NURSING THEORIES AND THEORISTS: THE DEFINITIVE
GUIDE FOR NURSES
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
o The first nursing theories appeared in the late
1800s when a strong emphasis was placed on
nursing education.
o 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.”
o 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.
o In 1952, Hildegard Peplau introduced her Theory
of Interpersonal Relations that emphasizes the
nurse-client relationship as the foundation of
nursing practice.
o 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.
o 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.
o 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.
o 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.
o 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.
o 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.
o 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.
o 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.
o In 1979, Sr. Callista Roy viewed the individual as
a set of interrelated systems that maintain the
balance between these various stimuli.
o 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.
o Person (also referred to as Client or Human
Beings) is the recipient of nursing care and may
include individuals, patients, groups, families,
and communities.
o 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.
o 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.
o 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.
You’ll find that these four concepts are used
frequently and defined differently throughout
different nursing theories. Each nurse theorist’s
definition varies by their orientation, nursing
experience, and different factors that affect the
theorist’s nursing view. 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:
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.
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.
o Abstract Concepts. Defined as mentally
constructed independently of a specific time or
place.
o 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.
o Theoretical Definitions. Define a particular
concept based on the theorist’s perspective.
o 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:
o Nursing theories help recognize what should set
the foundation of practice by explicitly describing
nursing.
o By defining nursing, a nursing theory also helps
nurses understand their purpose and role in the
healthcare setting.
o 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.
o Nursing theories provide the foundations of
nursing practice, generate further knowledge,
and indicate which direction nursing should
develop in the future (Brown, 1964).
o 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).
o Nursing theories prepare the nurses to reflect on
the assumptions and question the nursing values,
thus further defining nursing and increasing the
knowledge base.
o Nursing theories aim to define, predict, and
demonstrate nursing phenomenon (Chinn and
Jacobs, 1978).
 o It can be regarded as an attempt by the nursing
profession to maintain and preserve its
professional limits and boundaries.
o Nursing theories can help guide research and
informing evidence-based practice.
o Provide a common language and terminology for
nurses to use in communication and practice.
o Serves as a basis for the development of nursing
education and training programs.
o 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 essential for the development and
advancement of the nursing profession. 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 the 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
o Grand theories are abstract, broad in scope, and
complex, therefore requiring further research for
clarification.
o Grand nursing theories do not guide specific
nursing interventions but rather provide a
general framework and nursing ideas.
o Grand nursing theorists develop their works
based on their own experiences and their time,
explaining why there is so much variation among
theories.
o Address the nursing metaparadigm components
of person, nursing, health, and environment.
Middle-Range Nursing Theories
 o 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.
o Due to the difficulty of testing grand theories,
nursing scholars proposed using this level of
theory.
o 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
o Practice nursing theories are situation-specific
theories that are narrow in scope and focuses on
a specific patient population at a specific time.
o Practice-level nursing theories provide
frameworks for nursing interventions and
suggest outcomes or the effect of nursing
practice.
o Theories developed at this level have a more
direct effect on nursing practice than more
abstract theories.
o 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
o Also known as category-formulating or labeling
theory.
o Theories under this category describe the
properties and dimensions of phenomena.
Explanatory Theory
o Explanatory theories describe and explain the
nature of relationships of certain phenomena to
other phenomena.
Prescriptive Theories
o Address the nursing interventions for a
phenomenon, guide practice change, and predict
consequences.
o Includes propositions that call for change.
o 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.
o 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.
o 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.
o 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.
o 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.
o 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.
o 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.
o 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
o Founder of Modern Nursing and Pioneer of the
Environmental Theory.
o Defined Nursing as “the act of utilizing the
environment of the patient to assist him in his
recovery.”
o 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.”
o Identified five (5) environmental factors: fresh
air, pure water, efficient drainage, cleanliness or
sanitation, and light or direct sunlight.
Hildegard E. Peplau
o Pioneered the Theory of Interpersonal Relations
o 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.”
o Her work is influenced by Henry Stack Sullivan,
Percival Symonds, Abraham Maslow, and Neal
Elgar Miller.
o It helps nurses and healthcare providers develop
more therapeutic interventions in the clinical
setting.
Virginia Henderson
o Developed the Nursing Need Theory
o Focuses on the importance of increasing the
patient’s independence to hasten their progress
in the hospital.
o Emphasizes the basic human needs and how
nurses can assist in meeting those needs.
o “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
o Developed the 21 Nursing Problems Theory
o “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.”
o Changed the focus of nursing from disease-
centered to patient-centered and began to
include families and the elderly in nursing care.
o The nursing model is intended to guide care in
hospital institutions but can also be applied to
community health nursing, as well.
Ernestine Wiedenbach
o Developed The Helping Art of Clinical Nursing
conceptual model.
o 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.”
o Guides the nurse action in the art of nursing and
specified four elements of clinical nursing:
philosophy, purpose, practice, and art.
o 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
o Developed the Care, Cure, Core Theory is also
known as the “Three Cs of Lydia Hall.“
o 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.”
o The major purpose of care is to achieve an
interpersonal relationship with the individual to
facilitate the development of the core.
o 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
o 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.
o Nursing was accomplished through human-to-
human relationships.
o Extended the interpersonal relationship theories
of Peplau and Orlando.
Kathryn E. Barnard
o Developed the Child Health Assessment Model.
o Concerns improving the health of infants and
their families.
o Her findings on parent-child interaction as an
important predictor of cognitive development
helped shape public policy.
o 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.
o Borrows from psychology and human
development and focuses on mother-infant
interaction with the environment.
o 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
o Focuses on the development of models and
theories on the concept of nursing.
o 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.
o A good example of using a unique basis of
nursing for further expansion.
Nancy Roper, Winifred Logan, and Alison J.
Tierney
o A Model for Nursing Based on a Model of Living
o Logan produced a simple theory, “which actually
helped bedside nurses.”
o 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.
o 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
o She developed the Nursing Process Theory.
o “Patients have their own meanings and
interpretations of situations, and therefore
nurses must validate their inferences and
analyses with patients before drawing
conclusions.”
o 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.
o 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.
o The role of the nurse is to find out and meet the
patient’s immediate needs for help.
Jean Watson
o She pioneered the Philosophy and Theory of
Transpersonal Caring.
o “Nursing is concerned with promoting health,
preventing illness, caring for the sick, and
restoring health.”
o 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.
o Focuses on health promotion, as well as the
treatment of diseases.
o Caring is central to nursing practice and
promotes health better than a simple medical
cure.
Marilyn Anne Ray
o Developed the Theory of Bureaucratic Caring
o “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.”
o Challenges participants in nursing to think
beyond their usual frame of reference and
envision the world holistically while considering
the universe as a hologram.
o Presents a different view of how health care
organizations and nursing phenomena
interrelate as wholes and parts in the system.
Patricia Benner
o Caring, Clinical Wisdom, and Ethics in Nursing
Practice
o “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.”
o Attempts to assert and reestablish nurses’ caring
practices when nurses are rewarded more for
efficiency, technical skills, and measurable
outcomes.
o States that caring practices are instilled with
knowledge and skill regarding everyday human
needs.
Kari Martinsen
o Philosophy of Caring
o “Nursing is founded on caring for life, on
neighborly love, *…+At the same time, the nurse
must be professionally educated.”
o Human beings are created and are beings for
whom we may have administrative
responsibility.
o Caring, solidarity, and moral practice are
unavoidable realities.
Katie Eriksson
 o Theory of Carative Caring
o “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.”
o The ultimate goal of caring is to lighten suffering
and serve life and health.
o Inspired many in the Nordic countries and used it
as the basis of research, education, and clinical
practice.
Myra Estrin Levine
o According to the Conservation Model, “Nursing is
human interaction.”
o Provides a framework within which to teach
beginning nursing students.
o 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. Roger
o In Roger’s Theory of Human Beings, she defined
Nursing as “an art and science that is humanistic
and humanitarian.
o 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.
o A patient can’t be separated from his or her
environment when addressing health and
treatment.
Dorothea E. Orem
o 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.”
o Focuses on each individual’s ability to perform
self-care.
o 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
o Conceptual System and Middle-Range Theory of
Goal Attainment
o “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.”
o 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.
o 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
o 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.”
o 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.
o 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
o 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.”
o Views the individual as a set of interrelated
systems that strives to maintain a balance
between various stimuli.
o Inspired the development of many middle-range
nursing theories and adaptation instruments.
Dorothy E. Johnson
o 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.”
o 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.
o 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
o The Theory of Nursing as Caring: A Model for
Transforming Practice
o Nursing is an “exquisitely interwoven” unity of
aspects of the discipline and profession of
nursing.
o Nursing’s focus and aim as a discipline of
knowledge and a professional service are
“nurturing persons living to care and growing in
caring.”
o Caring in nursing is “an altruistic, active
expression of love, and is the intentional and
embodied recognition of value and
connectedness.”
Afaf Ibrahim Meleis
o Transitions Theory
o It began with observations of experiences faced
as people deal with changes related to health,
well-being, and the ability to care for themselves.
o Types of transitions include developmental,
health and illness, situational, and organizational.
o Acknowledges the role of nurses as they help
people go through health/illness and life
transitions.
o Focuses on assisting nurses in facilitating
patients’, families’, and communities’ healthy
transitions.
Nola J. Pender
o Health Promotion Model
o Describes the interaction between the nurse and
the consumer while considering the role of the
health promotion environment.
o It focuses on three areas: individual
characteristics and experiences, behavior-specific
cognitions and affect, and behavioral outcomes.
o Describes the multidimensional nature of
persons as they interact within their
environment to pursue health.
Madeleine M. Leininger
o Culture Care Theory of Diversity and Universality
o 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.”
o 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.
o 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
o Health as Expanding Consciousness
o “Nursing is the process of recognizing the patient
in relation to the environment, and it is the
process of the understanding of consciousness.”
o “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 . . . “
o 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
o Human Becoming Theory
o “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.”
o 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.
o It centered around three themes: meaning,
rhythmicity, and transcendence.
Helen C. Erickson, Evelyn M. Tomlin, and Mary
Ann P. Swain
o Modeling and Role-Modeling
o “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.”
o Modeling is a process that allows nurses to
understand the unique perspective of a client
and learn to appreciate its importance.
o Role-modeling occurs when the nurse plans and
implements interventions that are unique for the
client.
Gladys L. Husted and James H. Husted
o Created the Symphonological Bioethical Theory
o “Symphonology (from ‘symphonia,’ a Greek word
meaning agreement) is a system of ethics based
on the terms and preconditions of an
agreement.”
o Nursing cannot occur without both nurse and
patient. “A nurse takes no actions that are not
interactions.”
o 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
o Maternal Role Attainment—Becoming a Mother
o “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.”
o “Nurses are the health professionals having the
most sustained and intense interaction with
women in the maternity cycle.”
o 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).
o Provides proper health care interventions for
nontraditional mothers for them to favorably
adopt a strong maternal identity.
Merle H. Mishel
o Uncertainty in Illness Theory
o Presents a comprehensive structure to view the
experience of acute and chronic illness and
organize nursing interventions to promote
optimal adjustment.
o Describes how individuals form meaning from
illness-related situations.
o 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
o Self-Transcendence Theory
o 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).
o Has three basic concepts: vulnerability, self-
transcendence, and well-being.
o Gives insight into the developmental nature of
humans associated with health circumstances
connected to nursing care.
Carolyn L. Wiener and Marylin J. Dodd
o Theory of Illness Trajectory
o “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.”
o Provides a framework for nurses to understand
how cancer patients stand uncertainty
manifested as a loss of control.
o 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
o Theory of Chronic Sorrow
o “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.”
o This middle-range theory defines the aspect of
chronic sorrow as a normal response to the
ongoing disparity created by the loss.
Phil Barker
o Barker’s Tidal Model of Mental Health Recovery
is widely used in mental health nursing.
o It focuses on nursing’s fundamental care
processes, is universally applicable, and is a
practical guide for psychiatry and mental health
nursing.
o 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
o Theory of Comfort
o “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.”
o Patient comfort exists in three forms: relief, ease,
and transcendence. These comforts can occur in
four contexts: physical, psychospiritual,
environmental, and sociocultural.
o As a patient’s comfort needs change, the nurse’s
interventions change, as well.
Cheryl Tatano Beck
o Postpartum Depression Theory
o “The birth of a baby is an occasion for joy—or so
the saying goes *…+ But for some women, joy is
not an option.”
o Described nursing as a caring profession with
caring obligations to persons we care for,
students, and each other.
o Provides evidence to understand and prevent
postpartum depression.
Kristen M. Swanson
o Theory of Caring
o “Caring is a nurturing way of relating to a valued
other toward whom one feels a personal sense
of commitment and responsibility.”
o Defines nursing as informed caring for the well-
being of others.
o 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
o Peaceful End-of-Life Theory
o 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.
o The purpose was to reflect the complexity
involved in caring for terminally ill patients.
Wanda de Aguiar Horta
o Also known as Wanda Horta, she introduced the
concepts of nursing that are accepted in Brazil.
o Wrote the book Nursing Process which presents
relevance to the various fields of Nursing practice
for providing a holistic view of the patient.
o Her work was recognized in all the teaching
institutions called the Theory of Basic Human
Needs. It is based on Maslow’s Theory of Human
Motivation, whose primary concept is the
hierarchy of Basic Human Needs (BHN).
o Horta’s Theory of Basic Human Needs is
considered the highest point of her work, and
the summary of all her research concludes
sickness as a science and art of assisting a human
being in meeting basic human needs, making the
patient independent of this assistance through
education in recovery, maintenance, and health
promotion.
o Classified basic human needs into three main
dimensions – psychobiological, psychosocial and
psychospiritual – and establishes a relationship
between the concepts of human being,
environment, and nursing.
o The theory describes nursing as an element of a
healthcare team and states that it can function
efficiently through a scientific method. Horta
referred this method as the nursing process.
o She defined the nursing process as the dynamics
of systematic and interrelated actions to assist
human beings. It is characterized by six phases:
nursing history, nursing diagnosis, assistance
plan, care plan or nursing prescription, evolution,
and prognosis.
Biography of Florence Nightingale
Florence Nightingale (12 May 1820 – 13 August
1910) was a nurse who contributed to developing
and shaping the modern nursing practice and has
set examples for nurses who are standards for
today’s profession. Nightingale is the first nurse
theorist well-known for developing the
Environmental Theory that revolutionized nursing
practices to create sanitary conditions for patients
to get care. She is recognized as the founder of
modern nursing. During the Crimean War, she
tended to wounded soldiers at night and was known
as “The Lady with the Lamp.”
Early Life
Florence Nightingale was born on May 12,
1820, in Nightingale, Italy. She was the younger of
two children. Her British family belonged to elite
social circles. Her father, William Shore Nightingale,
a wealthy landowner who had inherited two
estates—one at Lea Hurst, Derbyshire, and the
other in Hampshire, Embley Park Nightingale was 5
years old.
Her mother, Frances Nightingale, hailed
from a family of merchants and took pride in
socializing with prominent social standing people.
Despite her mother’s interest in social climbing,
Nightingale herself was reportedly awkward in
social situations. She preferred to avoid being the
center of attention whenever possible. Strong-
willed, Nightingale often butted heads with her
mother, whom she viewed as overly controlling.
Still, like many daughters, she was eager to please
her mother. “I think I am got something more good-
natured and complying,” Nightingale wrote in her
own defense concerning the mother-daughter
relationship.
Education
Florence Nightingale was raised on the
family estate at Lea Hurst, where her father
provided her with a classical education, including
German, French, and Italian studies. As for being
homeschooled by her parents and tutors,
Nightingale gained excellence in Mathematics.
 Nightingale was active in philanthropy from
a very young age, ministering to the ill and poor
people in the village neighboring her family’s estate.
At seventeen, she decided to dedicate her life to
medical care for the sick resulting in a lifetime
commitment to speak out, educate, overhaul and
sanitize the appalling health care conditions in
England.
Despite her parents’ objections, Nightingale
enrolled as a nursing student in 1844 at the
Lutheran Hospital of Pastor Fliedner in
Kaiserswerth, Germany.
Personal Life
Only announcing her decision to enter the
field in 1844, following her desire to be a nurse, was
not easy for Florence Nightingale. Her mother and
sister were against her chosen career, but
Nightingale stood strong and worked hard to learn
more about her craft despite society’s expectation
that she become a wife and mother.
As a woman, Nightingale was beautiful and
charming that made every man like her. However,
she rejected a suitor, Richard Monckton Milnes, 1st
Baron Houghton, because she feared that
entertaining men would interfere with the process.
The income given to her by her father during this
time allowed her to pursue her career and still live
comfortably. Though Nightingale had several
important friendships with women, including
correspondence with an Irish nun named Sister
Mary Clare Moore, she had little respect for women
in general and preferred friendships with powerful
men.
Environmental Theory
Florence Nightingale’s Environmental
Theory defined Nursing as “the act of utilizing the
patient’s environment to assist him in his recovery.”
It involves the nurse’s initiative to configure
environmental settings appropriate for the gradual
restoration of the patient’s health and that external
factors associated with the patient’s surroundings
affect the life or biologic and physiologic processes
and his development.
She identified 5 environmental factors:
fresh air, pure water, efficient drainage, cleanliness
or sanitation, and light or direct sunlight.
Works
Based on her observations in the Crimea,
Florence Nightingale wrote Notes on Matters
Affecting the Health, Efficiency, and Hospital
Administration of the British Army, an 830-page
report analyzing her experience and proposing
reforms for other military hospitals operating under
poor conditions. The book would spark a total
restructuring of the War Office’s administrative
department, including establishing a Royal
Commission for the Health of the Army in 1857.
In 1860, her best-authored works were
published, “Notes on Nursing,” outlining nursing
principles. It is still in print today with translation in
many foreign languages. In all, she had published
some 200 books, reports, and pamphlets. Using the
money she got from the British government, she
funded St. Thomas’ Hospital’s establishment, and
within it, the Nightingale Training School for Nurses.
In the 1870s, Nightingale mentored Linda
Richards, “America’s first trained nurse,” and
enabled her to return to the USA with adequate
training and knowledge to establish high-quality
nursing schools. Linda Richards went on to become
a great nursing pioneer in the USA and Japan.
In the early 1880s, Nightingale wrote an
article for a textbook in which she advocated strict
precautions designed, she said, to kill germs.
Nightingale’s work served as an inspiration for
nurses in the American Civil War. The Union
government approached her for advice in organizing
field medicine. Although her ideas met official
resistance, they inspired the volunteer body of the
United States Sanitary Commission.
Appointments
In 1853, Florence Nightingale accepted the
superintendent’s position at the Institute for the
Care of Sick Gentlewomen in Upper Harley Street,
London. She held this position until October 1854.
In 1854, Britain was involved in the war
against the Russians (Crimean War). British
battlefield medical facilities were deplorable,
prompting Minister at War Sidney Herbert to
appoint Nightingale to oversee the wounded’s care.
She arrived in Constantinople, Turkey, with a
company of 38 nurses. The introduction of female
nurses in military hospitals was a major success.
Sanitary conditions were improved while nurses
worked as capable assistants to physicians and
raised the British soldier’s morale by acting as
bankers, sending the injured man’s wages home,
wrote letters to their families, and read to the
wounded.
Crimean War
The Crimean War began, and soon reports
in the newspapers described the desperate lack of
proper medical facilities for wounded British
soldiers at the front. Sidney Herbert, the war
minister, already knew Nightingale and asked her to
oversee a team of nurses in Turkey’s military
hospitals. In 1854 she led an expedition of 38
women to take over the management of the barrack
hospital at Scutari, where she observed the
disastrous sanitary conditions.
She returned to England in 1856. In 1860,
she established the Nightingale Training School for
nurses at St Thomas’ Hospital in London. Once the
nurses were trained, they were sent to hospitals all
over Britain, where they introduced the ideas they
had learned and established nursing training on the
Nightingale model.
Awards and Honors
England has given Florence Nightingale
numerous awards and honors.
Nightingale became known as “The Lady
with the Lamp.” During the Crimean War, she
initially made her rounds on horseback and at night
used an oil lamp to light her way, then reverted to a
mule cart and finally a carriage with a hood and
curtains. Nightingale remained at Scutari for a year
and a half. In the summer of 1856, she left once the
Crimean conflict was resolved and returned to her
childhood home at Lea Hurst. To her surprise, she
was met with a hero’s welcome, which the humble
nurse did her best to avoid.
The Queen rewarded Nightingale’s work by
presenting her with an engraved brooch that came
to be known as the “Nightingale Jewel” and by
granting her a prize of $250,000 from the British
government.
In 1883, Nightingale was awarded the Royal
Red Cross by Queen Victoria. In 1904, she was
appointed a Lady of Grace of St John’s Order (LGStJ).
In 1907, she became the first woman to be awarded
the Order of Merit. In the following year, she was
given the Honorary Freedom of the City of London.
Death
Despite being known as the heroine of the
Crimean War, Florence Nightingale fell ill in August
1910. She seemed to recover and was reportedly in
good spirits. However, she developed an array of
troubling symptoms a week later, on the evening of
Friday, August 12, 1910. She died unexpectedly at 2
pm the following day, Saturday, August 13, at her
home in London. She left a large body of work,
including several hundred previously unpublished
notes.
Usually, well-known people with great
contributions are offered national funerals, but
Nightingale had expressed the desire that her
funeral is a quiet and modest affair.
Respecting her last wishes, her relatives
turned down a national funeral, and the “Lady with
the Lamp” was laid to rest in her family’s plot at St.
Margaret’s Church, East Wellow, in Hampshire,
England.
In honor of the life and career of the “Angel
of the Crimea,” the Florence Nightingale Museum
sits at the site of the original Nightingale Training
School for Nurses, which houses more than 2,000
artifacts. And up to this day, the name “Florence
Nightingale” is universally recognized and known as
the pioneer of modern nursing.
Memory
Florence Nightingale has a memorial in St. Committee instituted the Florence Nightingale
Paul’s Cathedral, where a formal memorial service Medal, awarded every two years to nurses or
was held. There is a Florence Nightingale Museum nursing aides for outstanding service.
located at St. Thomas Hospital in London, where she
founded the nursing school. The US Navy launched a International CFS Awareness Day are celebrated on
namesake troop transport during World War II, her birthday each year.
“USS Florence Nightingale,” which served gallantly
during the course of the war, receiving four battle
stars.
In addition to the Florence Nightingale
School of Nursing and Midwifery’s continued
operation at King’s College London, The Nightingale
Building in the School of Nursing and Midwifery at
the University of Southampton is also named after
her.
Hospitals
Furthermore, four hospitals in Istanbul are
named after Nightingale: F. N. Hastanesi in Şişli (the
biggest private hospital in Turkey), Metropolitan
F.N. Hastanesi in Gayrettepe, Avrupa F.N. Hastanesi
in Mecidiyeköy, and Kızıltoprak F.N. Hastanesi in
Kadiköy, all belonging to the Turkish Cardiology
Foundation.
Audio
Florence Nightingale’s voice was saved in a
phonograph recording from 1890 preserved in the
British Library Sound Archive. The recording is in aid
of the Light Brigade Relief Fund and says: “When I
am no longer even a memory, just a name, I hope
my voice may perpetuate the great work of my life.
God bless my dear old comrades of Balaclava and
bring them safely to shore. Florence Nightingale.”
Museums
Many exhibits and artifacts are displayed
and a bit of folklore with an exhibit featuring the
preserved owl Athena, her little pet and companion
who lived in her pocket. With America’s first female
doctor, Elizabeth Blackwell opened the Women’s
Medical College.
In 1912, the Red Cross’s International
The International Nurses Day and
Nightingale’s Environmental Theory
The Environmental Theory by Florence
Nightingale defined Nursing as “the act of utilizing
the environment of the patient to assist him in his
recovery.” It involves the nurse’s initiative to
configure environmental settings appropriate for
the gradual restoration of the patient’s health and
that external factors associated with the patient’s
surroundings affect the life or biologic and
physiologic processes and his development.
Nightingale discussed the Environmental Theory in
her book Notes on Nursing: What it is, What it is
Not. She is considered the first theorist in nursing
and paved the way in the foundation of the nursing
profession we know today.
Major Concepts of Florence Nightingales
Theory
The major concepts of Florence
Nightingale’s Theory are:
Nursing
“What nursing has to do… is to put the
patient in the best condition for nature to act upon
him” (Nightingale, 1859/1992)
Nightingale 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.” She reflected the art of
nursing in her statement that “the art of nursing, as
now practiced, seems to be expressly constituted to
unmake what God had made disease to be, viz., a
reparative process.”
Human Beings
Human beings are not defined by
Nightingale specifically. They are defined in relation
to their environment and the impact of the
environment upon them.
Environment
Nightingale stresses the physical
environment in her writing. In her theory,
Nightingale’s writings reflect a community health
model in which all that surrounds human beings is
considered concerning their health state.
Health
Nightingale (1859/1992) did not define
health specifically. She stated, “We know nothing of
health, the positive of which pathology is negative,
except for the observation and experience. Given
her definition that the art of nursing is to “unmake
what God had made disease,” then the goal of all
nursing activities should be client health.
She believed that nursing should provide
care to the healthy and the ill and discussed health
promotion as an activity in which nurses should
engage.
Subconcepts of the Environmental Theory
The following are the subconcepts of
Florence Nightingale’s theory:
Health of Houses
“Badly constructed houses do for the
healthy what badly constructed hospitals do for the
sick. Once ensure that the air is stagnant and
sickness is certain to follow.”
Ventilation and Warming
“Keep the air he breathes as pure as the
external air, without chilling him.”
Nightingale believed that the person who
repeatedly breathed his or her own air would
become sick or remain sick. She was very concerned
about “noxious air” or “effluvia” and foul odors
from excrement. She also criticized “fumigations,”
for she believed that the offensive source, not the
smell, must be removed.
Nightingale also stressed the importance of
room temperature. The patient should not be too
warm or too cold. The temperature could be
controlled by an appropriate balance between
burning fires and ventilation from windows.
Light
Nightingale believed that second to fresh
air, the sick needed light. She noted that direct
sunlight was what patients wanted.
Noise
She stated that patients should never be
“waked intentionally” or accidentally during the first
part of sleep. She asserted that whispered or long
conversations about patients are thoughtless and
cruel. She viewed unnecessary noise, including
noise from the female dress, as cruel and irritating
to the patient.
Variety
She discussed the need for color and form
changes, including bringing the patient brightly
colored flowers or plants. She also advocated
rotating 10 or 12 paintings and engravings each day,
week, or month to provide variety for the patient.
Nightingale also advocated reading, needlework,
writing, and cleaning to relieve the sick of boredom.
Bed and Bedding
Nightingale noted that an adult in health
exhales about three pints of moisture through the
lungs and skin in a 24-hour period. This organic
matter enters the sheets and stays there unless the
bedding is changed and aired frequently.

She believed that the bed should be placed
in the lightest part of the room and placed so the
patient could see out of a window. She also
reminded the caregiver never to lean against, sit
upon, or unnecessarily shake the patient’s bed.
Personal Cleanliness
“Just as it is necessary to renew the air
around a sick person frequently to carry off morbid
effluvia from the lungs and skin, by maintaining free
ventilation, so it is necessary to keep pores of the
skin free from all obstructing excretions.”
“Every nurse ought to wash her hands very
frequently during the day.”
Nutrition and Taking Food
Nightingale noted in her Environmental
Theory that individuals desire different foods at
different times of the day and that frequent small
servings may be more beneficial to the patient than
a large breakfast or dinner. She urged that no
business be done with patients while they are
eating because this was a distraction.
Chattering Hopes and Advice
Florence Nightingale wrote in her
Environmental Theory that to falsely cheer the sick
by making light of their illness and its danger is not
helpful. She encouraged the nurse to heed what is
being said by visitors, believing that sick persons
should hear the good news that would help them
become healthier.
Social Considerations
Nightingale supported the importance of
looking beyond the individual to the social
environment in which they lived.
Environmental Factors
In Florence Nightingale’s Environmental
Theory, she identified five (5) environmental
factors: fresh air, pure water, efficient drainage,
cleanliness or sanitation, and light or direct sunlight.
o Pure fresh air – “to keep the air he breathes as
pure as the external air without chilling him.”
o Pure water – “well water of a very impure kind is
used for domestic purposes. And when the
epidemic disease shows itself, persons using such
water are almost sure to suffer.”
o Effective drainage – “all the while the sewer may
be nothing but a laboratory from which epidemic
disease and ill health are being installed into the
house.”
o Cleanliness – “the greater part of nursing consists
in preserving cleanliness.”
o Light (especially direct sunlight) – “the usefulness
of light in treating disease is very important.”
The factors posed great significance during
Nightingale’s time when health institutions had
poor sanitation, and health workers had little
education and training and were frequently
incompetent and unreliable in attending to the
patients’ needs.
Also emphasized in her environmental
theory is providing a quiet or noise-free and warm
environment, attending to patient’s dietary needs
by assessment, documentation of time of food
intake, and evaluating its effects on the patient.
Deficiencies in these five factors produce
illness or lack of health, but the body could repair
itself with a nurturing environment.
Analysis of the Environmental Theory
In the era that we are in today, we are faced
with environmental conditions beyond what ought
to be natural and nurturing. Some of the global
environmental issues we have now are global
warming, nuclear radiation threats, human-made
environmental calamities, and pollution. From these
occurrences, Nightingale’s model seemed to be
ideal. Her concept of providing fresh air to patients
is in question with today’s industrialization effects.
In addition to the analysis of the concept of
ventilation, it is not always beneficial for all clients
to have fresh air. Natural air has its impurities which
in turn may infect open wounds and drainages such
as in burns.
 With the idea of providing light, the light
emitted by the sun today is proven to be harmful
already because of the destruction of the Earth’s
ozone layer. Exposing the patient constantly to
direct sunlight may be more destructive to the
patient’s betterment than beneficial.
A healthy environment indeed heals, as
Nightingale stated. Still, the question now is how
our environment would remain healthy amidst the
negative effects of the progress of technology and
industrialization.
Since the applicability of some of the
concepts to specific situations today is non-feasible,
this theory’s development is utterly needed to
accommodate the changes in the environment that
we currently have. Still, above all this, it is very clear
that Nightingale’s Environmental Theory is superb
as a starting point of our profession’s progression
and catalyzed nursing improvement.
Assumptions of Florence Nightingale’s Theory
The assumptions of Florence Nightingale in
her Environmental Theory are as follows:
o Florence Nightingale believed that five points
were essential in achieving a healthful house:
“pure air, pure water, efficient drainage,
cleanliness, and light.”
o A healthy environment is essential for healing.
She stated that “nature alone cures.”
o Nurses must make accurate observations of their
patients and report the state of the patient to
the physician in an orderly manner.
o Nursing is an art, whereas medicine is a science.
Nurses are to be loyal to the medical plan but not
servile.
nurse about how the environment influences client
outcomes.
Weaknesses
In Nightingale’s Environmental Theory,
there is scant information on the psychosocial
environment compared to the physical
environment. The application of her concepts in the
twentieth century is in question.
Conclusion
The Environmental Theory of Nursing is a
patient-care theory. It focuses on altering the
patient’s environment to affect change in his or her
health. Caring for the patient is of more importance
than the nursing process, the relationship between
patient and nurse, or the individual nurse.
In this way, the model must be adapted to
fit the needs of individual patients. The
environmental factors affect different patients
unique to their situations and illnesses. The nurse
must address these factors on a case-by-case basis
to make sure the factors are altered to best care for
an individual patient and his or her needs.

Strengths
Florence Nightingale’s language to write her
books was cultured and flowing, logical in format,
and elegant in style. Nightingale’s Environmental
Theory has broad applicability to the practitioner.
Her model can be applied in most complex hospital
intensive care environments, the home, a worksite,
or the community. Reading Nightingale’s
Environmental Theory raises consciousness in the