What are 

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.

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
Development of nursing theory demands an understanding of selected
terminologies, definitions, and assumptions.

 Philosophy. 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
thinking behind the theory 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. Domain is the perspective or territory of a profession or
discipline.
 Process. Processes are a series of 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 environment of the patient 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 puts emphasis on 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” that 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 the professional function of
nursing 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 states 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 states 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 who strives to 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.

Nursing: Historical Developments in Nursing Theory and Research

1850 Florence Nightingale: first nurse researcher; first nurse theorist

 ‘Dark Ages’

Late
1800s– Nursing viewed as an apprenticeship
1900

Little focus on research-based practice

American Journal of Nursing (AJN) published

Research focus: nursing education and administration

1900–
1949
Questions: What is nursing? What do nurses do? How is nursing unique?

Debates: nursing vs. medicine as separate disciplines

1950s Growing emphasis on need to identify a body of nursing knowledge

Nursing Research journal established (1952)

American Nurses Foundation

 Federal support for funding

Number of nurse researchers miniscule

Early funding for nursing doctorate education — “hyphenated nurse”

1960s Emphasis on nursing’s rightful place in the university setting

Nursing theory to guide practice: person, environment, health, and nursing

Beginning of “Grand” Theory development

Nursing educators aware of need to develop new knowledge

American Nurses’ Association (ANA) Commission on Nursing Research

1970s Journals published: Research in Nursing and Health, Advances in Nursing Science, and

Western Journal of Nursing Research

Increase in doctoral programs in nursing education

 Conduct and Utilization of Research in Nursing (CURN) project published

National Center for Nursing for Nursing Research (NCNR) established within the

National Institutes of Health (NIH)

Journals published: Annual Review of Nursing Research and Applied Nursing Research

1980s Research focus: patients and patient behavior

Empirical modes of inquiry (logical positivitist)

Beginnings of qualitative research (phenomenology and ethnography

Better preparation for nurse researchers

Federal funding $16.2 million at NCNR

1990s Healthy People 2000 published

Clinical Practice Guidelines (AHCPR)

 Clinical Nursing Research journal published

NCNR renamed the National Institute for Nursing Research (NINR) in 1993

Nursing doctoral programs in 65 institutions

Emphasis on clinical research

Research-based practice-research utilization, evidence-based practice

Multiple modes of inquiry

Emphasis on explanatory and predictive-level studies (vs. descriptive and exploratory)

Encyclopedia of Nursing Research published in 1998

Federal funding $55 million at NINR

1995– Community-based nursing models

1999

NINR research priorities: effectiveness of nursing interventions in HIV/AIDS; cognitive impairment;

 living with chronic illness; biobehavioral factors related to immunocompetence

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

The Nursing Metaparadigm

There are four major concepts that are frequently interrelated and fundamental to
nursing theory: person, environment, health, and nursing. These four are
collectively referred to as metaparadigm for nursing.

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)

Components of Nursing Theories

For a theory to be a theory it has to contain a set of 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 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.

 Abstract Concepts. Defined as mentally constructed independent 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 are
statements that 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 it 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 providing a definition of nursing, nursing theory also helps nurses to
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, helps
generate further knowledge, and indicate in 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 values in nursing, thus further defining nursing and
increasing knowledge base.
 Nursing theories aim to define, predict, and demonstrate the
phenomenon of nursing (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 influence the
others. (Fitzpatrick and Whall, 2005).

Purposes of Nursing Theories

The primary purpose of theory in the profession of nursing is to improve practice
by positively influence 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. The accomplishments of nursing in the
past led to the recognition of nursing in 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. 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.

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.
Levels of Nursing Theory According to Abstraction

Grand Nursing Theories

 Grand theories are abstract, broad in scope, and complex, therefore

requiring further research for clarification.
 Grand nursing theories do not provide guidance for specific nursing
interventions but rather provide a general framework and ideas about
nursing.
 Grand nursing theorists develop their works based on their own
experiences and the time they were living 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 (as 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 the works of a grand theorist
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 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

 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 placed the emphasis of nursing on
the establishment and maintenance of relationships and highlight 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 by using their knowledge of the human physiological
and behavioral systems. 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. 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.

List of Nursing Theories and Theorists

You’ve learned from the previous sections the definition of nursing theory, its
significance in nursing, and purpose in generating a knowledge base for nursing. In
this section, we’ll 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 selectiozn 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 especially 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.
 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 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 the care of 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 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 that will facilitate the development of the core.
 The “care” circle defines the primary role of a professional nurse such as
providing bodily care for the patient. The “core” is the patient receiving
nursing care. The “cure” is the aspect of nursing which 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 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.

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 have
an 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 on 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 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.

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, is externally and internally consistent, has breadth as
well as 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 the science of nursing creatively to help better the life of the patient.
 A patient can’t be separated from his or her environment when
addressing health and treatment.

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

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

others in the provision and management of self-care to maintain or
improve human functioning at 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

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 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 the goals
towards good health.
 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) and is conceptualized as an
inner core (basic energy resources) surrounded by concentric circles that
include lines of resistance, a normal line of defense, 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
promotion of health for individuals, families, groups, and society as a
whole.”
 Views the individual as a set of interrelated systems who strives to
maintain balance between various stimuli.
 Inspired the development of many middle-range nursing theories and of
adaptation instruments.

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

 The Behavioral System Model defined Nursing as “an external regulatory

force which acts to preserve the organization and integration of 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 the fostering of 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.
 The focus and aim of nursing as a discipline of knowledge and a
professional service is “nurturing persons living caring 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
 Began with observations of experiences faced as people deal with
changes related to health, well-being, and 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 environment in health promotion.
 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 with the goal of
providing 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 with regard to
nursing and health-illness caring practices, beliefs, and values with the
intention to implement significant and efficient nursing care services to
people according to their cultural values and health-illness context.
 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 are inseparable, and that nursing is a human science and
art that uses an abstract body of knowledge to help people.
 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 nonaggression among rational people that 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 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.

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 a 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 the organization of care.

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.
 Focuses on the fundamental care processes of nursing, 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 moment
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. 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.

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.