Nursing Theories & Theorists Explained
What is Nursing Theory?
Nursing theory is "a creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomena," per the book Integrated Theory and Knowledge Development in Nursing.
Nursing theory provides the foundational knowledge that enables nurses to care for their patients and guides their actions. Theories are in place, regardless of nursing specialization, to establish guidelines for both broad and specific nursing practices.
Nursing theory is heavily influenced by Florence Nightingale's pioneering work, which significantly influenced the modern nursing definition. Nightingale's Environmental Theory 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.”
By identifying potential risk factors for illness or conditions that would exacerbate an illness and potentially lead to death, Nightingale saw the importance of a patient’s environment to their overall health and well-being. As a result, healthcare professionals, including nurses, began to treat patients differently and the start of population health and public health is seen.
In Florence Nightingale’s Environmental Theory, she identified five environmental factors:
- Fresh air
- Pure water
- Efficient drainage
- Cleanliness or sanitation
- Light or direct sunlight
These factors were essential to decrease the spread of contagious diseases and decreasing mortality and morbidity.
While Florence Nightingale may have introduced the first nursing theory in 1860, it is still extremely relevant today. In countries where fresh air, pure water, efficient drainage, cleanliness or sanitation, and light or direct sunlight are not present, morbidity and mortality are increased.
What are Nursing Theories Used For?
Nursing theories provide the foundation for nursing practice and are essential to the care of patients. Academic hospitals and Magnet hospitals will consistently ensure that nursing theories are incorporated into their policies and procedures to ensure best practice is being used.
Most nurses and institutions will employ a variety of nursing theories within their everyday practice versus just one theory. Most do it unknowingly.
Nursing theories help bedside nurses evaluate patient care and base nursing interventions on the evaluation of the findings.
The theories can also provide nurses with the rationale to make certain decisions. An example of a nursing theory in use is seen in the care of a Jehovah’s Witnesses patient that does not believe in blood transfusions. While the patient may need a blood transfusion, Dorothea Orem’s Self-Care theory provides nurses with a solid basis for assisting their patients and giving them the opportunity to express independence and control in caring for themselves. While the nurse may not agree with the patient’s decision to not receive a blood transfusion, Orem’s theory suggests the importance of allowing the patient to make the decision and respecting it as their own choice.
Oftentimes, the integration of nursing theory is not as obvious as in the aforementioned example. However, it is important for nurses and nursing students to understand and respect the importance of nursing theories and their impact on modern-day nursing and healthcare.
Who are Nursing Theories Used By?
While all nurses, regardless of position and specialty, utilize nursing theories in their practice, not all nurses are aware of their implications. Generally speaking, most nursing theories are used by nurse educators and nurse researchers.
Nurse educators will utilize nursing theories in designing course curriculums based on educational principles, research, and theories to provide nursing students with the knowledge and skills needed to provide care to their patients.
Nurse researchers will conduct theory-guided research in order to create best practices and to predict potential clinical problems or explain existing knowledge.
Nursing Metaparadigms
There have been countless nursing theories introduced since Florence Nightingale's Environmental Theory, including Imogene King‘s Theory of Goal and Dorothy Johnson’s Behavioral System Model. What they all have in common is they center around the nursing metaparadigm.
A metaparadigm is a set of theories or ideas that provide structure for how a discipline should function. Nursing metaparadigms were first classified by Fawcett into four specific categories,
- Person
- Environment
- Health
- Nursing
These four concepts are fundamental to all nursing theories and without identification of them and their relevance to the theory, it is incomplete.
Furthermore, these four basic nursing metaparadigms point to the holistic care of a patient and their medical health is interconnected to the four concepts.
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The Four Main Concepts of Nursing Theory
Fawcett’s four specific concepts help define nursing and set it apart from other disciplines and professions. These four concepts have been used to define the context and content of the nursing profession. The person is the most important concept in nursing theory, but each theorist's interpretation of the other concepts is how to differentiate between them.
1. Person
Person (also referred to as Client or Human Being) is the recipient of nursing care and may include individuals, patients, groups, families, and communities.
2. Environment
Environment or situation is defined as the internal and external surroundings that affect the patient. 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.
3. 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.
4. Nursing
The attributes, characteristics, and actions of the nurse providing care on behalf of or in conjunction with, the client.
Levels of Nursing Theory
Nursing theories are categorized into three levels including,
- Grand Nursing Theories
- Mid-range Nursing Theories
- Nursing Practice Theories
Grand Nursing Theories
These are theories based on broad, abstract, and complex concepts. They provide the general framework for nursing ideas pertaining to components such as people and health. These theories typically stem from a nurse theorist’s own experience.
Mid-Range Nursing Theories
These are theories that drill down into specific areas of nursing rather than deal with sweeping concepts. They can emerge from nursing practice, research, or from the theories of similar disciplines.
Nursing Practice Theories
These are theories that narrow their focus even further, specifically focusing on concepts concerning a defined patient population. These theories tend to directly affect patients more than the other two types of theories. Bedside nurses will often use these theories in their everyday practice.
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Nursing Theorists
We talked about Nightingale and Orems' role as nursing theorists and reviewed their respective theories. Let's explore the work of some other notable nursing theorists and how their work helps nurses and other healthcare providers give better patient care.
Virginia Henderson: Nursing Need Theory
Virginia Henderson's Nursing Need Theory centers around the concept of basic human needs. Henderson believed that the role of a nurse is to assist individuals in meeting their fundamental needs and help them increase their independence.
Her theory emphasizes the nurse's role in supporting patients in activities such as:
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Breathing
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Eating
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Sleeping
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Moving
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Maintaining desired postures
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Dress and undress
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Cleanliness
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Communicating fears, opinions, and needs, and
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Worshiping according to their faith
Jean Watson: Theory of Human Caring
Jean Watson is a contemporary nursing theorist renowned for her Theory of Human Caring. Watson emphasizes the importance of creating a caring and compassionate relationship between the nurse and the patient.
Her theory focuses on ten factors:
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Upholding humanistic-altruistic values by practicing kindness and compassion
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Being genuinely present and fostering faith, hope, and belief systems while respecting the subjective experiences of oneself and others
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Cultivating self-awareness and spiritual practices, transcending ego-centeredness to achieve a transpersonal presence.
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Developing and nurturing loving, trusting, and caring relationships
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Encouraging the expression of both positive and negative emotions, actively listening to others' stories without judgment
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Applying creative problem-solving through the caring-healing process
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Engaging in transpersonal teaching and learning within a caring relationship, adapting to the individual's perspective and transitioning towards a coaching approach for enhanced health
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Creating a healing environment on various levels, fostering an atmosphere of authentic caring presence at an energetic and subtle level.
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Acknowledging the interconnectedness of mind, body, and spirit while upholding human dignity
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Embracing the spiritual, mysterious, and unknown aspects of life
Madeleine Leininger: Transcultural Nursing Theory
Leininger's Transcultural Nursing Theory, also called Culture Care Theory, focuses on providing culturally congruent care by understanding and respecting the values, beliefs, and practices of diverse individuals and groups.
Hildegard Peplau: Interpersonal Relations Theory
Peplau's Interpersonal Theory of Interpersonal Relations emphasizes that the journey of nurse-patient relationships involves three pivotal stages that are essential for their success:
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The initial orientation
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A dynamic working phase, and
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A thoughtful termination process
According to Peplau, the nurse's role is to facilitate the patient's growth and development by utilizing therapeutic communication, empathy, and understanding.
Betty Neuman: Neuman Systems Model
The Neuman Systems Model focuses on identifying stressors that have the potential to negatively impact an individual's health and overall well-being. It incorporates various factors such as physiological, psychological, sociocultural, and developmental aspects.
The theory also provides a flexible structure for assessment, intervention, and evaluation in nursing practice.
Sister Callista Roy: Adaptation Model
The Roy Adaptation Model is based on the belief that individuals are adaptive systems, constantly interacting with their environment to maintain their physiological and psychosocial integrity. It views the person as a holistic being, consisting of four interconnected adaptive modes:
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Physiological Mode: Deals with physical and biological aspects of adaptation, including the body's response to stressors, maintaining homeostasis, and meeting basic physiological needs.
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Self-Concept Mode: Focuses on individuals' perception of themselves, including self-esteem and self-image.
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Role Function Mode: Considers the roles people have in their lives, such as spouse, parent, employee, or student.
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Interdependence Mode: Emphasizes the importance of social relationships and how individuals interact with others, such as support from social networks.
Martha Rogers: Science of Unitary Human Being
Rogers' Science of Unitary Human Beings believed that nursing should focus on promoting harmony and balance within the individual and their environment.
Her theory emphasizes the interconnectedness of human beings with their surroundings and the importance of energy fields in health and healing. Spoken another way, patients cannot be considered as “separate” from their environment.
Patricia Benner: Novice to Expert Theory
Benner's Novice to Expert Theory describes the stages of nursing skill from novice to advanced beginner, and finally, to competent.
She emphasizes the importance of practical experience and clinical judgment in nursing practice and highlights that expertise develops over time through practice and reflection.
Imogene King: Theory of Goal Attainment
King's Theory of Goal Attainment focuses on the nurse-patient relationship and the mutual goal-setting process. Her theory emphasizes that nurses and patients should collaborate to establish goals that promote the patient's well-being and health.
Katharine Kolcaba: Comfort Theory
Kolcaba's Comfort Theory highlights the significance of providing comfort to patients as a central goal of nursing care.
Her theory defines comfort as the immediate experience of being strengthened in physical, psychospiritual, environmental, and sociocultural dimensions.
Kolcalba’s framework proposes that healthcare providers:
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Assess if patient’s comfort needs are not being met
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Create interventions to meet those needs
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Measure comfort prior to and after the interventions
Nursing Theory in Practice
Nursing theories are used every day in practice even if nurses aren’t aware of their use. Theories help guide evidence-based research which then leads to best practices and policies. These policies and procedures keep patients safe, while providing the best care possible.
Nursing theories also allow nurses to positively influence the health and well-being of their patients beyond taking care of them at the bedside. Nursing theory-guided practice helps improve the quality of care delivered and helps continue to move the nursing profession forward into the 21st century.
Most bedside nurses will not necessarily know the theories behind their practice so their usefulness is often dismissed. Advanced practice nurses, nurse scholars, nurse educators, and nurse researchers are most likely going to be up to date on current nursing theories and their impact on the nursing profession.
Nursing theories should continue to guide nursing practice both in academia and at the bedside. It allows nurses to provide current best-practice care to their patients while also impacting them beyond the bedside. Florence Nightingale’s Environmental Theory was groundbreaking during the 1860s and helped change the course of nursing and healthcare while changing the outcomes of patients through the identification of environmental factors that may hinder their health and well-being.
