Nursing Theories

Nikko Glenn Ramones RN, SCFHS-RN, MAN(cand)

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.
What are Nursing Theories?
• 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
• Philosophy. 
These are beliefs and values that define a way of thinking and are generally
known and understood by a group or discipline.
Defining Terms
• 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.
Defining Terms
• 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.
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
Two types of definition
• Theoretical Definitions. Define a particular concept based on the
theorist’s perspective.
• Operational Definitions. States how concepts are measured (using
your own words)
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.
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
History of Nursing Theories
• 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.”
• In the 1950s, there is a consensus among nursing scholars that nursing needed to validate itself
through the production of its own scientifically tested body of knowledge.
• In 1952, Hildegard Peplau introduced her Theory of Interpersonal Relations that emphasizes the 
nurse-client relationship as the foundation of nursing practice.
• In 1955, Virginia Henderson conceptualized the nurse’s role as assisting sick or healthy individuals to
gain independence in meeting 14 fundamental needs. Thus her Nursing Need Theory was
developed.
• In 1960, Faye Abdellah published her work “Typology of 21 Nursing Problems,” which shifted the
focus of nursing from a disease-centered approach to a patient-centered approach.
• In 1962, Ida Jean Orlando emphasized the reciprocal relationship between patient and nurse and
viewed nursing’s professional function as finding out and meeting the patient’s immediate need for
help.
History of Nursing Theories
• In 1968, Dorothy Johnson pioneered the Behavioral System Model and upheld the fostering of
efficient and effective behavioral functioning in the patient to prevent illness.
• In 1970, Martha Rogers viewed nursing as both a science and an art as it provides a way to view the
unitary human being, who is integral with the universe.
• In 1971, Dorothea Orem stated in her theory that nursing care is required if the client is unable to
fulfill biological, psychological, developmental, or social needs.
• In 1971, Imogene King‘s Theory of Goal attainment stated that the nurse is considered part of the
patient’s environment and the nurse-patient relationship is for meeting goals towards good health.
• In 1972, Betty Neuman, in her theory, states that many needs exist, and each may disrupt client
balance or stability. Stress reduction is the goal of the system model of nursing practice.
• In 1979, Sr. Callista Roy viewed the individual as a set of interrelated systems that maintain the
balance between these various stimuli.(adaptation)
• In 1979, Jean Watson developed the philosophy of caring, highlighted humanistic aspects of nursing
as they intertwine with scientific knowledge and nursing practice.
• 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.
• 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.
• Grand Nursing Theories. Are works derived from nursing philosophies, conceptual models, and
other grand theories that are generally not as specific as middle-range theories. Works of
Levine, Rogers, Orem, and King are some of the theories under this category.
• Middle-Range Theories. Are precise and answer specific nursing practice questions. They
address the specifics of nursing situations within the model’s perspective or theory from which
they are derived. Examples of Middle-Range theories are that of Mercer, Reed, Mishel, and
Barker.
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 selection 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 specially 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.
• It helps nurses and healthcare providers develop more therapeutic
interventions in the clinical setting
• 2. Identification Phase
• The identification phase begins when the client works
interdependently with the nurse, expresses feelings, and begins to
feel stronger.
• Selection of appropriate professional assistance
• Patient begins to have a feeling of belonging and a capability of
dealing with the problem, which decreases the feeling of helplessness
and hopelessness.
• 3. Exploitation Phase
• In the exploitation phase, the client makes full use of the services offered.
• In the exploitation phase, the client makes full use of the services offered.
• Use of professional assistance for problem-solving alternatives
• Advantages of services are used based on the needs and interests of the patients.
• The individual feels like an integral part of the helping environment.
• They may make minor requests or attention-getting techniques.
• The principles of interview techniques must be used to explore, understand and adequately deal
with the underlying problem.
• Patient may fluctuate on independence.
• Nurse must be aware of the various phases of communication.
• Nurse aids the patient in exploiting all avenues of help, and progress is made towards the final step.
• 4. Resolution Phase
• In the resolution phase, the client no longer needs professional services and gives up
dependent behavior. The relationship ends.
• In the resolution phase, the client no longer needs professional services and gives up
dependent behavior. The relationship ends.
• Termination of professional relationship
• The patient’s needs have already been met by the collaborative effect of patient and nurse.
• Now they need to terminate their therapeutic relationship and dissolve the links between
them.
• Sometimes may be difficult for both as psychological dependence persists.
• The patient drifts away and breaks the nurse’s bond, and a healthier emotional balance is
demonstrated, and both become mature individuals