4 Major Concepts of Nursing Theories:

I. Introduction to Nursing Theories

a. Person
Nursing is as varied as the people who
practice it, and is dynamic and diverse as a b. Health
kaleidoscope of ethnic, cultural and religious
manifestations of the people who receive nursing c. Environment
care. All nursing acts are geared towards
realizing and restoring the patient’s d. Nursing
biopsychospiritual well-being and assisting the
client to live a dignified and normal life. It is PERSON
important that nursing is grounded on accepted  Unique
scientific truths and principles in order to give  Open system with subsystems
safe and quality nursing care. Simply put, a  Motivated by needs
Nursing Theory strives to explain the Science  Capable of Adaption
and Art of Nursing.  Seeks Homeostasis
 Interacts with Environment
There is no single exact classification of
Nursing Theory in a given time, place, and HEALTH
setting. Nursing theorists regardless of  Dynamic
orientation, have tried to shed light to it in their  A continuum
own unique way. We Filipinos, as a unique  Holistic (Physical, emotional, spiritual,
nation and race, have our own interpretation of social and psychological)
Nursing, both as an art and a science. It can be  Affected by health beliefs and health
said then, that Filipino nurses do practice a behaviors
unique form of Nursing that is attune with the
Filipino spirit and culture. ENVIRONMENT
 Promotes of interferes with well-
Nursing Science, therefore, is a melting – being
pot of the different knowledge, creeds and  Physical environment
backgrounds of care and healing that has been  Non-Physical environment
collected and preserved since the dawn of time.
It is important for the nursing students to achieve NURSING
a simple and working knowledge of the concepts  Integrates concepts from person,
that make up a nursing theory, since ii is highly environment, and health to form a
dynamic and undergoes change, or evolution, as meaningful whole
new discoveries are made and information are  It is the diagnosis and treatment of
renewed from time to time ( Octaviano and human responses to actual or
Balita, 2008). potential health problems

Nursing is a dynamic discipline. It is

II. DEFINITION OF TERMS and an art and a science of caring for
STRUCTURES OF NURSING individuals, families, groups, and
KNOWLEDGE: communities geared toward promotion
and restoration of health, prevention of
□ CONCEPT: an idea, thought or notion illness, alleviation of suffering and
conceived in the mind; a general assisting clients to face death with
impression; building blocks of theories dignity and peace. It is focused on
which can either be an empirical or assisting the client as he or she
abstract data. responds to health- illness situations,
utilizing the nursing process and guided
Types of Concepts: by ethico -legal moral principles(
ADPCN- Association of Deans of the
 Abstract concepts are indirectly Philippine Colleges of Nursing)
observed or intangible. It is
independent of time and place.  PROPOSITION: explains the
Example: relationship of different concepts
Love, Care, Freedom, Hope
 DEFINITION: is composed of various
 Concrete Concepts are directly descriptions which convey a general
observed of tangible. meaning and reduces the vagueness
Example: in understanding a set of concepts
Nurse, Mother
  ASSUMPTIONS: are beliefs about
phenomena one must accept as true
 THEORY: is an organized system of
accepted knowledge that is
composed of concepts, propositions,
definitions and assumptions intended
to explain a set of fact, event or
phenomena.
Components of a theory
 Concept
 Definition
 Assumptions or
proposiitons
 Phenomenon
 PHENOMENA: are the designation
of an aspect of reality that can be
consciously sensed or experienced
Examples of Phenomena in
Nursing:
 Caring
 Nursing Care
 NURSING THEORY: is a group of
interrelated concepts or a compilation of data
that defines, describes, and logically relates
information that will explain past nursing
phenomena and predict future trends.
Theories provide a foundation for developing
models or frameworks for nursing practice.
 THEORETICAL MODELS OR
FRAMEWORKS: highly established set of
concepts that are testable; it is a structure of
concepts which has existed and tested in the
literature
 CONCEPTUAL FRAMEWORK OR
CONCEPTUAL MODEL : representation of a
body of knowledge based on the own
understanding or perception of a person or
researcher on a certain topic, phenomena, or
theory
 Also referred to as PARADIGMS
□ PARADIGM – a pattern or
a model; another term for
conceptual model
□ METAPARADIGM- core content of a
discipline, stated in the most global or
abstract terms
 Meta – “with”
 Paradigms – “Patterns”
A collective term used to denote four
concepts for Nursing ( Person, Environment,
Health, Nursing). These four major concepts
establish a better direction and
understanding of nursing profession.
 PRINCIPLE: fundamental truth, law,
doctrine, or motivating force upon which
others are based; a basic generalization
that is accepted as true and that can be
used as a basis for reasoning or
conduct
III. HISTORY AND DEVELOPMENT OF
NURSING THEORY AND PHILOSOPHY
OF SCIENCE
The history of professional nursing began with
Florence Nightingale. It was Nightingale who
envisioned nurses as a body of educated women
at a time when women were neither educated nor
employed in public service.
Nursing began with a strong emphasis on
practice, but throughout the century, nurses
worked toward the development of nursing as a
profession through successive periods
recognized as historical eras.
The curriculum era addressed the question of
what prospective nurses should study to learn
how to be a nurse. In this era, the emphasis was
on what courses nursing students should take,
with the goal of arriving at a standardized
curriculum. By the mid-1930s, a standardized
curriculum had been published. However, it was
also in this era that the idea of moving nursing
education from hospital-based diploma programs
into colleges and universities emerged.
As nurses increasingly sought degrees in higher
education, a research emphasis era, as it is
deemed, began to emerge. This era came about
as more and more nurses embraced higher
education and arrived at a common
understanding of the scientific age, that is, that
research is the path to new nursing knowledge.
The research era and the graduate education era
developed in tandem. Master’s degree programs
in nursing emerged to meet the public need for
nurses with specialized clinical nursing
education.
The theory era was a natural outgrowth of the
research and graduate education eras. As our
understanding of research and knowledge
development increased, it soon became obvious
that research without theory produced isolated
information, and that it was research and theory
together that produced nursing science. In the
early years of the theory era, doctoral education
in nursing flourished with an emphasis on theory
development.
In the theory utilization era, emphasis was placed
on middle range theory for theory- based nursing
practice, as well as on theory development.
Each era addressed nursing knowledge in a
unique way that contributed to and is observable
in the history of nursing. Within each era, the
pervading question “What is the nature of the
knowledge that is needed for the practice of
nursing?”
Nightingale’s (1859/1969) vision of nursing has
been practiced for more than a century, and
theory development in nursing has evolved
rapidly over the past 5 decades, leading to the
recognition of nursing as an academic discipline
with a substantive body of knowledge.
In the mid-1800s, Nightingale wrote that nursing
knowledge is distinct from medical knowledge.
She described a nurse’s proper function as
putting the patient in the best condition for nature
(God) to act upon him or her. She proposed that
care of the sick is based on knowledge of
persons and their surroundings—a different
knowledge base than that used by physicians in
their practice.
Until the emergence of nursing as a science in
the 1950s, nursing practice was based on
principles and traditions that had been passed on
through an apprenticeship model of education
and hospital-kept procedure manuals
Although some nursing leaders aspired for
nursing to be recognized as a profession and
become an academic discipline, nursing practice
continued to reflect its vocational heritage more
than a professional vision. The transition from
vocation to profession included successive eras
of history as nurses searched for a body of
substantive knowledge on which to base nursing
practice.
In the 1970s, nursing continued to make the
transition from vocation to profession as more
and more nurses asked, “Will nursing be other-
discipline based or be nursing based?”
The history records the answer, “Nursing practice
needs to be based on nursing science”. “theory is
not a luxury in the discipline of nursing ... but an
integral part of the nursing lexicon in education,
administration, and practice”
“Practice without theory, like map without route,
is blind; theory without practice, like route without
map, is empty. “
Highlight:
Nursing education has changed drastically since
the mid-1800s. Early apprenticeship programs
established in the 1800s were designed to meet
the service needs of the hospital, not educational
needs of the student.
Nursing Theories:
Florence Nigtingale
(1860/1969)
“Environmental Theory”
- defined nursing as “the act
of utilizing the environment
of the patient to assist him
in his recovery”
Linked health with five environmental factors:
1. Pure or fresh air
2. Pure water
3. Efficient drainage
4. Cleanliness
5. Light, especially direct sunlight

In the mid-1970s, an evaluation of the first 25

years of the journal Nursing Research revealed
that nursing studies lacked conceptual
connections and theoretical frameworks.

An awareness of the need for concept and theory

development coincided with two other significant
milestones in the evolution of nursing theory.

The nursing theory era, coupled with an

awareness of nursing as a profession and as an
academic discipline in its own right, emerged
from debates and discussions in the 1960s
regarding the proper direction and appropriate
discipline for nursing knowledge development.
Conceptual Framework of Nightingale’s Environmental problems. Abdellah’s 21 Nursing
Theory. Note that the client, the nurse, and the major
Problems are the following:
environment concepts are in balance; that is; the nurse
can manipulate the environment to compensate for the  To maintain good hygiene and physical
client’s response to it. The goal of the nurse is to assist comfort
the patient in staying in balance. If the environment of a  To promote optimal activity: exercise, rest,
client is out of balance, the client expends unnecessary
energy. sleep
 To promote safety through prevention of
accident, injury, or other trauma and
Deficiencies in these five factors produced lack through prevention of the spread of
or health or illness. infection
She also stated the importance of keeping
the client warm, maintaining a noise-free
environment, and attending to the client’s diet in
terms of assessing intake, timeless of the food,
and effect on the person.

Nightingale set the stage for further work

in the development of nursing theories. Her
general concepts were ventilation, cleanliness,
quiet, warmth, and diet remain integral parts of
nursing and health care today.

In this way, the model must be adapted to

fit the needs of individual patients. The
environmental factors affect different patients
unique to their situations and illnesses, and the
nurse must address these factors on a case-by-
case basis in order to make sure the factors are
altered in a way that best cares for an individual
patient and his or her needs.

Faye Abdellah

“21 Nursing Problems

Theory”

- Abdellah’s typology of 21
nursing problems is a
 To maintain good body mechanics and
conceptual model mainly
prevent and correct deformity
concerned with patient’s needs and the
 To facilitate the maintenance of a supply
role of nurses in problem identification
of oxygen to all body cells
using a problem analysis approach.
 To facilitate the maintenance of nutrition
for all body cells
According to Faye Glenn Abdellah’s
 To facilitate the maintenance of
theory, “Nursing is based on an art and
elimination
science that moulds the attitudes,
 To facilitate the maintenance of fluid and
intellectual competencies, and technical
electrolyte balance
skills of the individual nurse into the desire
 To recognize the physiologic responses of
and ability to help people, sick or well,
the body to disease conditions—
cope with their health needs.”
pathologic, physiologic, and
compensatory
The 21 nursing problems fall into three
 To facilitate the maintenance of regulatory
categories: physical, sociological, and
mechanisms and functions
emotional needs of patients; types of
 To facilitate the maintenance of sensory
interpersonal relationships between the
function
patient and nurse; and common elements
 To identify and accept positive and
of patient care. She used Henderson’s 14
negative expressions, feelings, and
basic human needs and nursing research
reactions
to establish the classification of nursing
  To identify and accept interrelatedness of
emotions and organic illness
 To facilitate the maintenance of effective
verbal and nonverbal communication
 To promote the development of
productive interpersonal relationships
 To facilitate progress toward achievement
and personal spiritual goals
 To create or maintain a therapeutic
environment
 To facilitate awareness of self as an
individual with varying physical,
emotional, and developmental needs
 To accept the optimum possible goals in
the light of limitations, physical and
emotional
 To use community resources as an aid in
resolving problems that arise from illness
 To understand the role of social problems
as influencing factors in the cause of
illness
Moreover, the needs of patients are further
divided into four categories: basic to all patients,
sustenal care needs, remedial care needs, and
restorative care needs.
Restorative Care Needs:
Abdellah’s work, which is based on the
problem-solving method, serves as a vehicle for
delineating nursing (patient) problems as the
patient moves toward a healthy outcome. The
theory identifies ten steps to identify the patient’s
problem and 11 nursing skills used to develop a
treatment typology.
The 11 nursing skills are:
1. observation of health status
2. skills of communication
3. application of knowledge
4. teaching of patients and families
5. planning and organization of work
6. use of resource materials
7. use of personnel resources
8. problem-solving
9. direction of work of others
10. therapeutic uses of the self
11. nursing procedure
Focus of Care Pendulum of Faye Abdellah’s
Theory. The nursing-centered orientation to client
care seems contrary to the client-centered
approach that Abdellah professes to uphold. The
apparent contradiction can be explained by her
desire to move away from a disease-centered
orientation. In her attempt to bring nursing
practice to its proper relationship with restorative
and preventive measures for meeting total client
needs, she seems to swing the pendulum to the
opposite pole, from the disease orientation to
nursing orientation, while leaving the client
somewhere in the middle.
Weakness of the Theory:
Framework seems to focus quite heavily
on nursing practice and individuals. This
somewhat limits the ability to generalize although
the problem-solving approach is readily
generalizable to clients with specific health needs
and specific nursing.
As a whole, the theory is intended to guide care
not just in the hospital setting, but can also be
applied to community nursing, as well. The model
has interrelated concepts of health and nursing
problems, as well as problem-solving, which is an
activity inherently logical in nature.
Hildegard Peplau
“Interpersonal Relations
Theory”
-Central to Peplau’s theory is
he use of a therapeutic
relationship between the
nurse and client. Continued
to be use when working with
individuals who have psychological problems.
Nurses enter into a personal relationship with an
individual when a need is present.
The nurse-client relationship evolves in four
phases:
1. Orientation – during this phase, the client
seeks help, and the nurse assists the
client to understand the problem and the
extent of the need for help.
 2. Identification – the client assumes a
posture of independence,
interdependence, or interdependence in
relation to the nurse. The nurse’s focus is
to assure a person that the nurse
understands the interpersonal meaning of
a client’s situation.
3. Exploitation – The client derives full
value from what the nurse offers through
the relationship. The client uses available
services based on self-interest and needs.
Power shifts from the nurse to the client.
4. Resolution – In this final phase, old
needs and goals are put aside and new
ones adopted. Once older needs are
resolved, newer and more mature ones
emerge.
To help the clients fulfill their needs, nurses
assume many roles: stranger, teacher,
resource person, surrogate, leader and
counselor.
Martha Rogers
“Science of Unitary
Human Beings”
Rogers’ theory defined
Nursing as “an art and
science that is humanistic
and humanitarian. It is
directed toward the
unitary human and is
concerned with the nature
and direction of human development. The goal of
nurses is to participate in the process of change.”
According to Rogers, the Science of
Unitary Human Beings contains two dimensions:
the science of nursing, which is the knowledge
specific to the field of nursing that comes from
scientific research; and the art of nursing, which
involves using the science of nursing creatively to
help better the life of the patient.
Major Concepts:
 Human-unitary human beings
A person is defined as an indivisible, pan-
dimensional energy field identified by a
pattern, and manifesting characteristics
specific to the whole, and that can’t be
predicted from knowledge of the parts. A
person is also a unified whole, having its
own distinct characteristics that can’t be
viewed by looking at, describing, or
summarizing the parts.
 Health
Rogers defines health as an expression of
the life process. It is the characteristics and
behavior coming from the mutual,
simultaneous interaction of the human and
environmental fields, and health and illness
are part of the same continuum. The
multiple events occurring during the life
process show the extent to which a person
is achieving his or her maximum health
potential.
 Nursing
It is the study of unitary, irreducible,
indivisible human and environmental fields:
people and their world. Rogers claims that
nursing exists to serve people, and the safe
practice of nursing depends on the nature
and amount of scientific nursing knowledge
the nurse brings to his or her practice.
 Scope of Nursing
Nursing aims to assist people in achieving
their maximum health potential.
Maintenance and promotion of health,
prevention of disease, nursing diagnosis,
intervention, and rehabilitation encompass
the scope of nursing’s goals.
 Environmental Field
“An irreducible, indivisible, pandimensional
energy field identified by pattern and
integral with the human field.”
 Energy Field
The energy field is the fundamental unit of
both the living and the non-living. It
provides a way to view people and the
environment as irreducible wholes. The
energy fields continuously vary in intensity,
density, and extent.
Subconcepts:
 Openness
 Pandimensional
 Pattern
 Principles of Homeodynamics
 Principle of Reciprocy
 Principle of synchrony
 Principle of Integrality
 Principle of Resonancy
 Principle of Helicy
The nursing process has three steps in Rogers’
Theory of Unitary Human
Beings: assessment, voluntary mutual
patterning, and evaluation.
The areas of assessment are: the total pattern of
events at any given point in space-time,
simultaneous states of the patient and his or her
environment, rhythms of the life process,
supplementary data, categorical disease entities,
subsystem pathology, and pattern appraisal. The
assessment should be a comprehensive
assessment of the human and environmental
fields.
Mutual patterning of the human and
environmental fields includes:
 sharing knowledge
 offering choices
 empowering the patient
 fostering patterning
 evaluation
 repeat pattern appraisal, which
includes nutrition, work/leisure
activities, wake/sleep cycles,
relationships, pain, and fear/hopes
 identify dissonance and harmony
 validate appraisal with the patient
 self-reflection for the patient
The Science of Unitary Human Beings is highly
generalizable as the concepts and ideas are not
confined with a specific nursing approach unlike
the usual way of other nurse theorists in defining
the major concepts of a theory.
Her statements, in general, made us believe that
a person and his or her environment are integral
to each other. That is, a patient can’t be
separated from his or her environment when
addressing health and treatment. Her conceptual
framework has greatly influenced all aspects of
nursing by offering an alternative to traditional
approaches of nursing.
Virginia Henderson
“Need Theory”
- The theory focuses on
the importance of
increasing the patient’s
independence to hasten
their progress in the
hospital. Henderson’s theory emphasizes on the
basic human needs and how nurses can assist in
meeting those needs.
Major Concepts of the Nursing Need Theory
 Individual - Henderson states that
individuals have basic needs that are
component of health and require
assistance to achieve health and
independence or a peaceful death.
According to her, an individual achieves
wholeness by maintaining physiological
and emotional balance. She defined the
patient as someone who needs nursing
care but did not limit nursing to illness
care. Her theory presented the patient as
a sum of parts with biopsychosocial needs
and the mind and body are inseparable
and interrelated.
 Environment - Although the Need Theory
did not explicitly define the environment,
Henderson stated that maintaining a
supportive environment conducive for
health is one of the elements of her 14
activities for client assistance.
Henderson’s theory supports the tasks of
the private and the public health sector or
agencies in keeping the people healthy.
She believes that society wants and
expects the nurse’s service of acting for
individuals who are unable to function
independently.
 Health - Although not explicitly defined in
Henderson’s theory, health was taken to
mean balance in all realms of human life.
It is equated with the independence or
ability to perform activities without any aid
in the 14 components or basic human
needs. Nurses, on the other hand, are key
persons in promoting health, prevention of
illness and being able to cure. According
to Henderson, good health is a challenge
because it is affected by numerous factors
such as age, cultural background,
emotional balance, and others.
 Nursing - Virginia Henderson wrote her
definition of nursing before the
development of theoretical nursing. She
defined nursing as “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 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.” The nurse’s goal is to make the
patient complete, whole, or independent.
In turn, the nurse collaborates with the
physician’s therapeutic plan. Nurses
 temporarily assist an individual who lacks
the necessary strength, will, and
knowledge to satisfy one or more of the
14 basic needs.
Application of the Need Theory
Henderson’s Needs Theory can be
applied to nursing practice as a way for
nurses to set goals based on Henderson’s 14
components. Meeting the goal of achieving
the 14 needs of the client can be a great
basis to further improve one’s performance
towards nursing care. In nursing research,
each of her 14 fundamental concepts can
serve as a basis for research although the
statements were not written in testable terms.
Betty Neuman
“Neuman Systems Model”
It focuses on the response
of the patient system to
actual or potential
environmental stressors and
the maintenance of the
client system’s stability
through primary, secondary, and tertiary nursing
prevention intervention to reduce stressors.
Betty Neuman describes the Neuman Systems
Model as “a unique, open-system-based
perspective that provides a unifying focus for
approaching a wide range of concerns. A system
acts as a boundary for a single client, a group, or
even a number of groups; it can also be defined
as a social issue. A client system in interaction
with the environment delineates the domain of
nursing concerns.”
The Neuman Systems Model views the client as
an open system that responds to stressors in the
environment. The client variables are
physiological, psychological, sociocultural,
developmental, and spiritual. The client system
consists of a basic or core structure that is
protected by lines of resistance. The usual level
of health is identified as the normal line of
defense that is protected by a flexible line of
defense. Stressors are intra-, inter-, and
extrapersonal in nature and arise from the
internal, external, and created environments.
When stressors break through the flexible line of
defense, the system is invaded and the lines of
resistance are activated and the system is
described as moving into illness on a wellness-
illness continuum. If adequate energy is
available, the system will be reconstituted with
the normal line of defense restored at, below, or
above its previous level.
Nursing interventions occur through three
prevention modalities. Primary
prevention occurs before the stressor invades
the system; secondary prevention occurs after
the system has reacted to an invading
stressor; tertiary prevention occurs after
secondary prevention as reconstitution is being
established.
 Primary prevention occurs before the
system reacts to a stressor; it
includes health promotion and
maintenance of wellness. Primary
prevention focuses on strengthening
the flexible line of defense through
preventing stress and reducing risk
factors. This intervention occurs when
the risk or hazard is identified but
before a reaction occurs. Strategies
that might be used include
immunization, health education,
exercise, and lifestyle changes.
 Secondary prevention occurs after
the system reacts to a stressor and is
provided in terms of existing
symptoms. Secondary prevention
focuses on strengthening the internal
lines of resistance and, thus, protects
the basic structure through appropriate
treatment of symptoms. The intent is to
regain optimal system stability and to
conserve energy in doing so. If
secondary prevention is unsuccessful
and reconstitution does not occur, the
basic structure will be unable to
support the system and its
interventions, and death will occur.
 Tertiary prevention occurs after the
system has been treated through
secondary prevention strategies. Its
purpose is to maintain wellness or
protect the client system reconstitution
through supporting existing strengths
and continuing to preserve energy.
Tertiary prevention may begin at any
point after system stability has begun
to be reestablished (reconstitution has
begun). Tertiary prevention tends to
lead back to primary prevention.
The delineation of Neuman’s three defense lines
were not clearly explained. In reality, the
individual resists stressors with internal and
external reflexes which were made complicated
with the formulation of different levels of
resistance in the open systems model of
Neuman.
Neuman made mention of energy sources in her
model as part of the basic structure. It can be
more of help when Neuman has enumerated all
sources of energy that she is pertaining to. With
such, new nursing interventions as to the
provision of needed energy of the client can be
conceptualized.
The holistic and comprehensive view of the client
system is associated with an open system.
Health and illness are presented on a continuum
with movement toward health described as
negentropic and toward illness as entropic. Her
use of the concept of entropy is inconsistent with
the characteristics of entropy which is closed,
rather than an open system.
Imogene King
“Theory of Goal Attainment”
focuses on this process to
guide and direct nurses in
the nurse-patient
relationship, going hand-in-
hand with their patients to meet the goals
towards good health.
King’s Theory of Goal Attainment was first
introduced in the 1960s. From the title itself, the
model focuses on the attainment of certain life
goals. It explains that the nurse and patient go
hand-in-hand in communicating information, set
goals together, and then take actions to achieve
those goals.
The Theory of Goal Attainment states
that “Nursing is a process of action, reaction and
interaction by which nurse and client share
information about their perception in a nursing
situation” and “a process of human interactions
between nurse and client whereby each
perceives the other and the situation, and
through communication, they set goals, explore
means, and agree on means to achieve goals.”
In this definition, the action is a sequence of
behaviors involving mental and physical action,
and the reaction is included in the sequence of
behaviors described in action. King states that
the goal of a nurse is to help individuals to
maintain their health so they can function in their
roles. The domain of the nurse “includes
promoting, maintaining, and restoring health, and
caring for the sick, injured and dying.” The
function of a professional nurse is “to interpret
information in the nursing process to plan,
implement, and evaluate nursing care.”
The theory explains that assessment takes
place during interaction. The nurse uses his or
her special knowledge and skills while the patient
delivers knowledge of him or her self, as well as
the perception of problems of concern to the
interaction. During this phase, the nurse gathers
data about the patient including his or her growth
and development, the perception of self, and
current health status. Perception is the base for
the collection and interpretation of data.
Communication is required to verify the accuracy
of the perception, as well as for interaction and
translation.
The next phase is the nursing diagnosis. This
phase is developed using the data collected in
the assessment. In the process of attaining
goals, the nurse identifies problems, concerns,
and disturbances about which the patient is
seeking help.
The planning phase arises after the diagnosis.
The nurse and other health care team members
create a care plan of interventions to solve the
problems identified. This phase is represented by
setting goals and making decisions about the
means to achieve those goals. This part of
transaction and the patient’s participation is
encouraged in making decisions on the means to
achieve the goals.
The actual activities done to achieve the goals
make up the implementation phase of the
nursing process. Whereas in this model of
nursing, it is the continuation of transaction.
Finally, in the evaluation phase, the nurse
evaluates the patient to determine whether or not
the goals were achieved. Evaluation involves
determining whether or not goals were achieved.
The explanation of evaluation in King’s theory
addresses meeting goals and the effectiveness
of nursing care.
In the healthcare field, the final goal in the nurse-
patient relationship is to help the patient achieve
his or her goals for getting healthy. By using the
nursing process described in King’s Theory of
Goal Attainment, a nurse can be more effective
in working with a patient to achieve those goals,
and can truly help patients.
Interacting Systems of Theory of Goal
Attainment
According to King, there are three interacting
systems in the Theory of Goal Attainment. These
are the personal system, the interpersonal
system, and the social system. Each system is
given different concepts. The concepts for the
personal system are: perception, self, growth and
development, body image, space, and time. The
concepts for the interpersonal system are:
interaction, communication, transaction, role, and
stress. The concepts for the social system are:
organization, authority, power, status, and
decision making.

1. Personal Systems
Each individual is a personal system. King
designated an example of a personal system as
a patient or a nurse. King specified the concepts
of body image, growth, and
development, perception, self, space, and time in
order to comprehend human beings as persons.
“The self is a composite of thoughts and feelings
which constitute a person’s awareness of his
individual existence, his conception of who and
what he is. A person’s self is the sum total of all
he can call his. The self includes, among other
things, a system of ideas, attitudes, values, and
commitments. The self is a person’s total
subjective environment. It is a distinctive center
of experience and significance. The self
constitutes a person’s inner world as
distinguished from the outer world consisting of
all other people and things. The self is the
individual as known to the individual. It is that to
which we refer when we say “I.”
Growth and development can be defined as the
processes in people’s lives through which they
move from a potential for the achievement to the
actualization of self.
King defines body image as the way one
perceives both one’s body and others’ reactions
to one’s appearance.
Space includes that space exists in all directions,
is the same everywhere, and is defined by the
physical area known as “territory” and by the
behaviors of those occupying it.
Time is defined as “a duration between one
event and another as uniquely experienced by
each human being; it is the relation of one event
to another event.”
King (1986) added learning as a subconcept in
the personal system but did not further define it.
2. Interpersonal Systems
These are formed by human beings interacting.
Two interacting individuals form a dyad; three
form a triad, and four or more form small or large
groups. As the number of interacting individuals
increases, so does the complexity of the
interactions. Understanding the interpersonal
system requires the concepts
of communication, interaction, role, stress,
and transaction.
Interactions are defined as the observable
behaviors of two or more individuals in mutual
presence.
King (1990) defines communication as “a
process whereby information is given from one
person to another either directly in a face-to-face
meeting or indirectly through telephone,
television, or the written word.”
King defines transactions as “a process of
interactions in which human beings communicate
with the environment to achieve goals that are
valued… goal-directed human behaviors.
The characteristics of the role include reciprocity
in that a person may be a giver at one time and a
taker at another time, with a relationship between
two or more individuals who are functioning in
two or more roles that learned, social, complex,
and situational.
Stress is “a dynamic state whereby a human
being interacts with the environment to maintain
balance for growth, development, and
performance, which involves an exchange of
energy and information between the person and
the environment for regulation and control of
stressors.”
3. Social Systems
A more comprehensive interacting system
consists of groups that make up society, referred
to as the social system. Religious, educational,
and health care systems are examples of social
systems. The influential behavior of an extended
family on an individual’s growth and development
is another social system example. Within a social
system, the concepts of authority, decision
making, organization, power, and status guide
system understanding.
Power is the capacity to use resources in
organizations to achieve goals… is the process
whereby one or more persons influence other
persons in a situation… is the capacity or ability
of a person or a group to achieve goals… occurs
in all aspects of life and each person has
potential power determined by individual
resources and the environmental forces
encountered. Power is a social force that
organizes and maintains society. Power is the
ability to use and to mobilize resources to
achieve goals.
Status is “the position of an individual in a group
or a group in relation to other groups in an
organization” and is identified that status is
accompanied by “privileges, duties, and
obligation.”
Decision making is “a dynamic and systematic
process by which goal-directed choice of
perceived alternatives is made and acted upon
by individuals or groups to answer a question
and attain a goal” (King, 1990).
King (1986) added control as a subconcept in
the social system but did not further define the
concept.
Dynamic Conceptual Systems
The figure below demonstrates the conceptual
system that provided “one approach to studying
systems as a whole rather than as isolated parts
of a system” and was “designed to explain the
organized wholes within which nurses are
expected to function.”
King has interrelated the concepts of interaction,
perception, communication, transaction, self,
role, stress, growth and development, time, and
space into a theory of goal attainment. Her theory
deals with a nurse-client dyad, a relationship to
which each person brings personal perceptions
of self, role, and personal levels of growth and
development. The nurse and client communicate,
first in interaction and then in transaction, to
attain mutually set goals. The relationship takes
place in space identified by their behaviors and
occurs in forward-moving time.
She believed that her “framework differs from
other conceptual schema in that it is concerned
not with fragmenting human beings and the
environment but with human transactions in
different kinds of environments.”
Process of Interaction
The figure above represents a process of human
interactions that lead to transactions: A model of
transaction. According to King, “The human
process of interactions formed the basis for
designing a model of transactions that depicted
theoretical knowledge used by nurses to help
individuals and groups attain goals.”
Interaction
Interaction is a process of perception and
communication between person and environment
and between person and person represented by
verbal and nonverbal behaviors that are goal-
directed.
Transaction
Transaction is a process of interactions in which
human beings communicate with the
environment to achieve goals that are valued;
transactions are goal-directed human behaviors.
Perception is “each person’s representation of
reality.”
Communication
Communication is defined as “a process whereby
information is given from one person to another
either directly in face-to-face meetings or
indirectly through telephone, television, or the
written word.”
Role
Role is defined as “a set of behaviors expected of
persons occupying a position in a social system;
rules that define rights and obligations in a
position; a relationship with one or more
individuals interacting in specific situations for a
purpose.”
Stress
Stress is “a dynamic state whereby a human
being interacts with the environment to maintain
balance for growth, development, and
performance… an energy response of an
individual to persons, objects, and events called
stressors.”

Growth and Development
Growth and development can be defined as the
“continuous changes in individuals at the cellular,
molecular, and behavioral levels of activities…
the processes that take place in the life of
individuals that help them move from potential
capacity for achievement to self-actualization.”
Time
Time is “a sequence of events moving onward to
the future… a continuous flow of events in
successive order that implies a change, a past
and a future… a duration between one event and
another as uniquely experienced by each human
being… the relation of one event to another.”
Space
Space exists in every direction and is the same in
all directions. Space includes that physical area
called territory. Space is defined by the behaviors
of those individuals who occupy it
All in all, King contributed to the advancement of
nursing knowledge through the development of
her conceptual system and middle-range Theory
of Goal Attainment. By focusing on the
attainment of goals, or outcomes, by nurse-
patient partnerships, King provided a conceptual
system and middle-range theory that has
demonstrated its usefulness to nurses. Nurses
working in a variety of settings with patients from
around the world continue to use King’s work to
improve the quality of patient care.
Non-Nursing Theories
Maslow’s Hierarchy of Human Needs
Maslow's hierarchy of needs is a
motivational theory in psychology comprising a
five-tier model of human needs, often depicted as
hierarchical levels within a pyramid. Needs lower
down in the hierarchy must be satisfied before
individuals can attend to needs higher up. From
the bottom of the hierarchy upwards, the needs
are: physiological, safety, love and belonging,
esteem, and self-actualization.
The original hierarchy of needs five-stage
model includes:
Maslow (1943, 1954) stated that people are
motivated to achieve certain needs and that
some needs take precedence over others.
Our most basic need is for physical survival, and
this will be the first thing that motivates our
behavior. Once that level is fulfilled the next level
up is what motivates us, and so on.
1. Physiological needs - these are biological
requirements for human survival, e.g. air, food,
drink, shelter, clothing, warmth, sex, sleep.
If these needs are not satisfied the human body
cannot function optimally. Maslow considered
physiological needs the most important as all the
other needs become secondary until these needs
are met.
2. Safety needs - Once an individual’s
physiological needs are satisfied, the needs for
security and safety become salient. People want
to experience order, predictability and control in
their lives. These needs can be fulfilled by the
family and society (e.g. police, schools, business
and medical care).
For example, emotional security, financial
security (e.g. employment, social welfare), law
and order, freedom from fear, social stability,
property, health and wellbeing (e.g. safety
against accidents and injury).
3. Love and belongingness needs - after
physiological and safety needs have been
fulfilled, the third level of human needs is social
and involves feelings of belongingness. The need
for interpersonal relationships motivates behavior
Examples include friendship, intimacy, trust, and
acceptance, receiving and giving affection and
love. Affiliating, being part of a group (family,
friends, work).
4. Esteem needs are the fourth level in Maslow’s
hierarchy - which Maslow classified into two
categories: (i) esteem for oneself (dignity,
achievement, mastery, independence) and (ii)
the desire for reputation or respect from others
(e.g., status, prestige).
Maslow indicated that the need for respect or
reputation is most important for children and
adolescents and precedes real self-esteem or
dignity.
5. Self-actualization needs are the highest level
in Maslow's hierarchy, and refer to the realization
of a person's potential, self-fulfillment, seeking
personal growth and peak experiences. Maslow
(1943) describes this level as the desire to
accomplish everything that one can, to become
the most that one can be.
Individuals may perceive or focus on this need
very specifically. For example, one individual
may have a strong desire to become an ideal
parent. In another, the desire may be expressed
economically, academically or athletically. For
others, it may be expressed creatively, in
paintings, pictures, or inventions.
Hierarchy of needs summary
(a) human beings are motivated by a hierarchy of
needs.
(b) needs are organized in a hierarchy of
prepotency in which more basic needs must be
more or less met (rather than all or none) prior to
higher needs.
(c) the order of needs is not rigid but instead may
be flexible based on external circumstances or
individual differences.
(d) most behavior is multi-motivated, that is,
simultaneously determined by more than one
basic need.
Changes to the original five-stage model are
highlighted and include a seven-stage model and
an eight-stage model; both developed during the
1960s and 1970s.
1. Biological and physiological needs - air, food,
drink, shelter, warmth, sex, sleep, etc.
2. Safety needs - protection from elements,
security, order, law, stability, freedom from fear.
3. Love and belongingness needs - friendship,
intimacy, trust, and acceptance, receiving and
giving affection and love. Affiliating, being part of
a group (family, friends, work).
4. Esteem needs - which Maslow classified into
two categories: (i) esteem for oneself (dignity,
achievement, mastery, independence) and (ii)
the desire for reputation or respect from others
(e.g., status, prestige).
5. Cognitive needs - knowledge and
understanding, curiosity, exploration, need for
meaning and predictability.
6. Aesthetic needs - appreciation and search for
beauty, balance, form, etc.
7. Self-actualization needs - realizing personal
potential, self-fulfillment, seeking personal growth
and peak experiences. A desire “to become
everything one is capable of becoming”(Maslow,
1987, p. 64).
8. Transcendence needs - A person is motivated
by values which transcend beyond the personal
self (e.g., mystical experiences and certain
experiences with nature, aesthetic experiences,
sexual experiences, service to others, the pursuit
of science, religious faith, etc.).
Sullivian’s Transactional Analysis
Transactional analysis is a brief
therapeutic approach based on Freud's as well
as Adler's and Sullivan's ideas. It was formulated
by Eric Berne (1910-1970) and had great
success, especially in America. Its strength is in
its simplicity, not least its everyday,
understandable terminology. TA therapists and
their patients talk about Parent, Adult, Child,
concepts which correspond to the Freudian
Superego, ego and id.
The therapy's main aim being that of
putting the patient's conscious, mature, realistic,
ethical Adult in charge of his reckless, impulsive,
selfish Child and the harsh, controlling Parent.
The therapy is conducted in a group setting,
where the members' "scripts", "games", self-
defeating and self-perpetuating transactions are
analysed. TA claims to demystify human
psychology, but it ends up by becoming
oversimplistic and mechanistic.
Ludwig von Bertalanffy’s General Systems
Theory
General system theory, therefore, is a
general science of wholeness... The meaning of
the somewhat mystical expression, “The whole is
more that the sum of its parts” is simply that
constitutive characteristics are not explainable
from the characteristics of the isolated parts. The
characteristics of the complex, therefore, appear
as new or emergent... - Ludwig von Bertalanffy
Systems theory was proposed in the
1940's by the biologist Ludwig von Bertalanffy
and furthered by Ross Ashby (1964). Von
Bertalanffy was reacting against both
reductionism and attempting to revive the
unity of science. He is considered to be the
founder and principal author of general
systems theory.
If one were to analyze current notions
and fashionable catchwords, he would find
“systems” high on the list - Ludwig von
Bertalanffy.
Ludwig von Bertalanffy (1968) wrote that
a system is a complex of interacting elements
and that they are open to, and interact with their
environments. In addition, they can acquire
qualitatively new properties through emergence,
thus they are in a continual evolution. When
referring to systems, it also generally means that
they are self-regulating (they self-correct through
feedback).
 System thinking is both part-to-whole
and whole-to-part thinking about making
connections between the various elements so
that they fit together as a whole.
Lewin’s Change Theory
 Kurt Lewin (1890-1947) is considered as
the father of social psychology
 He was born in Germany, later emigrated
to the US.
 He is well known for his writings on group
dynamics, group therapy and social
psychology.
 Kurt Lewin introduced his field theory
concepts, emphasizing that the group
differs from the simple sum of its parts.
 Lewin coined the term group dynamics in
1939.
 His field theory states that "one’s behavior
is related both to one’s personal
characteristics and to the social situation
in which one finds oneself."
LEWIN’S CHANGE THEORY
His most influencial theory was his model
of the change process in human systems.
Kurt Lewin theorized a three-stage model
of change that is known as the unfreezing-
change-refreeze model that requires prior
learning to be rejected and replaced.
Lewin's theory states behavior as "a
dynamic balance of forces working in
opposing directions."
CONCEPTS
Driving forces
 Driving forces are forces that push
in a direction that causes change
to occur.
 Driving forces facilitate change
because they push the person in
the desired direction.
 They cause a shift in the
equilibrium towards change.
Restraining forces
 Restraining forces are forces that
counter driving forces.
 Restraining forces hinder change
because they push the person in
the opposite direction.
 Restraining forces cause a shift in
the equilibrium which opposes
change.
Equilibrium
 Equilibrium is a state of being
where driving forces equal
restraining forces and no change
occurs
 Equilibrium can be raised or
lowered by changes that occur
between the driving and restraining
forces.
STAGES
Consists of three distinct and vital stages:
1. “Unfreezing”
 Unfreezing is the process which
involves finding a method of
making it possible for people to let
go of an old pattern that was
counterproductive in some way.
 Unfreezing is necessary to
overcome the strains of individual
resistance and group conformity.
 Unfreezing can be achieved by the
use of three methods.
o First, increase the driving
forces that direct behavior
away from the existing
situation or status quo.
o Second, decrease the
restraining forces that
negatively affect the
movement from the existing
equilibrium.
o Third, find a combination of
the two methods listed
above.
2. “Moving to a new level or Changing” or
Movement
 This stage involves a process of
change in thoughts, feeling,
behavior, or all three, that is in
some way more liberating or more
productive.
3. “Refreezing”
 Refreezing is establishing the
change as a new habit, so that it
now becomes the “standard
operating procedure.” Without this
stage of refreezing, it is easy to go
back to the old ways.
APPLICATION
 It is pertinant that the driving and
restraining forces must be analyzed
before implimenting a planned change.
Erikson’s Psychosocial Development Theory

Each stage in Erikson's theory builds on
the preceding stages and paves the way for
following periods of development. In each stage,
Erikson believed people experience a conflict
that serves as a turning point in development.
If people successfully deal with the
conflict, they emerge from the stage with
psychological strengths that will serve them well
for the rest of their lives.
If they fail to deal effectively with these
conflicts, they may not develop the essential
skills needed for a strong sense of self.
Stage 1: Trust vs. Mistrust
The first stage of Erikson's theory of
psychosocial development occurs between birth
and 1 year of age and is the most fundamental
stage in life. Because an infant is utterly
dependent, developing trust is based on the
dependability and quality of the child's
caregivers.
At this point in development, the child is
utterly dependent upon adult caregivers for
everything they need to survive including food,
love, warmth, safety, and nurturing. If a caregiver
fails to provide adequate care and love, the child
will come to feel that they cannot trust or depend
upon the adults in their life.
Outcomes
If a child successfully develops trust, the
child will feel safe and secure in the world.
Caregivers who are inconsistent, emotionally
unavailable, or rejecting contribute to feelings of
mistrust in the children under their care. Failure
to develop trust will result in fear and a belief that
the world is inconsistent and unpredictable.
During the first stage of psychosocial
development, children develop a sense of trust
when caregivers provide reliability, care, and
affection. A lack of this will lead to mistrust.
No child is going to develop a sense of 100%
trust or 100% doubt. Erikson believed that
successful development was all about striking a
balance between the two opposing sides. When
this happens, children acquire hope, which
Erikson described as an openness to experience
tempered by some wariness that danger may be
present.
Stage 2: Autonomy vs. Shame and Doubt
The second stage of Erikson's theory of
psychosocial development takes place during
early childhood and is focused on children
developing a greater sense of personal control.
The Role of Independence
At this point in development, children are
just starting to gain a little independence.
They are starting to perform basic
actions on their own and making simple
decisions about what they prefer. By
allowing kids to make choices and gain
control, parents and caregivers can help
children develop a sense of autonomy.
Potty Training
The essential theme of this stage is that
children need to develop a sense of personal
control over physical skills and a sense of
independence. Potty training plays an
important role in helping children develop this
sense of autonomy.
Like Freud, Erikson believed that toilet training
was a vital part of this process. However,
Erikson's reasoning was quite different than
that of Freud's. Erikson believed that learning
to control one's bodily functions leads to a
feeling of control and a sense of
independence. Other important events include
gaining more control over food choices, toy
preferences, and clothing selection.
Outcomes
Children who struggle and who are shamed for
their accidents may be left without a sense of
personal control. Success during this stage of
psychosocial development leads to feelings of
autonomy; failure results in feelings of shame
and doubt.
Stage 3: Initiative vs. Guilt
The third stage of psychosocial development
takes place during the preschool years. At this
point in psychosocial development, children
begin to assert their power and control over the
world through directing play and other social
interactions. Children who are successful at this
stage feel capable and able to lead others.
Those who fail to acquire these skills are left
with a sense of guilt, self-doubt, and lack of
initiative.
Outcomes
The major theme of the third stage of
psychosocial development is that children need
to begin asserting control and power over the
environment. Success in this stage leads to a
sense of purpose. Children who try to exert too
much power experience disapproval, resulting in
a sense of guilt.
Stage 4: Industry vs. Guilt
The fourth psychosocial stage takes place
during the early school years from approximately
ages 5 to 11. Through social interactions,
children begin to develop a sense of pride in
their accomplishments and abilities.
Children need to cope with new social and
academic demands. Success leads to a sense
of competence, while failure results in feelings of
inferiority.
Outcomes
Children who are encouraged and
commended by parents and teachers
develop a feeling of competence and belief
in their skills. Those who receive little or no
encouragement from parents, teachers, or
peers will doubt their abilities to be
successful.
Stage 5: Identity vs. Confusion
The fifth psychosocial stage takes place
during the often turbulent teenage years.
This stage plays an essential role in
developing a sense of personal identity
which will continue to influence behavior
and development for the rest of a person's
life. Teens need to develop a sense of self
and personal identity. Success leads to an
ability to stay true to yourself, while failure
leads to role confusion and a weak sense
of self.
During adolescence, children explore their
independence and develop a sense of self.
Those who receive proper encouragement
and reinforcement through personal
exploration will emerge from this stage with
a strong sense of self and feelings of
independence and control. Those who
remain unsure of their beliefs and desires
will feel insecure and confused about
themselves and the future.
What Is Identity?
When psychologists talk about identity, they
are referring to all of the beliefs, ideals, and
values that help shape and guide a
person's behavior. Completing this stage
successfully leads to fidelity, which Erikson
described as an ability to live by society's
standards and expectations.
While Erikson believed that each stage of
psychosocial development was important,
he placed a particular emphasis on the
development of ego identity. Ego identity is
the conscious sense of self that we develop
through social interaction and becomes a
central focus during the identity versus
confusion stage of psychosocial
development.
According to Erikson, our ego identity
constantly changes due to new experiences
and information we acquire in our daily
interactions with others. As we have new
experiences, we also take on challenges
that can help or hinder the development of
identity.
Stage 6: Intimacy vs. Isolation
Young adults need to form intimate, loving
relationships with other people. Success
leads to strong relationships, while failure
results in loneliness and isolation. This
stage covers the period of early adulthood
when people are exploring personal
relationships.
Erikson believed it was vital that people
develop close, committed relationships with
other people. Those who are successful at
this step will form relationships that are
enduring and secure.
Stage 7: Generativity vs. Stagnation
Adults need to create or nurture things that
will outlast them, often by having children or
creating a positive change that benefits
other people. Success leads to feelings of
usefulness and accomplishment, while
failure results in shallow involvement in the
world. During adulthood, we continue to
build our lives, focusing on our career and
family.
Those who are successful during this
phase will feel that they are contributing to
the world by being active in their home and
community. Those who fail to attain this
skill will feel unproductive and uninvolved in
the world.
Stage 8: Integrity vs. Despair
The final psychosocial stage occurs during
old age and is focused on reflecting back
on life. At this point in development, people
look back on the events of their lives and
determine if they are happy with the life that
they lived or if they regret the things they
did or didn't do.
Erikson's theory differed from many others
because it addressed development
throughout the entire lifespan, including old
age. Older adults need to look back on life
and feel a sense of fulfillment. Success at
this stage leads to feelings of wisdom, while
failure results in regret, bitterness, and
despair.
At this stage, people reflect back on the
events of their lives and take stock. Those
who look back on a life they feel was well-
lived will feel satisfied and ready to face the
end of their lives with a sense of peace.
Those who look back and only feel regret
will instead feel fearful that their lives will
end without accomplishing the things they
feel they should have.
Outcomes
Those who are unsuccessful during this
stage will feel that their life has been
wasted and may experience many regrets.
The person will be left with feelings of
bitterness and despair. Those who feel
proud of their accomplishments will feel a
sense of integrity. Successfully completing
this phase means looking back with few
regrets and a general feeling of satisfaction.
These individuals will attain wisdom, even
when confronting death.
Strengths and Weaknesses of Erikson's
Theory
Erikson's theory also has its limitations and
attracts valid criticisms. What kinds of
experiences are necessary to successfully
complete each stage? How does a person
move from one stage to the next?
Criticism
One major weakness of psychosocial
theory is that the exact mechanisms for
resolving conflicts and moving from one
stage to the next are not well described or
developed. The theory fails to detail exactly
what type of experiences are necessary at
each stage in order to successfully resolve
the conflicts and move to the next stage.
Support
One of the strengths of psychosocial theory
is that it provides a broad framework from
which to view development throughout the
entire lifespan. It also allows us to
emphasize the social nature of human
beings and the important influence that
social relationships have on development.
Researchers have found evidence
supporting Erikson's ideas about identity
and have further identified different sub-
stages of identity formation. Some research
also suggests that people who form strong
personal identities during adolescence are
better capable of forming intimate
relationships during early adulthood. Other
research suggests, however, that identity
formation and development continues well
into adulthood.
Kohlberg’s Moral Development Theory
Lawrence Kohlberg was, for many years, a
professor at Harvard University. He became
famous for his work there beginning in the
early 1970s. He started as a developmental
psychologist and then moved to the field of
moral education. He was particularly well-
known for his theory of moral development
which he popularized through research
studies conducted at Harvard's Center for
Moral Education.
His theory of moral development was
dependent on the thinking of the Swiss
psychologist Jean Piaget and the American
philosopher John Dewey. He was also
inspired by James Mark Baldwin. These
men had emphasized that human beings
develop philosophically and
psychologically in a progressive fashion.
Kohlberg believed...and was able to
demonstrate through studies...that people
progressed in their moral reasoning (i.e., in
their bases for ethical behavior) through a
series of stages. He believed that there were
six identifiable stages which could be more
generally classified into three levels.
Level 1 - Pre-conventional morality
At the pre-conventional level (most nine-year-
olds and younger, some over nine), we don’t
have a personal code of morality. Instead, our
moral code is shaped by the standards of adults
and the consequences of following or breaking
their rules.
Authority is outside the individual and reasoning
is based on the physical consequences of
actions.
• Stage 1. Obedience and Punishment
Orientation. The child/individual is good in order
to avoid being punished. If a person is punished,
they must have done wrong.
• Stage 2. Individualism and Exchange. At this
stage, children recognize that there is not just
one right view that is handed down by the
authorities. Different individuals have different
viewpoints.
Level 2 - Conventional morality
At the conventional level (most adolescents and
adults), we begin to internalize the moral
standards of valued adult role models.
Authority is internalized but not questioned, and
reasoning is based on the norms of the group to
which the person belongs.
• Stage 3. Good Interpersonal Relationships.
The child/individual is good in order to be seen
as being a good person by others. Therefore,
answers relate to the approval of others.
• Stage 4. Maintaining the Social Order. The
child/individual becomes aware of the wider rules
of society, so judgments concern obeying the
rules in order to uphold the law and to avoid guilt.
Level 3 - Post-conventional morality
Individual judgment is based on self-chosen
principles, and moral reasoning is based on
individual rights and justice. According to
Kohlberg this level of moral reasoning is as far as
most people get.
Only 10-15% are capable of the kind of abstract
thinking necessary for stage 5 or 6 (post-
conventional morality). That is to say, most
people take their moral views from those around
them and only a minority think through ethical
principles for themselves.
• Stage 5. Social Contract and Individual
Rights. The child/individual becomes aware that
while rules/laws might exist for the good of the
greatest number, there are times when they will
work against the interest of particular individuals.
The issues are not always clear-cut. For
example, in Heinz’s dilemma, the protection of
life is more important than breaking the law
against stealing.
• Stage 6. Universal Principles. People at this
stage have developed their own set of moral
guidelines which may or may not fit the law. The
principles apply to everyone.
E.g., human rights, justice, and equality. The
person will be prepared to act to defend these
principles even if it means going against the rest
of society in the process and having to pay the
consequences of disapproval and or
imprisonment. Kohlberg doubted few people
reached this stage.
The first level of moral thinking is that
generally found at the elementary school level.
In the first stage of this level, people behave
according to socially acceptable norms
because they are told to do so by some
authority figure (e.g., parent or teacher). This
obedience is compelled by the threat or
application of punishment. The second stage
of this level is characterized by a view that
right behavior means acting in one's own best
interests.
The second level of moral thinking is that
generally found in society, hence the name
"conventional." The first stage of this level
(stage 3) is characterized by an attitude
which seeks to do what will gain the
approval of others. The second stage is
one oriented to abiding by the law and
responding to the obligations of duty.
The third level of moral thinking is one that
Kohlberg felt is not reached by the majority of
adults. Its first stage (stage 5) is an
understanding of social mutuality and a
genuine interest in the welfare of others. The
last stage (stage 6) is based on respect for
universal principle and the demands of
individual conscience. While Kohlberg always
believed in the existence of Stage 6 and had
some nominees for it, he could never get
enough subjects to define it, much less
observe their longitudinal movement to it.
Kohlberg believed that individuals could only
progress through these stages one stage at a
time. That is, they could not "jump" stages.
They could not, for example, move from an
orientation of selfishness to the law and order
stage without passing through the good boy/girl
stage. They could only come to a
comprehension of a moral rationale one stage
above their own. Thus, according to Kohlberg,
it was important to present them with moral
dilemmas for discussion which would help them
to see the reasonableness of a "higher stage"
morality and encourage their development in
that direction. The last comment refers to
Kohlberg's moral discussion approach. He saw
this as one of the ways in which moral
development can be promoted through formal
education. Note that Kohlberg believed, as did
Piaget, that most moral development occurs
through social interaction. The discussion
approach is based on the insight that
individuals develop as a result of cognitive
conflicts at their current stage.
Pre-Convetional
 Stage 1 Obedience and Punishment Driven
 Stage 2 Self Interest Driven
Conventional
 Stage 3 Interpersonal Accord & Conformity
Driven
 Stage 4 Authority & Social-order Obedience
Driven
Post-Conventional
 Stage 5 Social Contract Driven
 Stage 6 Universal Ethical Principles Driven