Guide To Nursing Theories
Guide To Nursing Theories
Guide To Nursing Theories
Nursing Theories?
Nursing theories are organized bodies of knowledge to define what nursing is,
what nurses do, and why do 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 the
practice of nursing at a more concrete and specific level.
Defining Terms
Development of nursing theory demands an understanding of selected
terminologies, definitions, and assumptions.
Late
1800s– Nursing viewed as an apprenticeship
1900
1970s Journals published: Research in Nursing and Health, Advances in Nursing Science, and
National Center for Nursing for Nursing Research (NCNR) established within the
NCNR renamed the National Institute for Nursing Research (NINR) in 1993
Chronic illnesses
2000
NINR research priorities: quality and cost effectiveness of care; health promotion and disease
prevention; management of symptoms; adaptation to new technologies; health disparities; palliative
care at the end of life budget: over $70 million
Person, Nursing, Environment, and Health – the four main concepts that make up the nursing
metaparadigm.
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 surrounds 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 attributes, characteristics, and actions of the nurse providing 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 in
accordance with their orientation, nursing experience, and different factors that
affect the theorist’s view of nursing. 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)
Phenomenon
A term given to describe an idea or responses 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.
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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.
Definitions
Definitions are used to convey the general meaning of the concepts of the theory.
Definitions can be theoretical or operational.
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 are
statements that explain the nature of concepts, definitions, purpose, relationships,
and structure of a theory.
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. The unique language in these models 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 to enhance the status of the profession.
In Research
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 the societal duties and responsibilities, there need 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, the
introduction of any framework that encourages nurses to reflect on, question, and
think about what they do provide an invaluable service.
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.
Levels of Nursing Theory According to Abstraction
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 as compared to 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.
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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
Explanatory Theory
Prescriptive Theories
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. 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. 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
perspective of the model or theory from which they are derived. Examples
of Middle-Range theories are that of Mercer, Reed, Mishel, and Barker.
Florence Nightingale
See Also: Florence Nightingale: Environmental Theory and Biography
Virginia Henderson
See Also: Virginia Henderson: Nursing Need Theory
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
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 goal of the profession, 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.
Jean Watson
See Also: Jean Watson: Theory of Human Caring
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 during a time
when nurses are rewarded more for efficiency, technical skills, and
measurable outcome.
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, it is necessary that the nurse is 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 as the basis of research,
education, and clinical practice.
Martha E. Rogers
See Also: Martha Rogers: Theory of Unitary Human Beings
Dorothea E. Orem
See Also: Dorothea E. Orem: Self-Care Theory
Imogene M. King
See Also: Imogene M. King: Theory of Goal Attainment
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Betty Neuman
See Also: Betty Neuman: Neuman’s Systems Model
Dorothy E. Johnson
See Also: Dorothy E. Johnson: Behavioral Systems Model
Nola J. Pender
See Also: Nola Pender: Health Promotion Model
Madeleine M. Leininger
See Also: Madeleine M. Leininger: Transcultural Nursing Theory
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.
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 in which the mother becomes attached to her infant,
acquires competence in the caretaking tasks involved in the role, and
expresses pleasure and gratification in the role. (Mercer, 1986).
Provides proper health care interventions for nontraditional mothers in
order for them to favorably adopt a strong maternal identity.
Merle H. Mishel
Uncertainty in Illness Theory
Presents a comprehensive structure within which to view the experience
of acute and chronic illness and to 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.
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. In addition, 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.
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.