize knowledge and explain phenomena
in nursing, at a more concrete and specific level
 Each discipline has a unique focus for knowledge development that directs its inquiry and
distinguishes it from other fields of study.(Smith & Liehr, 2008).
 Theory-guided, evidence-based practice is the hallmark of any professional discipline.
 Nursing is a professional discipline (Donaldson & Crowley, 1978).
 Almost 90% of all Nursing theories are generated in the last 20 years. 
 Nursing models are conceptual models, constructed of theories and concepts
 A paradigm is a model that explains the linkages of science, philosophy, and theory
accepted and applied by the discipline.

METAPARADIGMS IN NURSING

Person

 Recipient of care, including physical, spiritual, psychological, and sociocultural

components.
 Individual, family, or community

Environment

 All internal and external conditions, circumstances, and influences affecting the person

Health

 Degree of wellness or illness experienced by the person

Nursing

 Actions, characteristics and attributes of person giving care

COMPONENTS OF A THEORY

 A theory is a group of related concepts that propose action that guide practice.
 A nursing theory is a set of concepts, definitions, relationships, and assumptions or
propositions derived from nursing models or from other disciplines and project a
purposive, systematic view of phenomena by designing specific inter-relationships
among concepts for the purposes of describing, explaining, predicting, and /or
prescribing..
  Based on the knowledge structure levels the theoretical works in nursing can be
explained as:

o Metaparadigm (Person, Environment, Health & Nursing) – (Most abstract)

o Nursing philosophies.

o Conceptual models and Grand theories.

o Nursing theories and Middle range theories (Least abstract)

DEFINITIONS

Theory

 a set of related statements that describes or explains phenomena in a systematic way.

 the doctrine or the principles underlying an art as distinguished from the practice of that
particular art.
  a formulated hypothesis or, loosely speaking, any hypothesis or opinion not based upon
actual knowledge.
  a provisional statement or set of explanatory propositions that purports to account for or
characterize some phenomenon.

Concept

 a mental idea of a phenomenon

 Concepts are the building blocks—the primary elements—of a theory.

Construct

 a phenomena that cannot be observed and must be inferred

 Constructs are concepts developed or adopted for use in a particular theory. The key
concepts of a given theory are its constructs.

Proposition

 a statement of relationship between concepts

Conceptual model

 made up of concepts and propositions

 They epresent ways of thinking about a problem or ways of representing how complex
things work the way that they do.
 Different Frameworks will emphasize different variables and outcomes and their
interrelatedness.( Bordage, 2009)
  Models may draw on a number of theories to help understand a particular problem in a
certain setting or context. They are not always as specified as theory.

Variables

 Variables are the operational forms of constructs. They define the way a construct is to be
measured in a specific situation.
 Match variables to constructs when identifying what needs to be assessed during
evaluation of a theory-driven program.

Middle range theory

  a testable theory that contains a limited number of variables, and is limited in scope as well, yet
is of sufficient generality to be useful with a variety of clinical research questions.

NURSING PHILOSOPHIES
Theory Key emphasis
Florence Nightingale’s Legacy of Focuses on nursing and the patient environment relationship.
caring
Helping process meets needs through the art of individualizing
care.
Nurses should identify patients ‘need-for –help’ by:

Ernestine Wiedenbach: The  Observation

helping art of clinical nursing   Understanding client behaviour
 Identifying cause of discomfort

Determining if clients can resolve problems or have a

need for help
Virginia Henderson’s   Definition Patients require help towards achieving independence.
of Nursing Derived a definition of nursing

Identified 14 basic human needs on which nursing care is

based. 
Faye G.Abedellah’s Typology of Patient’s problems determine nursing care
twenty one Nursing problems 
Lydia E. Hall :Care, Cure, Core Nursing care is person directed towards self love.
model
Jean Watson’s Philosophy and Caring is moral ideal: mind -body – soul engagement with one
Science of caring and other.
Caring is a universal, social phenomenon that is only effective
when practiced interpersonally considering humanistic aspects
and caring.
Patricia Benner’s Primacy of
caring
CONCEPTUAL MODELS AND GRAND
THEORIES
Dorothea E. Orem’s Self care
deficit theory in nursing
Myra Estrin Levine’s: The
conservation model
Caring is central to the essence of nursing.  It sets up what
matters, enabling connection and concern.  It creates
possibility for mutual helpfulness.
Caring creates - possibilities of coping possibilities for
connecting with and concern for others, possibilities for giving
and receiving help
Described systematically five stages of skill acquisition in
nursing practice – novice, advanced beginner, competent,
proficient and expert.
Self–care maintains wholeness.
Three Theories:
 Theory of Self-Care
 Theory of Self-Care Deficit
 Theory of Nursing Systems
Nursing Care:
 Wholly compensatory (doing for the patient)
 Partly compensatory (helping the patient do for himself
or herself)
 Supportive- educative (Helping patient to learn self
care and emphasizing  on the importance of  nurses’
role
Holism is maintained by conserving integrity
Proposed that the nurses use the principles of conservation of:
 Client Energy
 Personal integrity
 Structural integrity
 Social integrity
A conceptual model with three nursing theories –

Martha E.Roger’s: Science of
unitary  human beings
Dorothy E.Johnson’s Behavioural Individuals maintain stability and balance through adjustments
system model  and adaptation to the forces that impinges them.
Sister Callista: Roy‘s  Adaptation Stimuli disrupt an adaptive system
model
Betty Neuman’s : Health care
systems model
 Conservation
 Redundancy
 Therapeutic intention
 Person and environment are energy fields that evolve
negentropically
 Nursing is a basic scientific discipline
 Nursing is using knowledge for human
betterment.                 
The unique focus of nursing is on the unitary or
irreducible  human being and the environment (both are
energy fields) rather than health and illness
Individual as a behavioural system is composed of seven
subsystems.
Attachment, or the affiliative subsystems – is the corner stone
of social organisations.                                
Behavioural system also includes the subsystems of
dependency, achievement, aggressive, ingestive-eliminative
and sexual.                                                         
Disturbances in these causes nursing problems. 
The individual is a biopsychosocial adaptive system within an
environment.
The individual and the environment provide three classes of
stimuli-the focal, residual and contextual.                                   
Through two adaptive mechanisms, regulator and cognator, an
individual demonstrates adaptive responses or ineffective
responses requiring nursing interventions 
Reconstitution is a status of adaptation to stressors
A conceptual model with two theories “Optimal patient
stability and prevention as intervention”
Neuman’s model includes intrapersonal, interpersonal and
 extrapersonal stressors.

Nursing is concerned with the whole person.  

Nursing actions (Primary, Secondary, and Tertiary levels of

prevention) focuses on the variables affecting the client’s
response to stressors.
Imogene King’s Goal attainment Transactions provide a frame of reference toward goal setting.
theory
A conceptual model of nursing from which theory of goal
attainment is derived.

From her major concepts (interaction, perception,

communication, transaction, role, stress, growth and
development) derived goal attainment theory. 

·Perceptions, Judgments and actions of the patient and the

Nancy Roper, WW.Logan and
A.J.Tierney    A model for
nursing based on a model of
living
nurse lead to reaction, interaction, and transaction (Process of
nursing).
Individuality in living.
A conceptual model of nursing from which theory of goal
attainment is derived.

Living is an amalgam of activities of living (ALs). 

Most individuals experience significant life events which can

affect ALs causing actual and potential problems.

This affects dependence – independence continuum which is

bi-directional.

Nursing helps to maintain the individuality of person by

Hildegard E. Peplau:
Psychodynamic Nursing Theory
preventing potential problems, solving actual problems and
helping to cope.
Interpersonal process is maturing force for personality.
Stressed the importance of nurses’ ability to understand own
behaviour to help others identify perceived difficulties.

The four phases of nurse-patient relationships are:

 1. Orientation

Ida Jean Orlando’s Nursing
Process Theory
Joyce Travelbee’s Human To
Human Relationship Model
Kathryn E. Barnard’s Parent
Child Interaction Model
 2. Identification
 3. Exploitations
 4. Resolution
The six nursing roles are:
 1. Stranger
 2. Resource person
 3. Teacher
 4. Leader
 5. Surrogate
 6. Counselor
Interpersonal process alleviates distress.
Nurses must stay connected to patients and assure that patients
get what they need, focused on patient’s verbal and non verbal
expressions of need and nurse’s reactions to patient’s
behaviour to alleviate distress.
Elements of nursing situation:   
1. Patient
2. Nurse reactions
3. Nursing actions
Therapeutic human relationships.
Nursing is accomplished through human to human
relationships that began with: The original encounter and then
progressed through stages of
Emerging identities
Developing feelings of empathy and sympathy, until the nurse
and patient attained rapport in the final stage.
Growth and development of children and mother–infant 
relationships
Individual characteristics of each member influence the
parent–infant system and adaptive behaviour modifies those
characteristics to meet the needs of the system.
Ramona T.Mercer’s :Maternal
Role Attainment
Katharine Kolcaba’s Theory of
comfort
Parenting and maternal role attainment in diverse populations
A complex theory to explain the factors impacting the
development of maternal role over time. 
Comfort is desirable holistic outcome of care.
Health care needs are needs for comfort, arising from stressful
health care situations that cannot be met by recipients’
traditional support system. 

These needs include physical, psycho spiritual, social and

environmental needs.                                             

Comfort measures include those nursing interventions

designed to address the specific comfort needs.
Madeleine Leininger’s Caring is universal and varies transculturally.
Transcultural nursing, culture- Major concepts include care, caring, culture, cultural values
care theory and cultural variations

Caring serves to ameliorate or improve human conditions and

life base.

Care is the essence and the dominant, distinctive and unifying

feature of nursing
Rosemarie Rizzo Parse’s :Theory Indivisible beings and environment co-create health.
of human becoming
A theory of nursing derived from Roger’s conceptual model.

Clients are open, mutual and in constant interaction with

environment.

The nurse assists the client in interaction with the environment

Nola J.Pender’s :The Health
promotion; model
and co creating health
Promoting optimum health supersedes disease prevention.
Identifies cognitive, perceptual factors in clients  which are
modified by demographical and biological characteristics,
interpersonal influences, situational and behavioural factors
that help predict in health promoting behaviour

CONCLUSION

 The conceptual and theoretical nursing models help to provide knowledge to improve
practice, guide research and curriculum and identify the goals of nursing practice.
  Nursing knowledge is the inclusive total of the philosophies, theories, research, and
practice wisdom of the discipline.As a professional discipline this knowledge is important
for guiding practice.(Smith & Liehr, 2008).
 It is important the nursing knowledge is learnt, used, and applied in the theory based
practice for the profession and the continued development of nursing and academic
discipline.

REFERENCES

1. Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook,
26, 113–120.
2. Smith, M. J., & Liehr, P. R. (2008). Middle range theory for nursing. New York: Springer
Publishing.
3. George B. Julia , Nursing Theories- The base for professional Nursing Practice, 3rd ed.
Norwalk, Appleton & Lange.
4. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia.
Lippincott Williams& wilkins.
5. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed.
Philadelphia,  Lippincott.
6. Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed.
Philadelphia,  Lippincott.
7. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process &
Practice 3rd ed. London Mosby Year Book.
8.  Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.).  Mosby, 
Philadelphia, 2002
9.  Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby, 
Philadelphia, 2002.