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Models & Theories Focused on Nursing Goals & Functions

Critical theorist and philosopher of education Paulo Freire explained the relationship

between theory and practice, where theory is the thought behind a performed action and practice

is the action one’s performing. The utility of a theory is related to the quality of the idea and

evaluated through research and practice (Butts & Rich, 2018). The doctor of nursing practice

(DNP) should apply nursing theory as a guide to their practice. Then they should reflect upon

their practice developing conceptual insight and recognizing patterns further, leading to theory

development. Applying this in practice and research gives way to theories that are testable in

patient care settings (Zaccagnini & Waud-White, 2017). The following four theorists are

compared to demonstrate the connectedness between theory, practice, and research.

Credited for laying the foundations of the nursing profession, Florence Nightingale would

develop the environmental model of nursing. This model outlines thirteen canons to include (1.)

ventilation and warmth, (2.) health of houses, (3.) petty management, (4.) noise, (5.) variety, (6.)

food intake, (7.) food preference, (8.) bed and bedding, (9.) light, (10.) cleanliness of rooms and

walls, (11.) personal cleanliness, and (12.) chattering hopes and advice, and (13.) observation of

the sick (Butts & Rich, 2018). Sanitation, infection rates, ventilation, color, noise, light, and

nurse presence are things she observed that directly contributed to a patient’s outcome. Her

systems model centered around the patient and how characteristics of the environment affected

their health (Zborowsky, 2014). When the DNP applies these canons to practice questioning and

observation becomes evident in their patient assessment. Nightingale’s model evaluates the

relationship between environment to patient, nurse to the environment, and nurse to the patient

(Butts & Rich, 2018).

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In contrast, Virginia Henderson’s developed the definition of nursing. Her idea involves

nurses assisting patients in their performance of fourteen basic human needs aiding in the

patient’s health, recovery, or peaceful death that they would accomplish independently with

proper strength, will, or knowledge. As such, it is the unique impact of the nurse’s role in

helping the patient become as independent of assistance as soon as possible. Henderson’s

fourteen basic human needs are (1.) normal breathing, (2.) adequate consumption of food and

drink, (3.) proper body waste elimination, (4.) ability to move and maintain desirable body

posture, (5.) sleep and rest, (6.) suitable attire, (7.) ability to maintain proper body temperature

through appropriate clothing or adjustment of environment, (8.) hygiene for integument

protection, (9.) avoid environmental dangers to self and others, (10.) communication with others,

(11.) worship according to faith background, (12.) work for a sense of accomplishment, (13.)

recreation, and (14.) continue to learn, discover, and satisfy curiosity for normal health and

development (Waller-Wise, 2013). Although a novel idea at the time Henderson believed that

nursing care based upon evidence instead of tradition was more meaningful, this is foundational

and a trademark to the DNP (Butts & Rich, 2018).

Influenced by Nightingale, Dorothy Johnson theorized a patient’s ability to maintain

balance during stressful events needs support through nursing care. Johnson’s model of

behavioral systems defines humans as open systems with seven subsystems conceptualizing that

human interaction with their environment occurs in a variety of ways. In utilizing the behavioral

systems model, the nurse assesses the patient identifying the source of the problem and then

intervenes to produce change (Zaccagnini & Waud-White, 2017). The seven subsystems include

(1.) achievement, (2.) affiliative, (3.) aggressive, (4.) dependence, (5.) sexual, (6.) eliminative,

and (7.) ingestive subsystems. When the DNP utilizes Johnson’s model, information is obtained
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to evaluate behaviors from the past and present to determine and establish an optimal level of

health with the goal of the patient achieving balance and function (Butts & Rich, 2018).

As a comparison to the previous theorists, Nola J. Pender’s theory of health promotion

has three points (1.) personal characteristics, (2.) the experience of the individual, and (3.) group

knowledge regarding behavior the patient wishes to attain. Pender’s theory initially focused on

the geriatric population strategy of maintaining autonomy and independence (Santos, Barlem,

Silva, Cestari, & Lunardi, 2008). This theory is practical and applicable to illness care in the

acute setting, which is why it is accessible and useful for advanced practice nurses (APN).

Pender’s model gives a good foundation focusing on prevention and population health (Butts &

Rich, 2018).

The theories discussed above, among others, help guide the knowledge base and shape

the role of the APN as to how nurses decide to apply theory to their practice. The APN/DNP

needs a solid foundation of knowledge, and these theories distinguish us from physicians and the

medical model. Medically, patients are circumstantial parts of data, where the source of nursing

lies between the developed relationship between nurse and patient (Zaccagnini & Waud-White,

2017). Although developed by four different nurses, each one highlighted practice concerning

patient health outcomes. Nightingale focused on nursing, changing the environment to improve

patient health. Henderson used the role of the nurse to assist in the patient’s ability to establish

independence. Johnson instructs the nurse to carry out tasks of regulation to restore balance to

the health of the patient, and Pender raises awareness, promotes independence, and controls

external circumstances to change behaviors, thus improving patient health (Butts & Rich, 2018).

Applying each nurse theory individually or together to patient care, the DNP restores the health

of their patients, giving autonomy and acceptance of patient choices. Doing so allows us to
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better empathize with our patient’s issues and tailor care we provide to their unique needs and

situations (Zaccagnini & Waud-White, 2017).

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Reference

Butts, J. B., & Rich, K. L. (2018). Philosophies and theories for advanced nursing practice (3rd

ed.). Burlington, MA: Jones & Bartlett Learning.

Santos, S. S. C., Barlem, E. L. D., Silva, B. T., Cestari, M. E., & Lunardi, V. L. (2008). Health

promotion for the elderly: Gerontogeriatric nursing commitment. ACTA Paulista de

Enfermagem, 21(4), 649-653. https://dx.doi.org/10.1590/S0103-21002008000400018

Waller-Wise, R. (2013). Utilizing Henderson’s Nursing Theory in Childbirth Education.

International Journal of Childbirth Education, 28(2), 30–34. Retrieved from

http://search.ebscohost.com.lib-proxy.jsu.edu/login.aspx?

direct=true&db=rzh&AN=104292455&site=ehost-live&scope=site

Zaccagnini, M. E., & Waud-White, K. (2017). The doctor of nursing practice essentials: A new

model for advanced practice nursing (3rd ed.). Burlington, MA: Jones & Bartlett

Learning.

Zborowsky, T. (2014). The Legacy of Florence Nightingale’s Environmental Theory: Nursing

Research Focusing on the Impact of Healthcare Environments. Health Environments

Research & Design Journal (HERD) (Vendome Group LLC), 7(4), 19–34. Retrieved

from http://search.ebscohost.com.lib-proxy.jsu.edu/login.aspx?

direct=true&db=rzh&AN=103880576&site=ehost-live&scope=site