What are 

Nursing Theories?
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.

Components of Nursing Theories

For a theory to be a theory, it has to contain concepts, definitions, relational
statements, and assumptions that explain a phenomenon. It should also explain
how these components relate to each other.
Phenomenon
A term given to describe an idea or response about an event, a situation, a
process, a group of events, or a group of situations. Phenomena may be
temporary or permanent. Nursing theories focus on the phenomena of nursing.

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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.

 Abstract Concepts. Defined as mentally constructed independently

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

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

 Theoretical Definitions. Define a particular concept based on the

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

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

Why are Nursing Theories

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

 Nursing theories help recognize what should set the foundation of

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

Purposes of Nursing Theories

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

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

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

Classification of Nursing Theories

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

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

Grand Nursing Theories

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

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

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

 Also known as category-formulating or labeling theory.

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

 Explanatory theories describe and explain the nature of relationships

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

Other Ways of Classifying Nursing Theories

Classification According to Meleis

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

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

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

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

In her book, Nursing Theorists and Their Work,  Raile Alligood (2017) categorized
nursing theories into four headings: nursing philosophy, nursing conceptual
models, nursing theories and grand theories, and middle-range nursing theories.

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

List of Nursing Theories and

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

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

 Founder of Modern Nursing and Pioneer of the Environmental

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

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

 Pioneered the Theory of Interpersonal Relations

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

 Developed the Nursing Need Theory

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

Faye Glenn Abdellah

See Also:  Faye Glenn Abdellah:  21 Nursing Problems Theory

 Developed the 21 Nursing Problems Theory

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

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

Lydia E. Hall
See Also:  Lydia Hall:  Care, Cure, Core Theory

 Developed the Care, Cure, Core Theory is also known as the

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

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

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

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

Nancy Roper, Winifred Logan, and Alison J.

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

 She developed the Nursing Process Theory.

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

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

 She pioneered the Philosophy and Theory of Transpersonal

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

Marilyn Anne Ray 

 Developed the Theory of Bureaucratic Caring
  “Improved patient safety, infection control, reduction in medication
errors, and overall quality of care in complex bureaucratic health care
systems cannot occur without knowledge and understanding of
complex organizations, such as the political and economic systems,
and spiritual-ethical caring, compassion and right action for all
patients and professionals.”
 Challenges participants in nursing to think beyond their usual frame
of reference and envision the world holistically while considering the
universe as a hologram.
 Presents a different view of how health care organizations and
nursing phenomena interrelate as wholes and parts in the system.

Patricia Benner
 Caring, Clinical Wisdom, and Ethics in Nursing Practice
 “The nurse-patient relationship is not a uniform, professionalized
blueprint but rather a kaleidoscope of intimacy and distance in some
of the most dramatic, poignant, and mundane moments of life.”
 Attempts to assert and reestablish nurses’ caring practices when
nurses are rewarded more for efficiency, technical skills, and
measurable outcomes.
 States that caring practices are instilled with knowledge and skill
regarding everyday human needs.

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

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

Myra Estrin Levine

See Also: Myra Estrin Levine: Conservation Model for Nursing

 According to the Conservation Model, “Nursing is human

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

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

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

and science that is humanistic and humanitarian.
 The Science of Unitary Human Beings contains two dimensions: the
science of nursing, which is the knowledge specific to the field of
nursing that comes from scientific research; and the art of nursing,
which involves using nursing creatively to help better the lives of the
patient.
 A patient can’t be separated from his or her environment when
addressing health and treatment.
Dorothea E. Orem
 In her Self-Care Theory, she defined Nursing as “The act of assisting
others in the provision and management of self-care to maintain or
improve human functioning at the home level of effectiveness.”
 Focuses on each individual’s ability to perform self-care.
 Composed of three interrelated theories: (1) the theory of self-care,
(2) the self-care deficit theory, and (3) the theory of nursing systems,
which is further classified into wholly compensatory, partially
compensatory, and supportive-educative.

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

 Conceptual System and Middle-Range Theory of Goal

Attainment
 “Nursing is a process of action, reaction and interaction by which
nurse and client share information about their perception in a
nursing situation” and “a process of human interactions between
nurse and client whereby each perceives the other and the situation,
and through communication, they set goals, explore means, and
agree on means to achieve goals.”
 Focuses on this process to guide and direct nurses in the nurse-
patient relationship, going hand-in-hand with their patients to meet
good health goals.
 Explains that the nurse and patient go hand-in-hand in
communicating information, set goals together, and then take
actions to achieve those goals.

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

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

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

Sister Callista Roy

See Also:  Sister Callista Roy:  Adaptation Model of Nursing

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

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

Dorothy E. Johnson
See Also:  Dorothy E. Johnson:  Behavioral Systems Model

 The Behavioral System Model defined Nursing as “an external

regulatory force that acts to preserve the organization and integrate
the patients’ behaviors at an optimum level under those conditions
in which the behavior constitutes a threat to the physical or social
health or in which illness is found.”
 Advocates to foster efficient and effective behavioral functioning in
the patient to prevent illness and stresses the importance of
research-based knowledge about the effect of nursing care on
patients.
 Describes the person as a behavioral system with seven subsystems:
the achievement, attachment-affiliative, aggressive-protective,
dependency, ingestive, eliminative, and sexual subsystems.
Anne Boykin and Savina O. Schoenhofer
 The Theory of Nursing as Caring: A Model for Transforming
Practice
 Nursing is an “exquisitely interwoven” unity of aspects of the
discipline and profession of nursing.
 Nursing’s focus and aim as a discipline of knowledge and a
professional service are “nurturing persons living to care and
growing in caring.”
 Caring in nursing is “an altruistic, active expression of love, and is the
intentional and embodied recognition of value and connectedness.”

Afaf Ibrahim Meleis

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

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

 Health Promotion Model

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

 Culture Care Theory of Diversity and Universality

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

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

Rosemarie Rizzo Parse

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

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

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

Gladys L. Husted and James H. Husted

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

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

Merle H. Mishel
 Uncertainty in Illness Theory
 Presents a comprehensive structure to view the experience of acute
and chronic illness and organize nursing interventions to promote
optimal adjustment.
 Describes how individuals form meaning from illness-related
situations.
 The original theory’s concepts were organized in a linear model
around the following three major themes: Antecedents of
uncertainty, Process of uncertainty appraisal, and Coping with
uncertainty.

Pamela G. Reed
 Self-Transcendence Theory
 Self-transcendence refers to the fluctuation of perceived boundaries
that extend the person (or self) beyond the immediate and
constricted views of self and the world (Reed, 1997).
 Has three basic concepts: vulnerability, self-transcendence, and well-
being.
 Gives insight into the developmental nature of humans associated
with health circumstances connected to nursing care.
Carolyn L. Wiener and Marylin J. Dodd
 Theory of Illness Trajectory
 “The uncertainty surrounding a chronic illness like cancer is the
uncertainty of life writ large. By listening to those who are tolerating
this exaggerated uncertainty, we can learn much about the trajectory
of living.”
 Provides a framework for nurses to understand how cancer patients
stand uncertainty manifested as a loss of control.
 Provides new knowledge on how patients and families endure
uncertainty and work strategically to reduce uncertainty through a
dynamic flow of illness events, treatment situations, and varied
players involved in care organization.

Georgene Gaskill Eakes, Mary Lermann Burke,

and Margaret A. Hainsworth
 Theory of Chronic Sorrow
 “Chronic sorrow is the presence of pervasive grief-related feelings
that have been found to occur periodically throughout the lives of
individuals with chronic health conditions, their family caregivers and
the bereaved.”
 This middle-range theory defines the aspect of chronic sorrow as a
normal response to the ongoing disparity created by the loss.

Phil Barker
 Barker’s Tidal Model of Mental Health Recovery is widely used in
mental health nursing.
 It focuses on nursing’s fundamental care processes, is universally
applicable, and is a practical guide for psychiatry and mental health
nursing.
 Draws on values about relating to people and help others in their
moments of distress. The values of the Tidal Model are revealed in
the Ten Commitments: Value the voice, Respect the language,
Develop genuine curiosity, Become the apprentice, Use the available
 toolkit, Craft the step beyond, Give the gift of time, Reveal personal
wisdom, Know that change is constant, and Be transparent.

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

Cheryl Tatano Beck

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

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

Cornelia M. Ruland and Shirley M. Moore

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

References
Suggested readings and resources for this study guide:

1. Alligood, M., & Tomey, A. (2010). Nursing theorists and their work, seventh edition (No ed.).
Maryland Heights: Mosby-Elsevier.
2. Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book. Elsevier Health Sciences.
3. Barnard, K. E. (1984). Nursing research related to infants and young children. In Annual review
of nursing research (pp. 3-25). Springer, Berlin, Heidelberg.
4. Brown, H. I. (1979). Perception, theory, and commitment: The new philosophy of science.
University of Chicago Press. [Link]
5. Brown M (1964) Research in the development of nursing theory: the importance of a
theoretical framework in nursing research. Nursing Research.
6. Chinn, P. L., & Jacobs, M. K. (1978). A model for theory development in nursing. Advances in
Nursing Science, 1(1), 1-12. [Link]
7. Colley, S. (2003). Nursing theory: its importance to practice. Nursing Standard (through
2013), 17(46), 33. [Link]
8. Fawcett, J. (2005). Criteria for evaluation of theory. Nursing science quarterly, 18(2), 131-135.
[Link]
9. Fitzpatrick, J. J., & Whall, A. L. (Eds.). (1996). Conceptual models of nursing: Analysis and
application. Connecticut, Norwalk: Appleton & Lange.
10. Kaplan, A. (2017). The conduct of inquiry: Methodology for behavioural science. Routledge.
[Link]
11. Meleis, A. I. (2011). Theoretical nursing: Development and progress. Lippincott Williams &
Wilkins.
12. Neuman, B. M., & Fawcett, J. (2002). The Neuman systems model.
13. Nightingale F (1860) Notes on Nursing. New York NY, Appleton.
14. Peplau H (1988) The art and science of nursing: similarities, differences, and relations. Nursing
Science Quarterly
15. Rogers M (1970) An Introduction to the Theoretical Basis of Nursing. Philadelphia PA, FA
Davis.