● 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.

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:

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.

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.

Classification of Nursing Theories

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

By Abstraction

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

Grand Nursing Theories

● Grand theories are abstract, broad in scope, and complex, therefore requiring
further research for clarification.
● Grand nursing theories do not 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.

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.

Florence Nightingale

● 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

● 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

● 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

● 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

● 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

● 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

● 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

 ● 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 Roger’s Biography and 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

● 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

● 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

● 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

● 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

● 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

● 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

● 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.