Nursing Theories

What is a Nursing Theory

Nursing Theories: The Shapers of Modern Nursing

By definition, theory is a proposed body of belief, policy or procedure that is followed as basis for action. In relation, a nursing theory can be defined as a thorough and dynamic collaboration of ideas that aims to understand a phenomenon from a systematic and scientific point of view. Nursing theories are guidelines, providing immeasurable knowledge to nursing professionals that in turn direct nursing care and practices, both broad and specific.

I. Purpose and Uses of Nursing Theories

The uses of nursing theories vary and is utilized across the nursing profession spectrum. As intended, nursing theories serve as the core of nursing practice and are essential especially to the care of patients. Some hospitals (i.e., Magnet accredited hospitals) critically ensures that these theories are incorporated well into their policies and thereby ensuring for best practices to flourish.

Nurses incorporate a variety of nursing theories in their day-to-day practice instead of utilizing only one. As such, nursing theories likewise directs and assist bedside nurses while providing care, especially the evaluation of interventions rendered.

Nursing theories also provide direction and rationale to employed decisions in nursing care. An example of a nursing theory in action is in the care of a Jehovah’s Witness patient refusing life-saving blood transfusion.

While the nurse may not agree with the patient’s health choice, but in citing Dorothea Orem’s Self-Care theory (A theory emphasizing the role of the nurse in assisting and allowing patients to take informed choices in their own care), such choice must be respected for the patient’s self determination.

While every nurse utilizes nursing theories (in one way or another and regardless of specialization), not all are acquainted enough on the impacts of such. Because of these, nursing theories are mostly employed by nursing educators and researchers.

Nursing educators apply these theories in designing course curriculums for future nurses so that they may be guided in the rendering of patient care. Nursing researchers, on the other hand, utilize these theories in the conduct of calculated researches in order to bring forth better care practices, predict future nursing matters, or explain established phenomena.

II. Metaparadigm of Nursing Theories

Many nurse theorists have put forth a variety of nursing theories that are still relevant in nursing care. (e.g., Florence Nightingale’s Environment theory, Imogene King’s Theory of Goal, etc.). Despite the number, all nursing theories follow a set of guidelines or what we call metaparadigms.

Metaparadigms are a collective set of concepts enlisted to provide structure in any given discipline. The nursing paradigms employs four parts namely:

1. Person
2. Environment
3. Health
4. Nursing

Employing all of these four metaparadigms renders any nursing theory to be complete. These are considered fundamental in any nursing theory and the absence of one metaparadigm signifies that the proposed nursing theory is incomplete.

In addition, these four concepts correlate in the holistic approach of nursing care as is the overall health of the patient is interconnected in such.

III. Main Concepts of Nursing Theories

Jacqueline Fawcett’s Theory on the Metaparadigms of Nursing states that the central concepts of nursing fall into four categories: 1. Person; 2. Environment; 3. Health; and 4. Nursing.

Due to this concept, Nursing has been distinctly different as it defines the full context and spirit of the profession that is different from other disciplines.

Nursing theorists are free to interpret these four as they see fit and will determine how to better explain each of their respective theories.

1. Person. This is also known as the Client/ Patient/Human being. A person is the recipient of nursing care and may connote individuals, groups, or communities. Out of the four ideas, the Person is the most important for it signifies the patient himself.
2. Environment. This is also known as the situation. It is the external or internal environmental aspect that will affect the Person. This includes the positive or negative conditions, the actual physical setting, (family, significant others), and the setting for access to health care.
3. Health. It is defined as the level of wellness that the Person is already subjected to. It may have different interpretations, depending on each patient, the healthcare setting, and the healthcare provider himself.
4. Nursing. It is the collective whole and representation of the nursing care provided to the patient. It involves the characteristics and actions of the nurse while caring for the patient.

IV. Components of Nursing Theories

There are various parts for a theory to be considered a theory. They are shown below, including the interrelatedness of these components that makes up a nursing theory.

A. Phenomenon. It is the term coined to define any nursing-centric response to a given situation, event, or process (may it be single or a group), that is either temporary or permanent.

B. Concepts. Concepts define a nursing theory. They are utilized to describe and give a clearer picture of the phenomena. They can be words or phrases, either abstract or concrete. Concepts identify and establish the intricacies and boundaries of a phenomenon.

C. Definitions. Definitions are general statements used to put forth the main concepts of a nursing theory.

• Theoretical definitions are definitions given by the nursing theorist based on his/her perspective and understanding.
• Operational definitions are definitions of how these concepts are gauged and measured.

D. Relational Statements. These are links that connect and define two or more concepts, showing the relationships of these concepts and how they signify to the theory as a whole.

E. Assumptions. They are educated and accepted truths that explain the totality of a nursing theory, including concepts, relationships, definitions, structure, etc.

V. Classifications of Nursing Theories

Nursing theories can be classified according to their function, abstraction levels, or orientation of goals.

A. Types of Nursing Theories By Abstraction

There are various levels and they are enlisted below:

1. Grand Nursing theories

• These are generally broad and encompassing, oftentimes requiring further clarification and researches.

• They usually provide a nursing framework for ideas and generally do not guide focused nursing interventions.

• Grand nursing theorists base and develop their work from their own nursing career and experiences, hence the variations derived from them.

• These theories fully address the four components of the metaparadigm, namely the Person, Environment, Health and Nursing. 

• An example of a grand nursing theory is the Environmental theory by Florence Nightingale.

2. Middle range Nursing theories

• They are more limited in scope, comparing to grand nursing theories. Due to this, they mainly address and explain certain phenomena in Nursing.
• Nursing scholars had proposed on using this level due to the complex testing of grand theories.
• Most nursing theories in this level are based on a grand nursing theory but can also be derived from others such as researches, nursing practice, or theories outside of nursing.
• An example of a middle range theory is the Interpersonal Relations Theory by Hildegard Peplau.

3. Practice level Nursing Theories

• The scope of these types of theories are narrow and mainly focuses on a phenomenon experienced by a certain population in a given time.
• These theories provide the basis for nursing interventions rendered in the nursing practice, giving valuable feedback and outcomes.
• Theories arising from this type have a more direct effect on nursing interventions and scope of practice compared to grand and middle range theories.
• Oftentimes, this theory has concepts interrelated with the concepts of grand or middle range theories.
• An example of this theory is the Theory of Care transition by Afaf Meleis.

B. Types of Nursing Theories By Goal Orientation

There are various subtypes and are listed below:

1. Descriptive Theories

• Descriptive theories are regarded as the first level in theory development, with the aim of detailing the components of a nursing phenomenon as it occurs.
•  This subtype does not seek to promote changes in the nursing phenomenon.
• Descriptive theories are further subdivided into two more categories: factor-isolating theory and explanatory theory
  • Factor-isolating theory focuses on explaining the properties and limitations of nursing phenomena. This is also known as labelling theory.
  • Explanatory theory focuses on explaining the relationships of nursing phenomena when compared to others.

2. Prescriptive Theories

• Prescriptive theories aim to address nursing practice for a phenomenon, consequently opening changes and predicting effects of these changes.
• These theories focus on calls for changes in the nursing practice, anticipating consequences of nursing interventions rendered.

C. Types of Nursing Theories: Other Ways of Classification

Examples of classifications are given by:

1. Meleis. Afaf Ibahim Meleis wrote her book (author of Theoretical Nursing: Development and Progress, 2011) and classified the major nursing theories through the following:

• Needs-based theories. These are nurse theorists whose theories revolve around helping and assisting the patient to fulfill either or both of their physical and mental needs. Examples of nurse theorists under this category are Dorothea Orem (Self Care Deficit theory), Faye Abdellah (21 Nursing Problems Theory), and Virginia Henderson (14 Basic Needs Theory)
• Interaction theories. In this group, the focus of the nurse theorists revolves around the relationships, their maintenance, and establishment. Examples of nurse theorists under this category are Imogene King (Theory of Goal Attainment) and Ida Jean Orlando (Deliberative Nursing Process theory).
• Outcome theories. Another sub-group, the Outcome theories postulates that the nurse is the one who navigates the care of the patient based on their mastery of physiological and behavioral systems. Nurse theorists under this classification include Dorothy Johnson (Behavioral System Model theory), Martha Rogers (Science of Unitary Human beings), and Sister Callista Roy (Adaptation Model of Nursing).

1. Alligood. As discussed by Raile Alligood (author of Nursing Theorists and their Work, 2017) she classified the theories into four:

• Nursing Philosophy. The theories under this category are characterized as the most abstract. Theories under this have studied the nursing phenomena through careful analysis and logical presentations. Nurse theorists under this subtype include Florence Nightingale (Environmental theory) and Patricia Benner (Novice to Expert theory).
• Nursing Conceptual models. The theories under this category are considered pioneers in the field of nursing. The focus of this subgroup revolves around the nursing metaparadigm and their interconnectedness to each other. Models by Myra Estrin Levine (Conservation Model of Nursing) and Martha Rogers (Science of Unitary Human beings) fall in his category.
• Grand Nursing Theories. Under this category, the theories were derived from nursing philosophies that are general in scopes such as the Self-care Deficit theory by Dorethea Orem and the Theory of Goal Attainment by Imogene King.
• Middle-range Theories. Under this category, the theories aims to answer specific nursing practice queries like the Maternal Role attainment theory by Ramona Mercer and the Tidal Model of Mental Health Recovery by Phil Barker.

VI. Levels of Nursing Theories

Nursing theories are subdivided into three levels and they are:

Grand Nursing Theories

These theories are based on dynamic, complex, and abstract ideas or knowledge that provides a general framework of the metaparadigm concepts of Nursing. Grand nursing theories usually arise from the nursing and professional experience of the nurse theorist.

Middle range Nursing Theories

These theories are more specific when compared to grand nursing theories. They aim to focus on specific nursing problems that may arise in clinical practice, research, or theories from other bodies of knowledge.

Nursing Practice Theories

These theories are more focused than mid-range theories, and are specifically geared towards certain population groups. These theories typically impact more patients, when compared to the previous two, because its primary users are bedside nurses who render these concepts in their everyday practice.

VI. Nursing Theories in Practice

The application of nursing theories in the clinical practice is evident all throughout, even if nurses are aware or not. The importance of these theories cannot be stressed enough for they guide nursing research that consequently leads to the formulation of best practices and policies. Because of these policies, effective, efficient, and safe nursing care can be given to the patients.

In addition, these theories allow nurses to influence the health and well-being of their patients, even extending beyond nursing care at the bedside. Nursing theories help improve clinical practice in order to move the profession forward into the future.

Furthermore, nursing theories assists and guide advanced practice nurses, nursing researchers, and nurse educators in their practice of nursing and therefore, would push impactful contributions to the profession.

VII. Famous Nursing Theories and Theorists

Some famous nursing theorists and their theories are enlisted below:

A. Florence Nightingale Nursing Theory

• She is the founder of Modern Nursing and the author of the Environmental Theory
• In this theory, Nightingale stated that Nursing is “the act of using the patients’ environment in order to assist in bringing back his health.”
• Furthermore, she identified five environmental factors that are crucial in affecting the recovery and health of the patient and they are fresh air, pure water, efficient drainage systems, proper sanitation, and sunlight.

B. Hildegard Peplau Nursing Theory

• She is the author and pioneer of the Theory of Interpersonal Relations which defined Nursing as “An interpersonal process of varied interactions between an individual who is in need of health services and a nurse trained specifically to address these concerns in the most therapeutic way possible.”
• This theory enables nurses to formulate and enforce more therapeutic interventions that are more impactful in the clinical setting.

C. Virginia Henderson Nursing Theory

• She is the nursing theorist who authored the Nursing Needs Theory
• Her theory states that patients must attain and satisfy 14 needs in order to gain independence and regain back their health.
• The 14 needs that the patient should attain, through the help of the nurse, as she explained are as follows:

1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes; ability to dress and undress
7. Maintain body temperature within normal parameters either by adjustment of clothing or modification of the environment
8. Keep the body clean and protected
9. Avoid dangers in the environment to safeguard self and others
10. Communicate with others of latent fears, emotional needs, and opinions.
11. Worship according to one’s belief system
12. Work fulfillment that brings up a sense of accomplishment
13. Play and participate in healthy recreational activities
14. Learn and satisfy curiosity as part of normal development and the use of these health facilities to address these concerns.

D. Lydia E. Hall Nursing Theory

• She developed the Care, Core, Cure Theory also known as the Three C’s of Lydia Hall.
• This theory postulates that Nursing is the “participation in the care, core and cure aspects of health care. In the theory, the care is the exclusive function of a nurse; the core and cure is a collaborative effort of other members of the healthcare team. Furthermore, this theory proposes that the primary purpose of care is to achieve an interpersonal relationship with the individual in order to develop the core.

E. Kathryn E. Barnard Nursing Theory

• The nurse theorist who developed the Child Health Assessment Model.
• This model focuses on improving the health of both the infant and their families.
• The findings of her model, the parent-child interaction, is highlighted as a crucial predictor of cognitive development that in turn influenced public policies.
• She is also the founder of NCAST (Nursing Child Assessment Satellite Training Project) that produces assessment and training programs that educates parents, caregivers, etc. of the necessary skills to provide a conducive environment for young children.

F. Ida Jean Orlando Nursing Theory

• She is the author of the Nursing Process Theory.
• Her theory allowed nurses to formulate effective and efficient nursing care plans that can adapt to the ever-changing complex needs of a patient.
• The theory also states that individuals become patients, that would be dependent on nursing care when they are unable to fulfill their activities independently because of body limitations, untoward reaction to the environment, or negative experiences that prohibit the communication of concerns.
• The nurse’s goal is to correctly identify and address the patient’s health care needs.

G. Jean Watson Nursing Theory

• She is the nurse theorist responsible for the Philosophy and Theory of Transpersonal Caring.
• In this theory, it explains that “Nursing’s main concern is with health promotion, illness prevention, care for the ill and restoration of their health.”
• A major concern of this theory is how the nurses care for the patient, and how that kind of care translates to better plans for health improvement and wellness.
• This theory focuses on the promotion of health and cure of illness.

H. Martha Rogers Nursing Theory

• This theorist proposed the Theory of Human Beings. This theory states that “Nursing is both an art and science but is also innately humanistic and humanitarian.”
• The Science of Unitary Human Beings explains that there are two dimensions: the science of nursing containing the body of knowledge stemming from the scientific study; and the art of nursing wherein care given is creatively rendered for the betterment of patient lives.
• Additional points of the theory state that the patient cannot be separated from his environment, particularly when addressing his health care needs.

I. Dorothea Orem Nursing Theory

• Dorothea Orem developed the Self Care Theory where in Nursing is described as “The act of assisting others on their self-care needs in order to maintain optimal human function effectiveness.”
• The main focus is the individual’s self-determination in providing self-care.
• There are three interconnected concepts in this theory: 1. The theory of self-care; 2. The self-care deficit theory; and 3. The theory of nursing systems; subdivided further as wholly compensatory, partially compensatory, and supportive-educative. 

J. Sister Callista Roy Nursing Theory

• She is the author of the Adaptation Model of Nursing.
• This model views Nursing as “a healthcare profession with main goals on human life processes that emphasizes health promotion of individuals, families, groups, and society collectively as a whole.”
• The theory views the individual as inside an interrelated set of systems that strives to achieve balance and harmony when exposed to various stimuli.

Conclusion

Nursing theories continue to influence the world of modern nursing in the academe and in bedside practice. Putting forth and applying these concepts ensures the advancement of professional practice that will have tremendous impact on patient safety and nursing care that goes beyond conventional bedside practice.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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