Nursing Theories and Theorists: The Definitive Guide for Nurses

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.
 Florence Nightingale

 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.

Florence Nightingale (12 May 1820 – 13 August 1910) was a nurse who contributed to developing
and shaping the modern nursing practice and has set examples for nurses who are standards for
today’s profession. Nightingale is the first nurse theorist well-known for developing the Environmental
Theory that revolutionized nursing practices to create sanitary conditions for patients to get care. She
is recognized as the founder of modern nursing. During the Crimean War, she tended to wounded
soldiers at night and was known as “The Lady with the Lamp.”

Nightingale’s Environmental Theory

The Environmental Theory by Florence Nightingale defined Nursing as “the act of utilizing the
environment of the patient to assist him in his recovery.” It involves the nurse’s initiative to
configure environmental settings appropriate for the gradual restoration of the patient’s health and that
external factors associated with the patient’s surroundings affect the life or biologic and physiologic
processes and his development. Nightingale discussed the Environmental Theory in her book Notes
on Nursing: What it is, What it is Not. She is considered the first theorist in nursing and paved the way
in the foundation of the nursing profession we know today.

Assumptions of Florence Nightingale’s Theory

The assumptions of Florence Nightingale in her Environmental Theory are as follows:
 Florence Nightingale believed that five points were essential in achieving a healthful
house: “pure air, pure water, efficient drainage, cleanliness, and light.”
 A healthy environment is essential for healing. She stated that “nature alone cures.”
 Nurses must make accurate observations of their patients and report the state of the
patient to the physician in an orderly manner.
 Nursing is an art, whereas medicine is a science. Nurses are to be loyal to the medical
plan but not servile.

Hildegard E. Peplau

 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.

Description

 Hildegard E. 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
especially educated to recognize, respond to the need for help.” It is a “maturing force and an
educative instrument” involving an interaction between two or more individuals with a common
goal.

 In nursing, this common goal provides the incentive for the therapeutic process in which the
nurse and patient respect each other as individuals, both of them learning and growing due to
the interaction. An individual learns when she or he selects stimuli in the environment and then
reacts to these stimuli.
 Assumptions

 Hildegard Peplau’s Interpersonal Relations Theory’s assumptions are:

1) Nurse and the patient can interact.
2) Peplau emphasized that both the patient and nurse mature as the result of the
therapeutic interaction.
3) Communication and interviewing skills remain fundamental nursing tools.
4) Peplau believed that nurses must clearly understand themselves to promote their
client’s growth and avoid limiting their choices to those that nurses value.

Virginia Henderson

 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.”

Virginia Avenel Henderson

(November 30, 1897 – March 19, 1996) was a nurse, theorist, and author known for her Need
Theory and defining 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 (or to peaceful death)
that he would perform unaided if he had the necessary strength, will or knowledge.” Henderson is also
known as “The First Lady of Nursing,” “The Nightingale of Modern Nursing,” “Modern-Day Mother of
Nursing,” and “The 20th Century Florence Nightingale.”

Virginia Henderson’s Need Theory

Virginia Henderson developed the Nursing Need Theory to define the unique focus of nursing
practice. The theory focuses on the importance of increasing the patient’s independence to hasten
their progress in the hospital. Henderson’s theory emphasizes the basic human needs and how
nurses can meet those needs.
“I believe that the function the nurse performs is primarily an independent one – that of acting
for the patient when he lacks knowledge, physical strength, or the will to act for himself as he would
ordinarily act in health or in carrying out prescribed therapy. This function is seen as complex and
creative, as offering unlimited opportunity to apply the physical, biological, and social sciences and the
development of skills based on them.” (Henderson, 1960)

Assumptions of the Need Theory

Virginia Henderson’s Need Theory assumptions are:

1) Nurses care for patients until they can care for themselves once again. Although not
precisely explained,
2) patients desire to return to health.
3) Nurses are willing to serve, and “nurses will devote themselves to the patient day and
night.”
4) Henderson also believes that the “mind and body are inseparable and are interrelated.”
 Faye Glenn Abdellah
 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.

Abdellah’s 21 Nursing Problems Theory

According to Faye Glenn Abdellah’s 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.”
The patient-centered approach to nursing was developed from Abdellah’s practice, and the
theory is considered a human needs theory. It was formulated to be an instrument for nursing
education, so it most suitable and useful in that field. The nursing model is intended to guide care in
hospital institutions but can also be applied to community health nursing, as well.
Assumptions
The assumptions Abdellah’s “21 Nursing Problems Theory” relate to change and anticipated changes
that affect nursing; the need to appreciate the interconnectedness of social enterprises and social
problems; the impact of problems such as poverty, racism, pollution, education, and so forth on health
and health care delivery; changing nursing education; continuing education for professional nurses;
and development of nursing leaders from underserved groups.
1. Learn to know the patient.
2. Sort out relevant and significant data.
3. Make generalizations about available data concerning similar nursing problems
presented by other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and make additional generalizations.
6. Validate the patient’s conclusions about his nursing problems.
7. Continue to observe and evaluate the patient over a period of time to identify any
attitudes and clues affecting this behavior.
8. Explore the patient’s and family’s reaction to the therapeutic plan and involve them in
the plan.
9. Identify how the nurse feels about the patient’s nursing problems.
10. Discuss and develop a comprehensive nursing care plan.
 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

 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.

Description
 Lydia Hall’s theory define 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.
 As Hall says, “To look at and listen to self is often too difficult without the help of a significant
figure (nurturer) who has learned how to hold up a mirror and sounding board to invite the
behaver to look and listen to himself. If he accepts the invitation, he will explore the concerns in
his acts. As he listens to his exploration through the reflection of the nurse, he may uncover in
sequence his difficulties, the problem area, his problem, and eventually the threat which is
dictating his out-of-control behavior.”

Assumptions
 Hall’s Care, Cure, Core Theory assumptions are as follows:
1) The motivation and energy necessary for healing exist within the patient rather than in
the healthcare team.
2) The three aspects of nursing should not be viewed as functioning independently but as
interrelated.
3) The three aspects interact, and the circles representing them change the size,
depending on the patient’s total course of progress .

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

 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.

Ida Jean Orlando-Pelletier

(August 12, 1926 – November 28, 2007) was an internationally known psychiatric health nurse,
theorist, and researcher who developed the “Deliberative Nursing Process Theory.” Her theory
allows nurses to create an effective nursing care plan that can also be easily adapted when and if any
complications arise with the patient.

Orlando’s Deliberative Nursing Process Theory

One important thing that nurses do is converse with the patients and let them know what the
plan of care will be. However, regardless of how well thought out a nursing care plan is for a patient,
unexpected problems to the patient’s recovery may arise at any time. With these, the nurse’s job is to
know how to deal with those problems so the patient can continue to get back and reclaim his or her
well-being. Ida Jean Orlando developed her Deliberative Nursing Process that 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.
Ida Jean Orlando’s nursing theory stresses the reciprocal relationship between patient and
nurse. It emphasizes the critical importance of the patient’s participation in the nursing process.
Orlando also considered nursing as a distinct profession. He separated it from medicine, where nurses
determining nursing action rather than being prompted by physician’s orders, organizational needs,
and past personal experiences. She believed that the physician’s orders are for patients and not for
nurses.
 She proposed that “patients have their own meanings and interpretations of situations and
therefore nurses must validate their inferences and analyses with patients before concluding.”

Assumptions
Ida Jean Orlando’s model of nursing makes the following assumptions:
1. When patients cannot cope with their needs on their own, they become distressed by
feelings of helplessness.
2. In its professional character, nursing adds to the distress of the patient.
3. Patients are unique and individual in how they respond.
4. Nursing offers mothering and nursing analogous to an adult who mothers and nurtures
a child.
5. The practice of nursing deals with people, the environment, and health.
6. Patients need help communicating their needs; they are uncomfortable and ambivalent
about their dependency needs.
7. People can be secretive or explicit about their needs, perceptions, thoughts, and
feelings.
8. The nurse-patient situation is dynamic; actions and reactions are influenced by both the
nurse and the patient.
9. People attach meanings to situations and actions that aren’t apparent to others.
10. Patients enter into nursing care through medicine.
11. The patient cannot state the nature and meaning of his or her distress without the
nurse’s help or him or her first having established a helpful relationship with the patient.
12. Any observation shared and observed with the patient is immediately helpful in
ascertaining and meeting his or her need or finding out that he or she is not in need at
that time.
13. Nurses are concerned with the needs the patient is unable to meet on his or her own.

Jean Watson

 She pioneered the Philosophy and Theory of Transpersonal Caring.

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

Theory of Human Caring of Jean Watson

 Nowadays, a lot of people choose nursing as a profession. There are many reasons to
consider becoming a professional nurse, but compassion is often a trait required of nurses.
This is for the reason that taking care of the patients’ needs is its primary purpose. Jean
Watson’s “Philosophy and Theory of Transpersonal Caring” mainly concerns how nurses
care for their patients and how that caring progresses into better plans to promote health and
wellness, prevent illness and restore health.

 In today’s world, nursing seems to be responding to the various demands of the machinery
with less consideration of the needs of the person attached to the machine. In Watson’s view,
the disease might be cured, but illness would remain because, without caring, health is not
attained. Caring is the essence of nursing and connotes responsiveness between the nurse
and the person; the nurse co-participates with the person. Watson contends that caring can
help the person gain control, become knowledgeable, and promote healthy changes.

What is Watson’s Theory of Transpersonal Caring?

 According to Watson’s theory, “Nursing is concerned with promoting health, preventing illness,
caring for the sick, and restoring health.” It focuses on health promotion, as well as the
treatment of diseases. According to Watson, caring is central to nursing practice and promotes
health better than a simple medical cure.

 The nursing model also states that caring can be demonstrated and practiced by nurses.
Caring for patients promotes growth; a caring environment accepts a person as they are and
looks to what they may become.
 Assumptions
 Watson’s model makes seven assumptions:
1) Caring can be effectively demonstrated and practiced only interpersonally.
2) Caring consists of carative factors that result in the satisfaction of certain human needs.
3) Effective caring promotes health and individual or family growth.
4) Caring responses accept the patient as he or she is now, as well as what he or she
may become.
5) A caring environment offers the development of potential while allowing the patient to
choose the best action for themselves at a given point in time. (6) The science of caring
is complementary to the science of curing. (7) The practice of caring is central to
nursing.

Carative Factors and Caritas Processes

Carative Factors Caritas Process

1. “The formation of a humanistic- “Practice of loving-kindness and equanimity within

altruistic system of values.” the context of caring consciousness.”

“Being authentically present and enabling and

2. “The instillation of faith-hope.” sustaining the deep belief system and subjective life-
world of self and one being cared for.”

3. “The cultivation of sensitivity to “Cultivation of one’s own spiritual practices and

one’s self and others.” transpersonal self going beyond the ego-self.”

4. “Development of a helping-trust
relationship” became “development “Developing and sustaining a helping trusting,
of a helping-trusting, human caring authentic caring relationship.”
relation” (in 2004 Watson website)

“Being present to, and supportive of, the expression

5. “The promotion and acceptance
of positive and negative feelings as a connection
of the expression of positive and
with deeper spirit and self and the one-being-cared
negative feelings.”
for.”

6. “The systematic use of the

scientific problem-solving method for
“Creative use of self and all ways of knowing as part
decision making” became
of the caring process; to engage in the artistry of
“systematic use of a creative
caring-healing practices.”
problem solving caring process” (in
2004 Watson website)

“Engaging in genuine teaching-learning experience

7. “The promotion of transpersonal
that attends to the unity of being and meaning,
teaching-learning.”
attempting to stay within others’ frame of reference.”

8. “The provision of the supportive, “Creating healing environment at all levels (physical
protective, and (or) corrective as well as the nonphysical, subtle environment of
mental, physical, societal, and energy and consciousness, whereby wholeness,
spiritual environment.” beauty, comfort, dignity, and peace are potentiated)”

“Assisting with basic needs, with an intentional

caring consciousness, administering ‘human care
9. “The assistance with the
essentials,’ which potentiate alignment of mind-
gratification of human needs.”
body-spirit, wholeness, and unity of being in all
aspects of care.”

10. “The allowance for existential-

phenomenological forces” became “Opening and attending to spiritual-mysterious and
“allowance for existential- existential dimensions of one’s own life-death; soul
phenomenological spiritual forces” care for self and the one-being-cared for”
(in 2004 Watson website)
 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

 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.

Nursing Theory: The Conservation Model

Levine’s conservation model believes nursing intervention is a conservation activity, with energy
conservation as a fundamental concern, four conservation principles of nursing. It guides nurses to
concentrate on the importance and responses at the level of the person. Nurses fulfill the theory’s
purpose by conserving energy, structure, and personal and social integrity.

Every patient has a different array of adaptive responses, which vary based on personal factors,
including age, gender, and illness. The fundamental concept of Myra Estrin Levine’s theory is
conservation. When an individual is in a phase of conservation, it means that the person can adapt to
the health challenges with the slightest amount of effort. The core of Levine’s Conservation Model is to
improve a person’s physical and emotional well-being by considering the four domains of conservation
she set out. By proposing to address the conservation of energy, structure, and personal and social
integrity, this nursing theory helps guide nurses in providing care that will help maintain and promote
the health of the patient.

What is the Conservation Model?

The core of the conservation model is to improve a person’s physical and emotional well-being by
considering the four domains of conservation she set out. Nursing’s role in conservation is to help the
person with the process of “keeping together” the total person through the least amount of effort.
Levine (1989) proposed the following four principles of conservation:

1. The conservation of energy of the individual.

2. The conservation of the structural integrity of the individual.
3. The conservation of the personal integrity of the individual.
4. The conservation of the social integrity of the individual.
“The conservation principles do not, of course, operate singly and in isolation from each other. They
are joined within the individual as a cascade of life events, churning and changing as the
environmental challenge is confronted and resolved in each individual’s unique way. The nurse as
a caregiver becomes part of that environment, bringing to every nursing opportunity his or her own
cascading repertoire of skill, knowledge, and compassion. It is a shared enterprise, and each
participant is rewarded.” (Levine, 1989).

Assumptions
The following are the major assumptions of The Conservation Model.

Assumptions About Individuals

Each individual “is an active participant in interactions with the environment… constantly seeking
information from it.” (Levine, 1969)

The individual “is a sentient being, and the ability to interact with the environment seems ineluctably
tied to his sensory organs.”

“Change is the essence of life, and it is unceasing as long as life goes on. Change is characteristic of
life.” (Levine, 1973)

Assumptions About Nursing

“Ultimately, the decisions for nursing intervention must be based on the unique behavior of the
individual patient.”

“Patient-centered nursing care means individualized nursing care. It is predicated on the reality of
common experience: every man is a unique individual, and as such he requires a unique constellation
of skills, techniques, and ideas designed specifically for him.” (Levine, 1973)

Martha E. Rogers

 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

 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.

Dorothea Orem’s Self-Care Deficit Theory

 There are instances wherein patients are encouraged to bring out the best in them despite
being ill for a period of time. This is very particular in rehabilitation settings, in which patients
are entitled to be more independent after being cared for by physicians and nurses. Between
1959 and 2001, Dorothea Orem developed the Self-Care Nursing Theory or the Orem Model of
Nursing. It is considered a grand nursing theory, which means the theory covers a broad scope
with general concepts applicable to all instances of nursing.

Description
 Dorothea Orem’s Self-Care Deficit Theory 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.” It focuses on each individual’s ability to perform self-care, defined
as “the practice of activities that individuals initiate and perform on their own behalf in
maintaining life, health, and well-being.”

 “The condition that validates the existence of a requirement for nursing in an adult is the
absence of the ability to maintain continuously that amount and quality of self-care which is
therapeutic in sustaining life and health, in recovering from disease or injury, or in coping with
their effects. With children, the condition is the parent’s inability (or guardian) to maintain
continuity for the child the amount and quality of care that is therapeutic.” (Orem, 1991)

Assumptions of the Self-Care Deficit Theory

 Dorothea Orem’s Self-Care Theory assumptions are: (1) To stay alive and remain functional,
humans engage in constant communication and connect among themselves and their
environment. (2) The power to act deliberately is exercised to identify needs and to make
needed judgments. (3) Mature human beings experience privations in the form of action in care
of self and others involving making life-sustaining and function-regulating actions. (4) Human
agency is exercised in discovering, developing, and transmitting to others ways and means to
identify needs for, and make inputs into, self and others. (5) Groups of human beings with
structured relationships cluster tasks and allocate responsibilities for providing care to group
members.

Imogene M. King

 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.

Theory of Goal Attainment

 The Theory of Goal Attainment states that “Nursing is a process of action, reaction, and
interaction whereby nurse and client share information about their perception in the nursing
situation.”
 Imogene 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 factors that affect the attainment of goals are roles, stress,
space, and time. On the other hand, the nurse’s goal is to help patients maintain health so they
can function in their individual roles. The nurse’s function is to interpret information in
the nursing process, plan, implement, and evaluate nursing care.

Theory of Goal Attainment of Imogene King

 Some people consider their “success” after being hired in a great and well-known institution.
But when someone decides to pursue a career in nursing, one should set his or her mind that
they should be an instrument in helping patients get healthy. And to achieve that, it’s important
to set health goals with the patient, then take steps to achieve those goals.

 Imogene M. King’s 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 good
health goals.

 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.

 King has interrelated the concepts of interaction, perception, communication, transaction, self,
role, stress, growth and development, time, and space into a goal attainment theory. Her
theory deals with a nurse-client dyad, a relationship to which each person brings personal
perceptions of self, role, and personal growth and development levels. The nurse and client
communicate, first in interaction and then in the transaction, to attain mutually set goals. The
relationship takes place in space identified by their behaviors and occurs in forward-moving
time.

What is Theory of Goal Attainment?

 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 activity,
and the reaction is included in the sequence of behaviors described in action. King states that
a nurse’s goal is to help individuals 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.”

Propositions
 The following propositions are made in Imogene King’s Theory of Goal Attainment: (1) If
perceptual interaction accuracy is present in nurse-patient interactions, the transaction will
occur. (2) If the nurse and patient make the transaction, the goal or goals will be achieved. (3)
If the goal or goals are achieved, satisfaction will occur. (4) If the goal or goals are achieved,
effective nursing care will occur. (5) If transactions are made in nurse-patient interactions,
growth and development will be enhanced. (6) If role expectations and role performance
perceived by the nurse and patient are congruent, the transaction will occur. (7) If role conflict
is experienced by either the nurse or the patient (or both), stress in the nurse-patient
interaction will occur. (8) If a nurse with special knowledge communicates appropriate
information to the patient, mutual goal-setting and goal achievement will occur.

Assumptions
 Imogene King’s personal philosophy about human beings and life influenced her assumptions
about the environment, health, nursing, individuals, and nurse-patient interactions. King’s
conceptual system and Theory of Goal Attainment were “based on an overall assumption that
 the focus of nursing is human beings interacting with their environment, leading to a state of
health for individuals, which is an ability to function in social roles.”

 The assumptions are:

1) The focus of nursing is the care of the human being (patient).
2) The goal of nursing is the health care of both individuals and groups.
3) Human beings are open systems interacting with their environments constantly.
4) The nurse and patient communicate information, set goals mutually, and then act to
achieve those goals. This is also the basic assumption of the nursing process.
5) Patients perceive the world as a complete person making transactions with individuals
and things in the environment.
6) The transaction represents a life situation in which the perceiver and the thing being
perceived are encountered. It also represents a life situation in which a person enters
the situation as an active participant. Each is changed in the process of these
experiences.
Betty Neuman

 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’s Nursing Theory

 Three words frequently used concerning stress are inevitable, painful, and intensifying. It is
generally subjective and can be interpreted as the circumstances of conceivably threatening
and out of their control. A nursing theory developed by Betty Neuman is based on the person’s
relationship to stress, response, and reconstitution factors that are progressive in nature. The
Neuman Systems Model presents a broad, holistic, and system-based method to nursing that
maintains a factor of flexibility. It focuses on the patient system’s response to actual or
potential environmental stressors and maintains the client system’s stability through primary,
secondary, and tertiary nursing prevention interventions to reduce stressors.

What is the Neuman Systems Model?

 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 several 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 health level is identified as the normal defense line
protected by a flexible line of defense. Stressors are intra-, inter-, and extra personal 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.
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 defense line 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.
Assumptions
The following are the assumptions or “accepted truths” made by Neuman’s Systems Model:

 Each client system is unique, a composite of factors and characteristics within a given
range of responses.
 Many known, unknown, and universal stressors exist. Each differs in its potential for
disturbing a client’s usual stability level or normal line of defense. The particular
interrelationships of client variables at any point in time can affect the degree to which a
client is protected by the flexible line of defense against possible reaction to stressors.
 Each client/client system has evolved a normal range of responses to the environment
referred to as a normal line of defense. The normal line of defense can be used as a
standard from which to measure health deviation.
 When the flexible line of defense is no longer capable of protecting the client/client
system against an environmental stressor, the stressor breaks through the normal line
of defense.
 Whether in a state of wellness or illness, the client is a dynamic composite of the
variables’ interrelationships. Wellness is on a continuum of available energy to support
the system in an optimal system stability state.
 Implicit within each client system is internal resistance factors known as lines of
resistance, which function to stabilize and realign the client to the usual wellness state.
 Primary prevention relates to general knowledge applied in client assessment and
intervention in identifying and reducing or mitigating possible or actual risk factors
associated with environmental stressors to prevent a possible reaction.
 Secondary prevention relates to symptomatology following a reaction to stressors, an
appropriate ranking of intervention priorities, and treatment to reduce their noxious
effects.
 Tertiary prevention relates to the adjustive processes as reconstitution begins and
maintenance factors move the client back in a circular manner toward primary
prevention.
 The client as a system is in dynamic, constant energy exchange with the environment.
(Neuman, 1995)

Sister Callista Roy

 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.

Callista Roy’s Adaptation Model of Nursing

 The Adaptation Model of Nursing is a prominent nursing theory aiming to explain or
define the provision of nursing science. In her theory, Sister Callista Roy’s model sees
the individual as a set of interrelated systems that maintain a balance between various
stimuli.
 The Roy Adaptation Model was first presented in the literature in an article published
in Nursing Outlook in 1970 entitled “Adaptation: A Conceptual Framework for
Nursing.” In the same year, Roy’s Adaptation Model of Nursing was adapted in Mount
St. Mary’s School in Los Angeles, California.
 Roy’s model was conceived when nursing theorist Dorothy Johnson challenged her
students to develop conceptual models of nursing during a seminar. Johnson’s nursing
model was the impetus for the development of Roy’s Adaptation Model.
 Roy’s model incorporated concepts from Adaptation-level Theory of Perception from
renowned American physiological psychologist Harry Helson, Ludwig von Bertalanffy’s
System Model, and Anatol Rapoport’s system definition.
 First, consider the concept of a system as applied to an individual. Roy conceptualizes
the person in a holistic perspective. Individual aspects of parts act together to form a
unified being. Additionally, as living systems, persons are in constant interaction with
their environments. Between the system and the environment occurs an exchange of
information, matter, and energy. Characteristics of a system include inputs, outputs,
controls, and feedback.
Assumptions:

Scientific Assumptions
 Systems of matter and energy progress to higher levels of complex self-organization.
 Consciousness and meaning are constructive of person and environment integration.
 Awareness of self and environment is rooted in thinking and feeling.
 Humans, by their decisions, are accountable for the integration of creative processes.
 Thinking and feeling mediate human action.
 System relationships include acceptance, protection, and fostering of interdependence.
 Persons and the earth have common patterns and integral relationships.
 Persons and environment transformations are created in human consciousness.
 Integration of human and environmental meanings results in adaptation.

Philosophical Assumptions
 Persons have mutual relationships with the world and God.
 Human meaning is rooted in the omega point convergence of the universe.
 God is intimately revealed in the diversity of creation and is the common destiny of
creation.
 Persons use human creative abilities of awareness, enlightenment, and faith.
 Persons are accountable for the processes of deriving, sustaining, and transforming the
universe.

Dorothy E. Johnson

 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.

Johnson’s Behavioral System Model

 Dorothy E. Johnson is well-known for her “Behavioral System Model,” which was first
proposed in 1968. Her model was greatly influenced by Florence Nightingale’s book, Notes on
Nursing. It advocates fostering 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.
 Johnson’s Behavioral System Model is a nursing care model that advocates the fostering of
efficient and effective behavioral functioning in the patient to prevent illness. The patient is
identified as a behavioral system composed of seven behavioral subsystems: affiliative,
dependency, ingestive, eliminative, sexual, aggressive, and achievement. Each subsystem’s
three functional requirements include protection from noxious influences, provision for a
nurturing environment, and stimulation for growth. An imbalance in any of the behavioral
subsystems results in disequilibrium. It is nursing’s role to assist the client in returning to a
state of equilibrium.

What is Behavioral System Model?

 Dorothy Johnson’s theory defined Nursing as “an external regulatory force which acts to
preserve the organization and integration of the patient’s 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.”
 It also states that “each individual has patterned, purposeful, repetitive ways of acting that
comprises a behavioral system specific to that individual.”

Assumptions of the Behavioral System Model

 The assumptions made by Dorothy Johnson’s theory are in three categories: assumptions
about system, assumptions about structure, and assumptions about functions.
 Johnson identified several assumptions that are critical to understanding the nature and
operation of the person as a behavioral system:
1) There is “organization, interaction, interdependency and integration of the parts and
elements of behaviors that go to make up the system.”
2) A system “tends to achieve a balance among the various forces operating within and
upon it, and that man strives continually to maintain a behavioral system balance and
steady-state by more or less automatic adjustments and adaptations to the natural
forces occurring on him.”
3) A behavioral system, which requires and results in regularity and constancy in
behavior, is essential to man. It is functionally significant because it serves a useful
purpose in social life and the individual. And
4) “System balance reflects adjustments and adaptations that are successful in some way
and to some degree.”

 The four assumptions about structure and function are that:

1) “From the form the behavior takes and the consequences it achieves can be inferred
what ‘drive’ has been stimulated or what ‘goal’ is being sought.”
2) Each person has a “predisposition to act concerning the goal, in certain ways rather
than the other ways.” This predisposition is called a “set.”
3) Each subsystem has a repertoire of choices called a “scope of action.” And
4) The individual patient’s behavior produces an outcome that can be observed.

 And lastly, there are three functional requirements for the subsystems.:
1) The system must be protected from toxic influences with which the system cannot
cope.
2) Each system has to be nurtured through the input of appropriate supplies from the
environment.
3) The system must be stimulated for use to enhance growth and prevent stagnation.

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

 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

 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.

Wanda de Aguiar Horta

 Wrote the book Nursing Process which presents relevance to the various fields of
Nursing practice for providing a holistic view of the patient.
 Her work was recognized in all the teaching institutions called the Theory of Basic
Human Needs. It is based on Maslow’s Theory of Human Motivation, whose primary
concept is the hierarchy of Basic Human Needs (BHN).
 Horta’s Theory of Basic Human Needs is considered the highest point of her work, and
the summary of all her research concludes sickness as a science and art of assisting a
human being in meeting basic human needs, making the patient independent of this
assistance through education in recovery, maintenance, and health promotion.
 Classified basic human needs into three main dimensions – psychobiological,
psychosocial and psychospiritual – and establishes a relationship between the
concepts of human being, environment, and nursing.
 The theory describes nursing as an element of a healthcare team and states that it can
function efficiently through a scientific method. Horta referred this method as
the nursing process.
 She defined the nursing process as the dynamics of systematic and interrelated actions
to assist human beings. It is characterized by six phases: nursing history, nursing
diagnosis, assistance plan, care plan or nursing prescription, evolution, and prognosis.