Nursing Theories

Plorence Nightingale (mid-1800) io

Developed and described the first theory of nursing, “Environmental

Model” (“Notes on Nursing: What It Is, What It Is Not’). She focused on

Changing and manipulating the environment in order to put the patient in tne

Best possible conditions for nature to act (nursing and the patient environment

Relationships).

She believed that in the nurturing environment, the body could repair

Itself. Client’s environment is manipulated to include appropriate nolse,

Nutrition, hygiene, light, comfort, socialization and hope.

She provided the nursing profession the “Legacy of Caring

Virginia Henderson (1955)

Introduced The Nature of Nursing Model” (‘Definitions and

Components of Nursing’). She identified fourteen basic needs on which

Nursing care is based. She postulated that the unique function of the nurse is to

Assist the clients, sick or well, in the performance of those activines

Contributing to health or its recovery, that clients would perform unaided if

They had the necessary strength, will or knowledge. She further believed that

Nursing involves assisting the client in gaining independence as rapidly as

Possible, or assisting him achieve peaceful death if recovery is no longer

Possible.
Faye Abdellah (1960)

Introduced “Patient -Centered Approaches to Nursing Model”. She

Identified twenty-one nursing problems which determine nursing care. She

Defined nursing as service to individuals and families; therefore to society.

Furthermore, she conceptualized nursing as an art and a 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, and cope with

Their health needs.

Dorothy E. Johnson (1960, 1980)

Conceptualized the “Behavioral System Model, According to Johnson

Each person as a behavioral system is comp0Sed or seven subsystems namelv

1. Ingestive. Taking In nourisnment in soclally and culturall

Acceptable ways.

2. Eliminative. Ridding the Doay or waste in sOclally and cultural

Turally

Fliative. Security seeking behavior.

Aggressive. Self- protective behavior.

5. Dependence. Nurturance – seeking behavior.

6. Achievement. Master or Oneseir ana one s Evironment according to

On internalized standards of excellence

7. Sexual and role identity behavior.

4
Disturbances in these subsystems cause nursing problems.

In addition, she viewed that each person strives to achieve balance and

Stability both internaly and externaly and to runction erectively by adjusting

And adapting to environmental forces through learned patterns of response.

Furthermore, Johnson believed that the patient strives to become a

Person whose behavior is commensurate with social demands; who is able to

Modify his behavior in ways that support biologiC imperatives; who is able to

Benefit to the fullest extent during illness from the health care professional’s

Knowledge and skills; and whose behavior does not give evidence ot

Unnecessary trauma as a consequence of filness.

Imogene King (1971, 1981)

Postulated the systems Framework and Goal Attainment Theory

She described nursing as a helping profession that assists individuals an

Broups in 0ciey to attaln, maintain, and restore health. If this is not possibie

Nurses help individuals die with dignity.

In addition, King viewed nursing as an interaction process betwe

Client and nurse whereby during perceiving setting goals, and acting on u

Transactions occur and goals are achieved.

Madeleine Leininger (1978

1984)
Developed the Ttheory of Calture Care Diversity and Universaliy

Wanscultural Nursing Modell.She advocated that nursing is a humanistic and

Scientific mode ot helplng a ciient through specific cultural caring processes

(cultural values, Denes and practices) to improve or maintain a health condition.

Advocated that caring is universal and varies transculturally. Maj

Concepts Inelude care, caringE culture, cultural values and cultural variations.

Furthermore, Leininger believed that caring serves to ameliorate Or

Improve human conditions and life base. And that care is the essence and the

Dominant, distinctive and unifying feature of nursing

Myra Estrin Levine (1973)

Described the “Conservation Principles: A Model for Health She

Advocated that nursing is a human interaction and proposed four conservation

Principles of nursing which are concerned with the unity and integrity of the

Individual. Holism is maintained by conserving integrity the tour

Conservation principles are as folows:

1. Conservation of energy. The human body functions by utilizing

Energy. The human body needs energy producing input (tood, oxygen,

Tluids) to allow energy utilization as output.

2. Conservation of Structural Integrity. The human body has physical

Boundaries (Skin and mucous membrane) that must be maintained to

Facilitate health and prevent harmful agents trom entering the body

3. Conservation of Personal ntegrity. The nursing interventions are

Based on the conservation ot the individual client’s personality. Every

Individual has a sense of identity, selt worth and self esteem, which

Must be preserved and enhanced by nurses.

4. Conservation of Social integrity. The soctal integrity of the client

Reflects the family and the community in which the client functions.

Health care institutions may separate individuals trom their family. It is

Important tor nurses to consider the individual in the context of the

Family.

Betty Neanman (1982, 1989, 1992)

Proposed the “Health Care Systems Model. She asserted that nursing

Is a unique profession in that it is concerned with all the variables afectin

Individual’s response to stresses, which are ntra- (within the individual

Inter- (between one or more other people), and etrapersonal (outside the

Individual) in nature. The concern af nursing is to prevent stness invasion. T

Protect the client’s basic structure and to obtain or ialntan a maadnuum Jevol

Of weliness. The nurse helps the dient, throug printay. Secondary and

Tertiary prevention modes, to adjust to envirphnlertal stressors and maintain

Dient stability.

Dorotbea Orem (1970, 1985) d ego

Devel.oped the. “Self- Care and Self-Care Deficit Nursing Theory”. Sbe

Defined self-care as “the practice of activities that individuals fnitiate and

Perfartn an thelr own behalt in malntalning life, hcalth and well-being She

Conceptualized three mursing systems as loluws:

Wlholly Compensatory: when the nurse 1s expectecd to accomplish

All the patient’s therapeutic selfcare or to Compensate for the

Patient’s inability to enguge in self care or when the patient needs

cOntinuaus guidance ln sell Cilne

3. Partialy Compeisatory: when tiotn nurse and paient engage in

Meetlng self care hecns;

4. Supportive-Educative: the systemthat equires assistance in

Decision muking, belavior control and acgquisition ot knowledge and

Skils to learb self- care.

Hildegard Peplau (1952)

Introduced the lnterpersoual Relatlons in Nursing Model”

(Psychodynamic Nursing Model). She defincd nuTsing as an interpersonal

Process of therapeutic interactions bebween an individual who is sick or in

Need of health services and a nurse especialy educated to recognize and

Respond o the nced tor help. She identifiecd four phases of the nurse-client

Relationshlp Damely:

1. Orlentation: the nuse and the client initially do not know each

Other’s goals and testing. The role each will assume. The client

Attempts to identify dittioulties and the amount of nursing help that

Is needed

2. Identification: the client responds to the professionals or ne

Signiicant others who can meet the identified needs. Both the client

And the nurse plan together an appropriate program to foster

Health;

3. Exploitation: the client utilizes all available resources to move

Toward a gal ot maximum health or functionality

4. Resolution: rerers to the termination phase of the nurse client

Relationship. It occurs when the client’s needs are met and he/she

Can move toward a new goal. Peplau further assumed that nurse

Cllentrelauonsnip fosters growth in both the client and the nurse

Peplau stated that there are six nursing roles which are as follows:

Stranger, resource person, teacher, leader, surrogate, counselor.

Martha Rogers (1970)

Conceptualized the “Science of Unitary Human Beings”. To Rogers,

Unitary man is an energy field in constant interaction with the environmen

She asserted that human beings are more than and different from the sum or

Their parts; the distinctive properties of the whole are significantly different

From those or its parts. Furthermore, she believed that human being s

Characterized by the capacity for abstraction and imagery, language and

Thought, sensation and emotion.

Sister Callista Roy (1979, 1984)

Presented the “Adaptation Model”. She viewed each person as a

Unified biopsychosocial system in constant interaction with a changing

Environment. She contended that the person as an adaptive system, functions

As a whole through interdependence of its parts. The system consists of input,

Control processes, output and feedback. In addition, she advocated that al

People have certain needs which they endeavor to meet in order to maintain

Integrity. These needs are divided into four diferent modes, the physiological,

Self concept, role function, and interdependence. Accordingly, Roy believed

That adaptive human behavior is directed as an attempt to maintain

Homeostasis or integrity of the individual by conserving energy and promoting

The survival, growth, reproduction and mastery of human system.

Jean Watson (1979-1985)

Conceptualized the “Transpersonal Caring Model” (Nursing: Human

Science ana Human Care). She emphasized that nursing is the application of

The art and numan sCience through transpersonal caring transactions tonep

Persons achieve mind-body-soul harmony, which generates self – knowieage

Self-control, self – care, and self – healing. She included health promotion and

Treatment or iness in nursing. She believed that a person is a valued being to

Be cared tor, respected, nurtured, understood and assisted; a fully functional

Integrated self.

Watson lenihed 10 carative factors in nursing. These are as rollows:

Forming humanistic – altruistic value systemaer) epdievt a

Instilling faith – hope

Ate Cultivating sensitivity to self and others

Gni Developing helping-trust relationship

1 Promoting expression of feelings

Using problem-solving for decision making

Promoting teaching – learning8

Promoting supportive environment

Assisting with gratification of human needs

Ib sidsoslgotot
Allowing for existential – phenomenological forces

Rosemarie Rizzo Parse (1981, 1987, 1992)

Introduced the “Theory of Human Becoming. She emphasized free

Choice of personal meaning in relating value priorities, co – creating of

Rhythmical patterns, in exchange with the environment, and cotranscending in

Many dimensions as possibilities unfold. She also believed that each choice

Opens certain opportunities while closing others. Thus, she referred to

Revealing-concealing, enabling-limiting, and connecting-separating. Since each

Individual makes his or her own personal choices, the role of the nurse is that

Of guide, not decision maker.

And

In capsule, Parse’s three principles are meaning rhythmicity and cotrancendence.

.Meaning

Man’s reality is given meaning through lived experiences

Man and environment co-create.

Rhythmicity

Man and environment cocreate (imaging valuing languaging) in

Rhythmical patterns

Cotrancendence

Refers to reachingg out and beyond the limits that a person sets,

One constantly transforms.

Joyce Travelbee (1966, 1971)

She postulated the “Interpersonal Aspects of Nursingg Model”. She

Advocated that the goal of nursing is to assist individual or family in preventine

Or coping with llness, regaining health, finding meaning in illness, or

Maintaining maximal degree of health. She further viewed that interpersonal

Process is a therapeutic human-to-human relationship formed during illness

And “experience of suffering”. She believed that a person is a unique,

Irreplaceable individual who is in a continuous process of becoming, evolving

And changing

Nurses and patients go through several stages to achieve the goal of

Established nurse-patient relationships. Each stage has certain tasks, and a

Healthy development of the relationship is accomplished by mastering each

Task. The stages are:

1. Phase of the original encounter: Emotional knowledge colors

Impressions and perceptions of both nurse and patient during initial

Encounters. The task is “to break the bond of categorization in order to

Perceive the human being in the patient” and vice versa (Travelbee, 1966,

p. 133).

2. Phase of emerging identities: Both nurse and patient begin to

Transcend their respective roles and perceive uniqueness in each other.

Tasks include separating oneself and one’s experiences from others and

Avoiding using oneself as a yardstick” by which to evaluate others

Barriers to such tasks may be due to role envy, lack of interest in others,

Inability to transcend the self, or refusal to initiate emotional investment

 2. Phase of empathy: This phase involves sharing another’s psycnoog

State but standing apart and not sharing feelings. It is characterized oy

The ability to predict the behavior of another” (Travelbee, 1966, p.143).

3. Phase of sympathy: Sharing, feeling, and experiencing what others are

Feeling and experiencing is accomplished. This phase demonstrates

Emotional involvement and discredits objectivity as dehumanizing. The

Task of the nurse Is to translate sympathy into helpful nursing aculo

(Travelbee, 1964).

. Phase ot rapport: All previous phases culminate into rapport, defined as

All those experiences, thoughts, feelings,

And patient undergo and are able to perceive, share, and communicate

(Travelbee, 1963, 1966, pp.133-162)

1 attitudes that both nurse

Josephine Paterson and Loretta Zderad (1976)

Provided the “Humanistic Nursing Practice Theory”. This is based on

Their belief that nursing is an existential experience. Nursing is viewed as a

Lived dialogue ihat involves the coming together of the nurse and the person to

Be nursed. The essential characteristic of nursing is nurturance. Humanistic

Care cannot take place without the authentic commitment of the nurse to being

With and the doing with the client. Humanistic nursing also presupposes

Responsible choices.

Helen Erickson, Evelyn Tomlin, and Mary Aun Swain (1983)

Developed “Modeling and Role-Modeling Theory”. The focus of this

Theory is on the person. The nurse models lassesses), role models plans), and

Intervenes in this interpersonal and interactive theory. They asserted that each

Individual is uníque, has some self-care knowledge, needs simultaneously to be

Attached to and separate from others, and has adaptive potential. Nurses in

This theory, facilitate, nurture and accept the person unconditionally.

Margaret Newman (1979, 1986, 1994) r

Introduced “Health as Expanding Consciousness Then

Believed that humans are unitary beings in whom disease is a manifee.

The pattern of health. She defined consciousness as the information ea of

Of the system which is infuenced by time, space and movement and is

Expanding. Change occurs through transformation. Nursing is involved

With human beings who have reached choice points and found that their old

Are no longer effective. Caring is a moral imperative for nursing. The nurse

Partner with the client rather than the goal setter and outcome predictor.

Patricia Benner (1989) e

Proposed the “Primacy of Caring Model”. She believed that carine gis

Central to the essence of nursing. Caring creates the possibilities for copine and

Creates possibilities for connecting with and concern for others.

Benner described systematically five stages of skill acquisitionin

Nursing practice- novice, advanced beginner, competent, proficient and expert

CProm Novice to Expert Model).

Novice A nursing student who has not experienced enough real

Situations to make judgments about them. Performance is limited.

Advanced Beginner Has marginally acceptable performance. Has

Experienced enough real situations to make a judgment. Consciously

And deliberately plans nursing care.

Competent Has been in a similar job situation for 2 to 3 years. Has

Organizational and planning activities

Proficient Has 3 to 5 years experience in a similar job situation. Has

Holistic understanding and perception of the client. Perceives

Situation as a whole.

Expert Has intuitive and analytic ability in new situations.

Performance is fluid. Is flexible. No longer requires rules or

Guidelines to understand current situation.