Nursing theories 

are organized bodies of knowledge to define what nursing

is, what nurses do, and why they do it. Nursing theories provide a way to
define nursing as a unique discipline that is separate from other disciplines
(e.g., medicine). It is a framework of concepts and purposes intended to guide
nursing practice at a more concrete and specific level.

Nursing, as a profession, is committed to recognizing its own unparalleled

body of knowledge vital to nursing practice—nursing science. To distinguish
this foundation of knowledge, nurses need to identify, develop, and
understand concepts and theories in line with nursing. As a science, nursing is
based on the theory of what nursing is, what nurses do, and why. Nursing is a
unique discipline and is separate from medicine. It has its own body of
knowledge on which delivery of care is based.

Defining Terms
The development of nursing theory demands an understanding of selected
terminologies, definitions, and assumptions.

 Philosophy. These are beliefs and values that define a way of

thinking and are generally known and understood by a group or
discipline.
 Theory. A belief, policy, or procedure proposed or followed as the
basis of action. It refers to a logical group of general propositions
used as principles of explanation. Theories are also used to
describe, predict, or control phenomena.
 Concept. Concepts are often called the building blocks of
theories. They are primarily the vehicles of thought that involve
images.
 Models. Models are representations of the interaction among
and between the concepts showing patterns. They present an
overview of the theory’s thinking and may demonstrate how
theory can be introduced into practice.
 Conceptual framework. A conceptual framework is a group of
related ideas, statements, or concepts. It is often used
interchangeably with the conceptual model and with grand
theories.
 Proposition. Propositions are statements that describe the
relationship between the concepts.
  Domain. The domain is the perspective or territory of a
profession or discipline.
 Process. Processes are organized steps, changes, or functions
intended to bring about the desired result.
 Paradigm. A paradigm refers to a pattern of shared
understanding and assumptions about reality and the world,
worldview, or widely accepted value system.
 Metaparadigm. A metaparadigm is the most general statement
of discipline and functions as a framework in which the more
restricted structures of conceptual models develop. Much of the
theoretical work in nursing focused on articulating relationships
among four major concepts: person, environment, health, and
nursing.

History of Nursing Theories

The first nursing theories appeared in the late 1800s when a strong emphasis was placed on
nursing education.

 In 1860, Florence Nightingale defined nursing in her “Environmental Theory” as

“the act of utilizing the patient’s environment to assist him in his recovery.”
 In the 1950s, there is a consensus among nursing scholars that nursing needed to
validate itself through the production of its own scientifically tested body of
knowledge.
 In 1952, Hildegard Peplau introduced her Theory of Interpersonal Relations that
emphasizes the nurse-client relationship as the foundation of nursing practice.
 In 1955, Virginia Henderson conceptualized the nurse’s role as assisting sick or
healthy individuals to gain independence in meeting 14 fundamental needs. Thus
her Nursing Need Theory was developed.
 In 1960, Faye Abdellah published her work “Typology of 21 Nursing Problems,”
which shifted the focus of nursing from a disease-centered approach to a patient-
centered approach.
 In 1962, Ida Jean Orlando emphasized the reciprocal relationship between patient
and nurse and viewed nursing’s professional function as finding out and meeting the
patient’s immediate need for help.
 In 1968, Dorothy Johnson pioneered the Behavioral System Model and upheld the
fostering of efficient and effective behavioral functioning in the patient to prevent
illness.
 In 1970, Martha Rogers viewed nursing as both a science and an art as it provides a
way to view the unitary human being, who is integral with the universe.
 In 1971, Dorothea Orem stated in her theory that nursing care is required if the client
is unable to fulfill biological, psychological, developmental, or social needs.
 In 1971, Imogene King‘s Theory of Goal attainment stated that the nurse is
considered part of the patient’s environment and the nurse-patient relationship is for
meeting goals towards good health.
  In 1972, Betty Neuman, in her theory, states that many needs exist, and each may
disrupt client balance or stability. Stress reduction is the goal of the system model of
nursing practice.
 In 1979, Sr. Callista Roy viewed the individual as a set of interrelated systems that
maintain the balance between these various stimuli.
 In 1979, Jean Watson developed the philosophy of caring, highlighted humanistic
aspects of nursing as they intertwine with scientific knowledge and nursing practice.

The Nursing Metaparadigm

Four major concepts are frequently interrelated and fundamental to nursing theory: person,
environment, health, and nursing. These four are collectively referred to as metaparadigm
for nursing.
Person
Person (also referred to as Client or Human Beings) is the recipient of nursing
care and may include individuals, patients, groups, families, and communities.

Environment
Environment (or situation) is defined as the internal and external surroundings
that affect the client. It includes all positive or negative conditions that affect
the patient, the physical environment, such as families, friends, and significant
others, and the setting for where they go for their healthcare.
Health
Health is defined as the degree of wellness or well-being that the client
experiences. It may have different meanings for each patient, the clinical
setting, and the health care provider.

Nursing
The nurse’s attributes, characteristics, and actions provide care on behalf of or
in conjunction with the client. There are numerous definitions of nursing,
though nursing scholars may have difficulty agreeing on its exact definition.
The ultimate goal of nursing theories is to improve patient care.

You’ll find that these four concepts are used frequently and defined differently
throughout different nursing theories. Each nurse theorist’s definition varies by
their orientation, nursing experience, and different factors that affect the
theorist’s nursing view. The person is the main focus, but how each theorist
defines the nursing metaparadigm gives a unique take specific to a particular
theory. To give you an example, below are the different definitions of various
theorists on the nursing metaparadigm:
An overview of the nursing metaparadigm of different nursing theories. (Click
to enlarge)
Components of Nursing Theories
For a theory to be a theory, it has to contain concepts, definitions, relational
statements, and assumptions that explain a phenomenon. It should also
explain how these components relate to each other.

Phenomenon
A term given to describe an idea or response about an event, a situation, a
process, a group of events, or a group of situations. Phenomena may be
temporary or permanent. Nursing theories focus on the phenomena of
nursing.

Concepts
Interrelated concepts define a theory. Concepts are used to help describe or
label a phenomenon. They are words or phrases that identify, define, and
establish structure and boundaries for ideas generated about a particular
phenomenon. Concepts may be abstract or concrete.

 Abstract Concepts. Defined as mentally constructed

independently of a specific time or place.
 Concrete Concepts. Are directly experienced and related to a
particular time or place.

Definitions
Definitions are used to convey the general meaning of the concepts of the
theory. Definitions can be theoretical or operational.

 Theoretical Definitions. Define a particular concept based on the

theorist’s perspective.
 Operational Definitions. States how concepts are measured.

Relational Statements
Relational statements define the relationships between two or more concepts.
They are the chains that link concepts to one another.
Assumptions
Assumptions are accepted as truths and are based on values and beliefs. These
statements explain the nature of concepts, definitions, purpose, relationships,
and structure of a theory.

Why are Nursing Theories

Important?
Nursing theories are the basis of nursing practice today. In many cases,
nursing theory guides knowledge development and directs education,
research, and practice. Historically, nursing was not recognized as an academic
discipline or as a profession we view today. Before nursing theories were
developed, nursing was considered to be a task-oriented occupation. The
training and function of nurses were under the direction and control of the
medical profession. Let’s take a look at the importance of nursing theory and
its significance to nursing practice:

 Nursing theories help recognize what should set the foundation

of practice by explicitly describing nursing.
 By defining nursing, a nursing theory also helps nurses
understand their purpose and role in the healthcare setting.
 Theories serve as a rationale or scientific reasons for nursing
interventions and give nurses the knowledge base necessary for
acting and responding appropriately in nursing care situations.
 Nursing theories provide the foundations of nursing practice,
generate further knowledge, and indicate which direction nursing
should develop in the future (Brown, 1964).
 By providing nurses a sense of identity, nursing theory can help
patients, managers, and other healthcare professionals to
acknowledge and understand the unique contribution that nurses
make to the healthcare service (Draper, 1990).
 Nursing theories prepare the nurses to reflect on the assumptions
and question the nursing values, thus further defining nursing and
increasing the knowledge base.
 Nursing theories aim to define, predict, and demonstrate nursing
phenomenon (Chinn and Jacobs, 1978).
  It can be regarded as an attempt by the nursing profession to
maintain and preserve its professional limits and boundaries.
 In many cases, nursing theories guide knowledge development
and directs education, research, and practice, although each
influences the others. (Fitzpatrick and Whall, 2005).

Purposes of Nursing Theories

The primary purpose of theory in nursing is to improve practice by positively
influencing the health and quality of life of patients. Nursing theories are also
developed to define and describe nursing care, guide nursing practice, and
provide a basis for clinical decision-making. In the past, the accomplishments
of nursing led to the recognition of nursing in an academic discipline,
research, and profession.

In Academic Discipline
Much of the earlier nursing programs identified the major concepts in one or
two nursing models, organized the concepts, and build an entire nursing
curriculum around the created framework. These models’ unique language
was typically introduced into program objectives, course objectives, course
descriptions, and clinical performance criteria. The purpose was to explain the
fundamental implications of the profession and enhance the profession’s
status.

In Research
The development of theory is fundamental to the research process, where it is
necessary to use theory as a framework to provide perspective and guidance
to the research study. Theory can also be used to guide the research process
by creating and testing phenomena of interest. To improve the nursing
profession’s ability to meet societal duties and responsibilities, there needs to
be a continuous reciprocal and cyclical connection with theory, practice, and
research. This will help connect the perceived “gap” between theory and
practice and promote the theory-guided practice.
In Profession
Clinical practice generates research questions and knowledge for theory. In a
clinical setting, its primary contribution has been the facilitation of reflecting,
questioning, and thinking about what nurses do. Because nurses and nursing
practice are often subordinate to powerful institutional forces and traditions,
introducing any framework that encourages nurses to reflect on, question, and
think about what they do provide an invaluable service.

Classification of Nursing Theories

There are different ways to categorize nursing theories. They are classified
depending on their function, levels of abstraction, or goal orientation.

By Abstraction
There are three major categories when classifying nursing theories based on
their level of abstraction: grand theory, middle-range theory, and practice-
level theory.

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Levels of Nursing Theory According to Abstraction

Grand Nursing Theories

 Grand theories are abstract, broad in scope, and complex,
therefore requiring further research for clarification.
 Grand nursing theories do not guide specific nursing
interventions but rather provide a general framework and nursing
ideas.
 Grand nursing theorists develop their works based on their own
experiences and their time, explaining why there is so much
variation among theories.
 Address the nursing metaparadigm components of person,
nursing, health, and environment.
Middle-Range Nursing Theories
 More limited in scope (compared to grand theories) and present
concepts and propositions at a lower level of abstraction. They
address a specific phenomenon in nursing.
 Due to the difficulty of testing grand theories, nursing scholars
proposed using this level of theory.
 Most middle-range theories are based on a grand theorist’s
works, but they can be conceived from research, nursing practice,
or the theories of other disciplines.
Practice-Level Nursing Theories
 Practice nursing theories are situation-specific theories that are
narrow in scope and focuses on a specific patient population at a
specific time.
 Practice-level nursing theories provide frameworks for nursing
interventions and suggest outcomes or the effect of nursing
practice.
 Theories developed at this level have a more direct effect on
nursing practice than more abstract theories.
 These theories are interrelated with concepts from middle-range
theories or grand theories.

By Goal Orientation
Theories can also be classified based on their goals. They can
be descriptive or prescriptive.

Descriptive Theories
 Descriptive theories are the first level of theory development.
They describe the phenomena and identify its properties and
components in which it occurs.
 Descriptive theories are not action-oriented or attempt to
produce or change a situation.
 There are two types of descriptive theories: factor-isolating
theory and explanatory theory.
Factor-Isolating Theory

 Also known as category-formulating or labeling theory.

 Theories under this category describe the properties and
dimensions of phenomena.
Explanatory Theory

 Explanatory theories describe and explain the nature of

relationships of certain phenomena to other phenomena.
Prescriptive Theories
 Address the nursing interventions for a phenomenon, guide
practice change, and predict consequences.
 Includes propositions that call for change.
 In nursing, prescriptive theories are used to anticipate the
outcomes of nursing interventions.

Other Ways of Classifying Nursing Theories

Classification According to Meleis

Afaf Ibrahim Meleis (2011), in her book Theoretical Nursing: Development and

Progress, organizes the major nurse theories and models using the following
headings: needs theories, interaction theories, and outcome theories. These
categories indicate the basic philosophical underpinnings of the theories.

 Needs-Based Theories. The needs theorists were the first group

of nurses who thought of giving nursing care a conceptual order.
Theories under this group are based on helping individuals to
fulfill their physical and mental needs. Theories of Orem,
Henderson, and Abdella are categorized under this group. Need
theories are criticized for relying too much on the medical model
of health and placing the patient in an overtly dependent
position.
 Interaction Theories. These theories emphasized nursing on the
establishment and maintenance of relationships. They highlighted
the impact of nursing on patients and how they interact with the
environment, people, and situations. Theories of King, Orlando,
and Travelbee are grouped under this category.
  Outcome Theories. These theories describe the nurse as
controlling and directing patient care using their knowledge of
the human physiological and behavioral systems. The nursing
theories of Johnson, Levine, Rogers, and Roy belong to this group.
Classification According to Alligood

In her book, Nursing Theorists and Their Work,  Raile Alligood (2017)

categorized nursing theories into four headings: nursing philosophy, nursing
conceptual models, nursing theories and grand theories, and middle-range
nursing theories.

 Nursing Philosophy. It is the most abstract type and sets forth

the meaning of nursing phenomena through analysis, reasoning,
and logical presentation. Works of Nightingale, Watson, Ray, and
Benner are categorized under this group.
 Nursing Conceptual Models. These are comprehensive nursing
theories that are regarded by some as pioneers in nursing. These
theories address the nursing metaparadigm and explain the
relationship between them. Conceptual models of Levine, Rogers,
Roy, King, and Orem are under this group.
 Grand Nursing Theories. Are works derived from nursing
philosophies, conceptual models, and other grand theories that
are generally not as specific as middle-range theories. Works of
Levine, Rogers, Orem, and King are some of the theories under
this category.
 Middle-Range Theories. Are precise and answer specific nursing
practice questions. They address the specifics of nursing
situations within the model’s perspective or theory from which
they are derived. Examples of Middle-Range theories are that of
Mercer, Reed, Mishel, and Barker.

List of Nursing Theories and

Theorists
You’ve learned from the previous sections the definition of nursing theory, its
significance in nursing, and its purpose in generating a nursing knowledge
base. This section will give you an overview and summary of the various
published works in nursing theory (in chronological order). Deep dive into
learning about the theory by clicking on the links provided for their biography
and comprehensive review of their work.

Florence Nightingale
See Also:  Florence Nightingale: Environmental Theory and Biography

 Founder of Modern Nursing and Pioneer of the Environmental

Theory. 
 Defined Nursing as “the act of utilizing the environment of the
patient to assist him in his recovery.”
 Stated that nursing “ought to signify the proper use of fresh air,
light, warmth, cleanliness, quiet, and the proper selection and
administration of diet – all at the least expense of vital power to
the patient.”
 Identified five (5) environmental factors: fresh air, pure water,
efficient drainage, cleanliness or sanitation, and light or direct
sunlight.

Hildegard E. Peplau
See Also:  Hildegard Peplau:  Interpersonal Relations Theory

 Pioneered the Theory of Interpersonal Relations

 Peplau’s theory defined Nursing as “An interpersonal process of
therapeutic interactions between an individual who is sick or in
need of health services and a nurse specially educated to
recognize, respond to the need for help.”
 Her work is influenced by Henry Stack Sullivan, Percival
Symonds, Abraham Maslow, and Neal Elgar Miller.
 It helps nurses and healthcare providers develop more
therapeutic interventions in the clinical setting.

Virginia Henderson
See Also:  Virginia Henderson: Nursing Need Theory 

 Developed the Nursing Need Theory

 Focuses on the importance of increasing the patient’s
independence to hasten their progress in the hospital.
  Emphasizes the basic human needs and how nurses can assist in
meeting those needs.
 “The nurse is expected to carry out a physician’s therapeutic plan,
but individualized care is the result of the nurse’s creativity in
planning for care.”

Faye Glenn Abdellah

See Also:  Faye Glenn Abdellah:  21 Nursing Problems Theory

 Developed the 21 Nursing Problems Theory

 “Nursing is based on an art and science that molds the attitudes,
intellectual competencies, and technical skills of the individual
nurse into the desire and ability to help people, sick or well, cope
with their health needs.”
 Changed the focus of nursing from disease-centered to patient-
centered and began to include families and the elderly in nursing
care.
 The nursing model is intended to guide care in hospital
institutions but can also be applied to community health nursing,
as well.

Ernestine Wiedenbach
 Developed The Helping Art of Clinical Nursing conceptual
model.
 Definition of nursing reflects on nurse-midwife experience as
“People may differ in their concept of nursing, but few would
disagree that nursing is nurturing or caring for someone in a
motherly fashion.”
 Guides the nurse action in the art of nursing and specified four
elements of clinical nursing: philosophy, purpose, practice, and
art.
 Clinical nursing is focused on meeting the patient’s perceived
need for help in a vision of nursing that indicates considerable
importance on the art of nursing.

Lydia E. Hall
See Also:  Lydia Hall:  Care, Cure, Core Theory
  Developed the Care, Cure, Core Theory is also known as the
“Three Cs of Lydia Hall.“
 Hall defined Nursing as the “participation in care, core and cure
aspects of patient care, where CARE is the sole function of nurses,
whereas the CORE and CURE are shared with other members of
the health team.”
 The major purpose of care is to achieve an interpersonal
relationship with the individual to facilitate the development of
the core.
 The “care” circle defines a professional nurse’s primary role, such
as providing bodily care for the patient. The “core” is the patient
receiving nursing care. The “cure” is the aspect of nursing that
involves the administration of medications and treatments.

Joyce Travelbee
 States in her Human-to-Human Relationship Model that the
purpose of nursing was to help and support an individual, family,
or community to prevent or cope with the struggles of illness and
suffering and, if necessary, to find significance in these
occurrences, with the ultimate goal being the presence of hope.
 Nursing was accomplished through human-to-human
relationships.
 Extended the interpersonal relationship theories of Peplau and
Orlando.

Kathryn E. Barnard
 Developed the Child Health Assessment Model.
 Concerns improving the health of infants and their families.
 Her findings on parent-child interaction as an important predictor
of cognitive development helped shape public policy.
 She is the founder of the Nursing Child Assessment Satellite
Training Project (NCAST), which produces and develops research-
based products, assessment, and training programs to teach
professionals, parents, and other caregivers the skills to provide
nurturing environments for young children.
 Borrows from psychology and human development and focuses
on mother-infant interaction with the environment.
  Contributed a close link to practice that has modified the way
health care providers assess children in light of the parent-child
relationship.

Evelyn Adam
 Focuses on the development of models and theories on the
concept of nursing.
 Includes the profession’s goal, the beneficiary of the professional
service, the role of the professional, the source of the beneficiary’s
difficulty, the intervention of the professional, and the
consequences.
 A good example of using a unique basis of nursing for further
expansion.

Nancy Roper, Winifred Logan, and Alison J.

Tierney
 A Model for Nursing Based on a Model of Living
 Logan produced a simple theory, “which actually helped bedside
nurses.”
 The trio collaborated in the fourth edition of The Elements of
Nursing: A Model for Nursing Based on a Model of Living and
prepared a monograph entitled The Roper-Logan-Tierney Model
of Nursing: Based on Activities of Daily Living.
 Includes maintaining a safe environment, communicating,
breathing, eating and drinking, eliminating, personal cleansing
and dressing, controlling body temperature, mobilizing, working
and playing, expressing sexuality, sleeping, and dying.

Ida Jean Orlando

See Also:  Ida Jean Orlando:  Nursing Process Theory

 She developed the Nursing Process Theory.

 “Patients have their own meanings and interpretations of
situations, and therefore nurses must validate their inferences and
analyses with patients before drawing conclusions.”
  Allows nurses to formulate an effective nursing care plan that can
also be easily adapted when and if any complexity comes up with
the patient.
 According to her, persons become patients requiring nursing care
when they have needs for help that cannot be met independently
because of their physical limitations, negative reactions to an
environment, or experience that prevents them from
communicating their needs.
 The role of the nurse is to find out and meet the patient’s
immediate needs for help.

Jean Watson
See Also:  Jean Watson: Theory of Human Caring

 She pioneered the Philosophy and Theory of Transpersonal

Caring.
 “Nursing is concerned with promoting health, preventing illness,
caring for the sick, and restoring health.”
 Mainly concerns with how nurses care for their patients and how
that caring progresses into better plans to promote health and
wellness, prevent illness and restore health.
 Focuses on health promotion, as well as the treatment of diseases.
 Caring is central to nursing practice and promotes health better
than a simple medical cure.

Marilyn Anne Ray 

 Developed the Theory of Bureaucratic Caring
 “Improved patient safety, infection control, reduction
in medication errors, and overall quality of care in complex
bureaucratic health care systems cannot occur without knowledge
and understanding of complex organizations, such as the political
and economic systems, and spiritual-ethical caring, compassion
and right action for all patients and professionals.”
 Challenges participants in nursing to think beyond their usual
frame of reference and envision the world holistically while
considering the universe as a hologram.
 Presents a different view of how health care organizations and
nursing phenomena interrelate as wholes and parts in the system.
Patricia Benner
 Caring, Clinical Wisdom, and Ethics in Nursing Practice
 “The nurse-patient relationship is not a uniform, professionalized
blueprint but rather a kaleidoscope of intimacy and distance in
some of the most dramatic, poignant, and mundane moments of
life.”
 Attempts to assert and reestablish nurses’ caring practices when
nurses are rewarded more for efficiency, technical skills, and
measurable outcomes.
 States that caring practices are instilled with knowledge and skill
regarding everyday human needs.

Kari Martinsen
 Philosophy of Caring
 “Nursing is founded on caring for life, on neighborly love, […]At
the same time, the nurse must be professionally educated.”
 Human beings are created and are beings for whom we may have
administrative responsibility.
 Caring, solidarity, and moral practice are unavoidable realities.

Katie Eriksson
 Theory of Carative Caring
 “Caritative nursing means that we take ‘caritas’ into use when
caring for the human being in health and suffering […] Caritative
caring is a manifestation of the love that ‘just exists’ […] Caring
communion, true caring, occurs when the one caring in a spirit of
caritas alleviates the suffering of the patient.”
 The ultimate goal of caring is to lighten suffering and serve life
and health.
 Inspired many in the Nordic countries and used it as the basis of
research, education, and clinical practice.

Myra Estrin Levine

See Also: Myra Estrin Levine: Conservation Model for Nursing

 According to the Conservation Model, “Nursing is human

interaction.”
  Provides a framework within which to teach beginning nursing
students.
 Logically congruent, externally and internally consistent, has
breadth and depth, and is understood, with few exceptions, by
professionals and consumers of health care.

Martha E. Rogers
See Also:  Martha Rogers:  Theory of Unitary Human Beings

 In Roger’s Theory of Human Beings, she defined Nursing as “an

art and science that is humanistic and humanitarian.
 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 nursing creatively to help better the
lives of the patient.
 A patient can’t be separated from his or her environment when
addressing health and treatment.

Dorothea E. Orem
See Also:  Dorothea E. Orem:  Self-Care Theory

 In her Self-Care Theory, she defined Nursing as “The act of

assisting others in the provision and management of self-care to
maintain or improve human functioning at the home level of
effectiveness.”
 Focuses on each individual’s ability to perform self-care.
 Composed of three interrelated theories: (1) the theory of self-
care, (2) the self-care deficit theory, and (3) the theory of nursing
systems, which is further classified into wholly compensatory,
partially compensatory, and supportive-educative.

Imogene M. King
See Also:  Imogene M. King: Theory of Goal Attainment

 Conceptual System and Middle-Range Theory of Goal

Attainment
  “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.”
 Focuses on this process to guide and direct nurses in the nurse-
patient relationship, going hand-in-hand with their patients to
meet good health goals.
 Explains that the nurse and patient go hand-in-hand in
communicating information, set goals together, and then take
actions to achieve those goals.

Betty Neuman
See Also: Betty Neuman: Neuman’s Systems Model

 In Neuman’s System Model, she  defined nursing as a “unique

profession in that is concerned with all of the variables affecting
an individual’s response to stress.”
 The focus is on the client as a system (which may be an individual,
family, group, or community) and on the client’s responses to
stressors.
 The client system includes five variables (physiological,
psychological, sociocultural, developmental, and spiritual). It is
conceptualized as an inner core (basic energy resources)
surrounded by concentric circles that include lines of resistance, a
normal defense line, and a flexible line of defense.

Sister Callista Roy

See Also:  Sister Callista Roy:  Adaptation Model of Nursing

 In Adaptation Model, Roy defined nursing as a “health care

profession that focuses on human life processes and patterns and
emphasizes the promotion of health for individuals, families,
groups, and society as a whole.”
 Views the individual as a set of interrelated systems that strives to
maintain a balance between various stimuli.
 Inspired the development of many middle-range nursing theories
and adaptation instruments.
Dorothy E. Johnson
See Also:  Dorothy E. Johnson:  Behavioral Systems Model

 The Behavioral System Model defined Nursing as “an external

regulatory force that acts to preserve the organization and
integrate the patients’ behaviors at an optimum level under those
conditions in which the behavior constitutes a threat to the
physical or social health or in which illness is found.”
 Advocates to foster efficient and effective behavioral functioning
in the patient to prevent illness and stresses the importance of
research-based knowledge about the effect of nursing care on
patients.
 Describes the person as a behavioral system with seven
subsystems: the achievement, attachment-affiliative, aggressive-
protective, dependency, ingestive, eliminative, and sexual
subsystems.

Anne Boykin and Savina O. Schoenhofer

 The Theory of Nursing as Caring: A Model for Transforming
Practice
 Nursing is an “exquisitely interwoven” unity of aspects of the
discipline and profession of nursing.
 Nursing’s focus and aim as a discipline of knowledge and a
professional service are “nurturing persons living to care and
growing in caring.”
 Caring in nursing is “an altruistic, active expression of love, and is
the intentional and embodied recognition of value and
connectedness.”

Afaf Ibrahim Meleis

 Transitions Theory
 It began with observations of experiences faced as people deal
with changes related to health, well-being, and the ability to care
for themselves.
 Types of transitions include developmental, health and illness,
situational, and organizational.
  Acknowledges the role of nurses as they help people go through
health/illness and life transitions.
 Focuses on assisting nurses in facilitating patients’, families’, and
communities’ healthy transitions.

Nola J. Pender
See Also: Nola Pender: Health Promotion Model

 Health Promotion Model

 Describes the interaction between the nurse and the consumer
while considering the role of the health promotion environment.
 It focuses on three areas: individual characteristics and
experiences, behavior-specific cognitions and affect, and
behavioral outcomes.
 Describes the multidimensional nature of persons as they interact
within their environment to pursue health.

Madeleine M. Leininger
See Also:  Madeleine M. Leininger: Transcultural Nursing Theory

 Culture Care Theory of Diversity and Universality

 Defined transcultural nursing as “a substantive area of study and
practice focused on comparative cultural care (caring) values,
beliefs, and practices of individuals or groups of similar or
different cultures to provide culture-specific and universal nursing
care practices in promoting health or well-being or to help people
to face unfavorable human conditions, illness, or death in
culturally meaningful ways.”
 Involves learning and understanding various cultures regarding
nursing and health-illness caring practices, beliefs, and values to
implement significant and efficient nursing care services to people
according to their cultural values and health-illness context.
 It focuses on the fact that various cultures have different and
unique caring behaviors and different health and illness values,
beliefs, and patterns of behaviors.

Margaret A. Newman
 Health as Expanding Consciousness
  “Nursing is the process of recognizing the patient in relation to
the environment, and it is the process of the understanding of
consciousness.”
 “The theory of health as expanding consciousness was stimulated
by concern for those for whom health as the absence of disease
or disability is not possible . . . “
 Nursing is regarded as a connection between the nurse and
patient, and both grow in the sense of higher levels of
consciousness.

Rosemarie Rizzo Parse

 Human Becoming Theory
 “Nursing is a science, and the performing art of nursing is
practiced in relationships with persons (individuals, groups, and
communities) in their processes of becoming.”
 Explains that a person is more than the sum of the parts, the
environment, and the person is inseparable and that nursing is a
human science and art that uses an abstract body of knowledge
to help people.
 It centered around three themes: meaning, rhythmicity, and
transcendence.

Helen C. Erickson, Evelyn M. Tomlin, and Mary

Ann P. Swain
 Modeling and Role-Modeling
 “Nursing is the holistic helping of persons with their self-care
activities in relation to their health . . . The goal is to achieve a
state of perceived optimum health and contentment.”
 Modeling is a process that allows nurses to understand the
unique perspective of a client and learn to appreciate its
importance.
 Role-modeling occurs when the nurse plans and implements
interventions that are unique for the client.

Gladys L. Husted and James H. Husted

 Created the Symphonological Bioethical Theory
  “Symphonology (from ‘symphonia,’ a Greek word meaning
agreement) is a system of ethics based on the terms and
preconditions of an agreement.”
 Nursing cannot occur without both nurse and patient. “A nurse
takes no actions that are not interactions.”
 Founded on the singular concept of human rights, the essential
agreement of non-aggression among rational people forms the
foundation of all human interaction.

Ramona T. Mercer
 Maternal Role Attainment—Becoming a Mother
 “Nursing is a dynamic profession with three major foci: health
promotion and prevention of illness, providing care for those who
need professional assistance to achieve their optimal level of
health and functioning, and research to enhance the knowledge
base for providing excellent nursing care.”
 “Nurses are the health professionals having the most sustained
and intense interaction with women in the maternity cycle.”
 Maternal role attainment is an interactional and developmental
process occurring over time. The mother becomes attached to her
infant, acquires competence in the caretaking tasks involved in
the role, and expresses pleasure and gratification. (Mercer, 1986).
 Provides proper health care interventions for nontraditional
mothers for them to favorably adopt a strong maternal identity.

Merle H. Mishel
 Uncertainty in Illness Theory
 Presents a comprehensive structure to view the experience of
acute and chronic illness and organize nursing interventions to
promote optimal adjustment.
 Describes how individuals form meaning from illness-related
situations.
 The original theory’s concepts were organized in a linear model
around the following three major themes: Antecedents of
uncertainty, Process of uncertainty appraisal, and Coping with
uncertainty.
Pamela G. Reed
 Self-Transcendence Theory
 Self-transcendence refers to the fluctuation of perceived
boundaries that extend the person (or self) beyond the immediate
and constricted views of self and the world (Reed, 1997).
 Has three basic concepts: vulnerability, self-transcendence, and
well-being.
 Gives insight into the developmental nature of humans associated
with health circumstances connected to nursing care.

Carolyn L. Wiener and Marylin J. Dodd

 Theory of Illness Trajectory
 “The uncertainty surrounding a chronic illness like cancer is the
uncertainty of life writ large. By listening to those who are
tolerating this exaggerated uncertainty, we can learn much about
the trajectory of living.”
 Provides a framework for nurses to understand
how cancer patients stand uncertainty manifested as a loss of
control.
 Provides new knowledge on how patients and families endure
uncertainty and work strategically to reduce uncertainty through a
dynamic flow of illness events, treatment situations, and varied
players involved in care organization.

Georgene Gaskill Eakes, Mary Lermann Burke,

and Margaret A. Hainsworth
 Theory of Chronic Sorrow
 “Chronic sorrow is the presence of pervasive grief-related feelings
that have been found to occur periodically throughout the lives of
individuals with chronic health conditions, their family caregivers
and the bereaved.”
 This middle-range theory defines the aspect of chronic sorrow as
a normal response to the ongoing disparity created by the loss.
Phil Barker
 Barker’s Tidal Model of Mental Health Recovery is widely used
in mental health nursing.
 It focuses on nursing’s fundamental care processes, is universally
applicable, and is a practical guide for psychiatry and mental
health nursing.
 Draws on values about relating to people and help others in their
moments of distress. The values of the Tidal Model are revealed in
the Ten Commitments: Value the voice, Respect the language,
Develop genuine curiosity, Become the apprentice, Use the
available toolkit, Craft the step beyond, Give the gift of time,
Reveal personal wisdom, Know that change is constant, and Be
transparent.

Katharine Kolcaba
 Theory of Comfort
 “Comfort is an antidote to the stressors inherent in health care
situations today, and when comfort is enhanced, patients and
families are strengthened for the tasks ahead. Also, nurses feel
more satisfied with the care they are giving.”
 Patient comfort exists in three forms: relief, ease, and
transcendence. These comforts can occur in four contexts:
physical, psychospiritual, environmental, and sociocultural.
 As a patient’s comfort needs change, the nurse’s interventions
change, as well.

Cheryl Tatano Beck

 Postpartum Depression Theory
 “The birth of a baby is an occasion for joy—or so the saying goes
[…] But for some women, joy is not an option.”
 Described nursing as a caring profession with caring obligations
to persons we care for, students, and each other.
 Provides evidence to understand and
prevent postpartum depression.

Kristen M. Swanson
 Theory of Caring
  “Caring is a nurturing way of relating to a valued other toward
whom one feels a personal sense of commitment and
responsibility.”
 Defines nursing as informed caring for the well-being of others.
 Offers a structure for improving up-to-date nursing practice,
education, and research while bringing the discipline to its
traditional values and caring-healing roots.

Cornelia M. Ruland and Shirley M. Moore

 Peaceful End-of-Life Theory
 The focus was not on death itself but on providing a peaceful and
meaningful living in the time that remained for patients and their
significant others.
 The purpose was to reflect the complexity involved in caring for
terminally ill patients.