Nursing Theories

Barnum
Theory - a construct that accounts for or organizes
some phenomenon. A nursing theory, then, describes
or explains nursing."

With the formulation of different theories, concepts,

and ideas in nursing it:

- guides nurses in their practice knowing what is

nursing and what is not nursing.
- helps in the formulations of standards, policies and
laws.
- will help the people to understand the competencies
and professional accountability of nurses.
- It will help define the role of the nurse in the
multidisciplinary health care team.

Four Major Concepts (Metaparadigm)

1. Person
- refers to all human beings.
- People are the recipients of nursing care;
individuals, families, communities, and
groups.

2. Environment
- factors that affect individuals internally and
externally. Erickson, Tomlin & Swain
- not only in the everyday surroundings but all - Modeling & Role: Modeling Theory (MRM)
setting where nursing care is provided.
Joyce J. Fitzpatrick
3. Health - Life Perspective Rhythm Model
- generally addresses the person's state of
well-being. Lydia E. Hall
- Core, Care and Cure Model
4. Nursing
- central to all nursing theories Virginia Henderson
- Definitions of nursing describe what nursing is, - Definition of Nursing
what nurses do, and how nurses interact with
clients. Imogene M. King
- Most nursing theories address each of the four - Systems Framework and Theory of Goal
central concepts implicitly or explicitly Attainment

Katharine Kolcaba
- Theory of Comfort
Manzano 11-14-22
Madeleine Leininger Florence Nightingale
- Transcultural Nursing Model

Myra Estrin Levine - First theory of nursing

- The Conservation Model - Focused on changing and manipulating environment
(put the patient in the best possible conditions for nature
Kari Martinsen to act)
- Nursing Philosophy - Identified 5 environmental factors: fresh air, pure water,
efficient drainage, cleanliness/sanitation and light/direct
Ramona T. Mercer sunlight.
- Maternal Role Attainment - include appropriate noise, nutrition, hygiene, light,
comfort, socialization and hope.
Betty Neuman
- The Neuman Systems Model - Born in May 12, 1820 - August 13, 1910 in Florence,
Italy
Rosemarie Rizzo Parse - Founder of Modern Nursing
- Theory of Human Becoming
- Institution of deaconesses at Kaiserswerth, Germany
Hildegard E. Peplau (training 3 months studied nursing.)
- Interpersonal Relations Model - Crimean war – wounded soldiers
- School of Nursing at St. Thomas Hospital in England
Martha E. Rogers - Notes Nursing: What It Is, What It Is Not
- The Science of Unitary Human Beings

Roper, Logan & Tierney

- The Elements of Nursing: A Model for Nursing
Based on a Model of Living

Callista Roy
- The Roy Adaptation Model

Jean Watson
- Theory of Caring in Nursing

Ernestine Wiedenbach
- The Helping Art of Clinical Nursing

Margaret Neuman
- Health as Expanding Consciousness

Florence Nightingale
- (Systemic approach to health care)

Dorothea E. Orem
- Self-Care Deficit Nursing Theory

Ida Jean Orlando

- Nursing Process Theory
✓ "Nursing knowledge is distinct from medical - A unique function of the nurse is to assist the clients,
knowledge" sick or well in the performance of those activities
✓ "Holistic individual and recognized nursing of the sick contributing to health or its recovery, that clients would
and nursing of well" perform unaided if they had the necessary strength, will
✓ Nightingale's 13 canons, health promotion and or knowledge.
spiritual distress identified to her theory - Believed that nursing involves in assisting the client in
gaining independence as rapidly as possible or assisting
- The Legacy of Caring" him achieve peaceful death if recovery is no longer
- "Notes of Nursing: What it is, What it is not" possible.
- "In nurturing environment, the body could repair itself"
Metaparadigm
"The most important practical lessons that can be given
to nurses is to teach them the P: - Individual requiring assistance to achieve health
what to observe-how-to-observe. and independence or a peaceful death.
If you can not get the habit of observation one way or the - Mind and body are inseparable.
other. You had better give up to be a nurse, for it is not
your calling however kind and anxious you may be" E: All external conditions and influences that affect life
and development.
Virginia Henderson
H: Equated with independence, viewed in terms
of the client's ability to perform 14 components of
The Nature of Nursing nursing care unaided: breathing, eating, drinking,
- The First Lady of Nursing maintaining comfort, sleeping, resting clothing,
- The Nightingale of Modern Nursing maintaining body temperature, ensuring safety,
- Modern-Day Mother of Nursing communicating, worshiping, working, recreation, and
- The 20th Century Florence Nightingale continuing development.
- Introduced The Nature of Nursing Model
N: Assists and supports the individual in life activities
Identified 14 basic needs: and the attainment of independence

1. Breathing normally Virginia Henderson's patterned with Abraham

2. Eating and drinking adequately Maslow's Hierarchy of Needs
3. Eliminating body wastes
4. Moving and maintaining desirable position
5. Sleeping and resting
6. Selecting suitable clothes
7. Maintaining body temperature within normal
range
8. Keeping the body clean and well-groomed
9. Avoiding dangers in the environment
10. Communicating with others
11. Worshiping according to one's faith
12. Working in such a way that one feels a sense of
accomplishment
13. Playing/participating in various forms of
recreation
14. Learning, discovering or satisfying the curiosity
that leads to normal development and health
and using available health facilities.
Two Additional Needs by Maslow - Self-respect
- Body image
• Need to know
Two factors affecting Self-esteem
• Need to understand
a. Yourself
Maslow - Sense of adequacy
- a need as a satisfaction whose absence can - Accomplishment
cause illness
b. Others
Characteristics of Basic Human Need: - Appreciation
- Recognition
1. Needs are universal. - Admiration
2. Needs may be met in different ways - Belongingness
3. Needs may be stimulated by external and internal
factor 5. Self-Actualization
4. Priorities may be deferred - Able to fulfill needs and ambitions and
5. Needs are interrelated maximizing one's full potential

Maslow's Hierarchy of Basic Human Needs 6. Aesthetics

- Beauty
1. Physiologic
- Oxygen
- Fluids Faye Abdellah
- Nutrition
- Body temperature
- Elimination ✓ Patient-Centered Approaches to Nursing Model
- Rest and sleep
- Sex 21 Nursing Problems

2. Safety and Security 1. To maintain good hygiene.

- Physical safety 2. To promote optimal activity: exercise, rest
- Psychological safety 3. To promote safety.
- The need for shelter and freedom from harm 4. To maintain good body mechanics and sleep.
and danger 5. To facilitate the maintenance of a supply of
oxygen
3. Love and belonging 6. To facilitate maintenance of nutrition
- The need to love and be loved 7. To facilitate maintenance of elimination
- The need to care and to be cared for. 8. To facilitate the maintenance of fluid and
- The need for affection: to associate or to belong electrolyte balance
- The need to establish fruitful and meaningful 9. To recognize the physiologic response of the
relationships with people, institution, or body to disease conditions
organization 10. To facilitate the maintenance of regulatory
mechanisms and functions
4. Self-Esteem Needs 11. To facilitate the maintenance of sensory
- Feeling good about one's self functions
- Self-worth
- Self-identity
 12. To identify and accept positive and negative Ernestine Wiedenbach
expressions, feelings and reactions
13. To identify and accept the interrelatedness of
emotions and illness. ✓ Developed the Clinical Nursing - A Helping Art Model
14. To facilitate the maintenance of effective verbal ✓ She believed that nurses meet the individual's need
and non-verbal communication for help through the identification of the needs,
15. To promote the development of productive administration of help and validation that actions were
interpersonal relationship helpful.
16. To facilitate progress toward achievement of ✓ Components of clinical practice: Philosophy, purpose,
personal spiritual goals practice and an art.
17. To create and maintain a therapeutic ✓ To assist the individuals in overcoming obstacles that
environment prevent meeting healthcare needs.
18. To facilitate awareness of self as an individual
with varying needs. P: Any individual who is receiving help from a member of
19. To accept the optimum possible goals the health profession or from a worker in the field of
20. To use community resources as an aid in health.
resolving problems arising from illness.
21. To understand the role of social problems as E: Not specifically addressed
influencing factors
H: Concepts of nursing, client, and need for help and
- Defined nursing as service to individuals and families. their relationships imply health-related concerns in the
nurse-client relationship..
- Conceptualized nursing as an art and a science that
molds the attitudes, intellectual competencies and N: the nurse is a functional human being who acts,
technical skills of the individual nurse into the desire and thinks, and feels. All actions, thoughts, and feelings
ability to help people, sick or well and cope with their underlie what the nurse does.
health needs

Focus/Development Jean Watson

- To deliver nursing care for the whole individual
✓ Human Caring Model (Nursing: Human Science and
P: The recipients of nursing care having physical,
Human Care)
emotional, and sociologic needs that may be overt or
✓ Nursing
Covert.
- application of the art and human science
through transpersonal caring transactions to
E: Not clearly defined. Some discussion indicates that
help persons achieve mind-body-soul harmony,
clients interact with their environment, of which nurse is
which generates self-knowledge, self-control,
a part.
self-care and self-healing
✓ Caring
H: a state when the individual has no unmet needs and
- nurturant way or responding to a valued client
no anticipated or actual impairment.
towards whom the nurse feels a personal sense
of commitment and responsibility.
N: - Broadly grouped in "21 nursing problems," which
- It is only demonstrated interpersonally that
center around needs for hygiene, comfort, activity, rest,
results in the satisfaction of certain human
safety, oxygen, nutrition, elimination, hydration, physical
needs.
and emotional health promotion, interpersonal
- Accepts the person as what he/she may become
relationships, and development of self-awareness.
in a caring
- Nursing care is doing something for an individual
Carative Factors: - Advocated the three elements composing
nursing situation:
1. The promotion of a humanistic-altruistic system of ✓Client behavior
values ✓ Nurse reaction
2. Instillation of faith-hope ✓ Nurse action
3. The cultivation of sensitivity to one's self and others
4. The development and acceptance of the expression of ✓ To interact with clients to meet immediate needs by
positive and negative feelings. identifying client behaviors, nurse's reactions, and
5. The systemic use of the scientific problem-solving nursing actions to take
method for decision making
6. The promotion of interpersonal teaching-learning P: Unique individual behaving verbally nonverbally.
7. The provision for supportive, protective and corrective Assumption is that individuals are at times able to meet
mental, physical, socio-cultural and spiritual environment their own needs and at other times unable to do so
8. Assistance with the gratification of human needs
9. The allowance for existential phenomenological forces E: Not defined

✓ To focus on curative factors derived from a humanistic H: Not defined. Assumption is that being without
perspective and from scientific knowledge. emotional or physical discomfort and having a sense of
well-being contribute to a healthy state.
P: A valued being to be cared for, respected, nurtured,
understood, and assisted, a fully functional, integrated N: Professional nursing is conceptualized as finding out
self and meeting the client's immediate need for help.

E: Social environment, caring and the culture of

caring affect health Lydia Hall

H: Physical, mental, and social wellness

Three Components of Nursing Care, Core and Cure
N: A human science of people and human health; illness ✓ Care: represent nurturance and is exclusive to
experiences that are mediated by professional, personal, nursing ✓ Core: involves therapeutic use of self and
scientific, aesthetic, and ethical human care emphasizes
transactions. the use of reflection
✓ Cure: focuses on nursing related to the physician's
Ida Jean Orlando orders
✔ Nursing
- To provide professional nursing care to people
- The Dynamic Nurse - Patient Relationship past the acute stage of illness.
Model
- Believed that the nurse helps patients meet a P: Client is composed of body, pathology, and person.
perceived need that the patients cannot meet for People set their own goals and are capable of learning
themselves. and growing.
- Observed that the nurse provides direct
assistance to meet an immediate need for help E: Should facilitate achievement of the client's personal
in order to avoid or to alleviate distress or goals.
helplessness.
- Nursing actions can be: H: Development of a mature self-identity that assists in
✓ Automatic the conscious selection of actions that facilitate growth.
✓ Deliberative
N: Caring is the nurse's primary function. Professional processes in the direction of creative, constructive,
nursing is most important during the recuperative period. productive, personal, and community living.
Hildegard Peplau
N: Interpersonal therapeutic process that "functions
cooperatively with others human processes that make
✓ Interpersonal Model health possible for individuals in communities. Nursing is
✓ Nursing an educative instrument, a maturing force that aims to
- interpersonal process of therapeutic interactions promote forward movement of personality.
between an individual who is sick or in need of
health services and a nurse especially educated
to recognize and respond to the need for help.
Joyce Travelbee
4 phases of the Nurse - Patient relationship:

1. Orientation ✓ Interpersonal Aspects of Nursing Model

- individual/family has a "felt need" and seeks ✓ The goal of nursing is to assist individual or family in
professional assistance from a nurse (who is a preventing or coping with illness, regaining health,
stranger). finding meaning in illness or maintaining maximal degree
- problem identification phase. of health.
✓ She further viewed that interpersonal process is a
2. Identification human-to-human -relationship formed during illness and
- patient begins to have feelings of "experience of suffering".
belongingness and a capacity for dealing with
the problem, creating an optimistic attitude from P: A unique, irreplaceable individual who is in a
which inner strength ensues. Here happens the continuous process of becoming, evolving, and
selection of appropriate professional assistance. changing.

3. Exploitation E: Not defined

- the nurse uses communication tools to offer
services to the patient, who is expected to take H: Heath includes the individual's perceptions of health
advantage of all services. and the absence of disease.

4. Resolution N: An interpersonal process whereby the professional

- where patient's needs have already been met nurse practitioner assists an individual, family, or
by the collaborative efforts between the patient community to prevent or cope with the experience of
and the nurse. Therapeutic relationship is illness and suffering, and if necessary, to find meaning in
terminated and the links are dissolved, as these experiences.
patient drifts away from identifying with the
nurse as the helping person Martha Rogers

P: An organism striving to reduce tension generated by

needs ✓ Science of Unitary Human Beings
✓ Unitary Man
E: The interpersonal process is always included, and - an energy field in constant interaction with the
psychodynamic milieu receives attention, with emphasis environment.
on the client's culture and mores.

H: Ongoing human process that implies forward

movement of personality and other ongoing human
✓ Human beings are more than and different from the - interaction process between client and nurse
sum of their parts; the distinctive properties of the whole whereby during perceiving, setting goals, and
are significantly different from those of its parts. acting on them, transactions occur and goals are
achieved
5 basic assumptions: ✓ To communicate to help the client reestablish a
positive adaptation to his or her environment.
- The human being is a unified whole, possessing
individual integrity and manifesting P: Biopsychosocial being
characteristics that are more than and different
from the sum of parts. E: Internal and external environment continually
interacts to assist in adjustments to change.
- The individual and the environment continuously
exchanging matter and energy with each other H: A dynamic life experience with continued goal S
attainment and adjustment to stressors.
- The life processes of human beings evolve
irreversibly and unidirectionally along a space- N: Perceiving, thinking, relating, judging, and acting with
time continuum an individual who comes to a nursing situations

- Patterns identify human being and reflect their

innovative wholeness Betty Neuman

- The individual is characterized by the capacity

for abstraction and imagery, language and - The Neuman System Model
thought, sensation and emotion - Health care System Model

P: Unitary man, a four- dimensional energy field. Nursing

- unique profession that is concerned with all the
E: Encompasses all that is outside any given human variables affecting an individual's response to
field. Person exchanging matter and energy. stresses, which are:
✓ intra (within the individual)
H: Not specifically addressed, but emerges out of ✓ inter (between one or more other people)
interaction between human and environment, moves ✓ extrapersonal (outside the individual)
forward, and maximizes human potential.
-nurse helps the client, through primary, secondary and
N: A learned profession that is both science and art. The tertiary prevention to adjust to environment stressors
professional practice of nursing is creative and and maintain client stability.
imaginative and exists to serve people.
- To address the effects of stress and reactions to it on
the development and maintenance of health.
Imogene King - The concern of nursing is to prevent stress invasion, to
protect the client's basic structure and to obtain or
maintain a maximum level of wellness.
✓ Goal Attainment Theory
✓ Nursing P: A client system that is composed of physiologic,
- helping profession that assists individuals and psychological, sociocultural, and environmental
groups in society to attain, maintain and restore variables.
health. If this is not possible, nurses help
individuals die with dignity.
E: Internal and external forces surrounding humans at ✓ Dependence
any time. ✓ Achievement
✓ Sexual and Role Identity Behavior
H: Health or wellness exists if all parts and subparts are
in harmony with the whole person.
N: Nursing is a unique profession in that it is concerned - To reduce stress so the client can recover as
with all the variables affecting an individual's response to quickly as possible.
stressors.
- Each person strives to achieve balance and
stability both internally and externally and to
Myra Levin function effectively by adjusting and adapting to
environmental forces through learned pattern of
response.
- Four Conservation Principles - patient strives to become a person whose
behavior is commensurate with social demands.
Nursing
- is a human interaction and proposed 4 P: A system of interdependent parts with patterned,
conservation principles of nursing which are repetitive, and purposeful ways of behaving.
concerned with the unity and integrity of the
individual. E: All forces that affect the person and that influence the
behavioral system
1. Conservation of Energy
2. Conservation of Structural Integrity H: Focus on person, not illness. Health is a dynamic
3. Conservation of Personal Integrity state influenced by biologic, psychological, and social
4. Conservation of Social Integrity factors

P: A holistic being N: Promotion of behavioral system, balance and stability.

An art and a science providing external assistance
E: Broadly, includes all the individual's experiences before and during balance disturbances

H: maintenance of the client's unity and integrity

Madeleine Leininger
N: A discipline rooted in the organic dependency of the
individual human being on his or her relationship with
others - Transcultural Nursing Model

Dorothy Johnson Nursing

- a learned humanistic and scientific profession
and discipline
- Behavioral System Model - focused on human care phenomena and
- According to her, each person as a behavioral activities in order to assist, support, facilitate, or
system is composed of seven subsystem enable individuals or to maintain or regain their
namely: well being (or health) in culturally meaningful
and beneficial ways, or to help people face
✓ Ingestive handicaps or death.
✓ Eliminative Transcultural nursing
✓ Affiliative - focuses upon the comparative study and
✓ Aggressive analysis of cultures with respect to nursing and
 health-illness caring practices, beliefs and recovering from surgery in a post-anesthesia
values with the goal to provide meaningful and care unit
efficacious nursing care services to people
according to their cultural values and
health-illness context.
- Focuses on the fact that different cultures have B. Partial compensatory
different caring behaviors and different health - nurse and client perform care, client can perform
and illness values, beliefs, and patterns of selected self-care activities, but also accepts
behaviors. care done by the nurse for needs the client
- Awareness of the differences allows the nurse to cannot meet independently.
design culture-specific nursing interventions - Example: Nurse can assist post operative client
to ambulate, Nurse can bring a meal tray for
client who can feed himself
Dorothea Orem
C. Supportive-educative
- nurse's actions are to help the client
✓ Self-Care and Self-Care Deficit Theory develop/learn their own self-care abilities
through knowledge, support and
Nursing encouragement.
- "The act of assisting others in the provision and - Example: Nurse guides a mother how to
management of self-care to maintain/improve breastfeed her baby, Counseling a psychiatric
human functioning at home level of client on more adaptive coping strategies.
effectiveness."

✓ Focuses on activities that adult individuals perform on Sister Callista Roy

their own behalf to maintain life, health and well-being.
✓ Has a strong health promotion and maintenance
focus. ✓ Adaptation Model
✓ Identified 3 related concepts:
✓ Viewed each person as a unified biopsychosocial
1. Self-care system in constant interaction with a changing
- activities an Individual performs independently environment.
throughout life to promote and maintain personal ✓ Person as an adaptive system consists of input,
well-being. control, processes, output and feedback.
✓ All people have certain needs which are divided into
2. Self-care deficit four different modes: physiological, self concept, role
- results when self-care agency (Individual's function and interdependence.
ability) is not adequate to meet the known
self-care needs. ✓ To identify the types and demands placed on a client
and client's adaptation to the demands.
3. Nursing System
- nursing interventions needed when Individual is P: Biopsychological being and the recipient of nursing
unable to perform the necessary self-care care.
activities:
E: All conditions, circumstances, and influences
A. Wholly compensatory surrounding and affecting the development of an
- nurse provides entire self-care for the client. organism or groups of organisms.
Example: care of a newborn, care of client
H: The person encounters adaptation problems in
changing the environment.

N: A theoretical system of knowledge that prescribes a

process of analysis and action related to the care of the
ill or potentially ill persons.
Rosemarie Rizzo Parse Josephine Paterson and Loretta Zderad

✓ Theory of Human Becoming ✓ Provided a Humanistic Nursing Practice Theory.

✓ based on their belief that nursing is an existential
✓ Emphasized free choice of personal meaning in experience.
relating value priorities, co-creating of rhythmical
patterns, in exchange with the environment, and co ✓ Nursing is viewed as a lived dialogue that involves the
transcending in many dimensions as possibilities unfold. coming together of the nurse and the person to be
nursed.
✓ Human becoming is freely choosing personal ✓ The essential characteristics of nursing is nurturance.
meaning in situation in the intersubjective process of ✓ Humanistic care cannot take place without the
relating value priorities authentic commitment of the nurse being with and doing
✓ Human becoming is co-creating rhythmic patterns or with the client.
relating in mutual process in the universe ✓ Humanistic nursing also presupposes responsible
✓ Human becoming is co-transcending choices.
multidimensionally with emerging possibilities.

✓ She also believed that each choice opens certain Helen Erickson, Evelyn Tomlin and Mary Ann
opportunities while closing others. Thus, referred to Swain
revealing-concealing, enabling-limiting, and connecting-
separating.
✓ Since each individual makes his or her own personal ✓ Developed the Modeling and Role - Modeling Theory.
choices, the role of the nurse is that of guide not ✓ The focus of this theory is on the person.
decision maker
✓ The nurse model (assesses), role models (plans), and
P: A major reason for nursing existence. intervenes in this interpersonal and interactive theory.
✓ They asserted that each individual is unique, has
E: Man and environment interchange energy to create some self-care knowledge, needs simultaneously to be
what is in the world, and man chooses the meaning attached to and separate from others, and has adaptive
given to the situations he creates. potential, nurses in this theory, facilitate, nurture and
accept the person unconditionally.
H: A lived experience that is a process of being and ✓ They view nursing as a self-care model based on the
becoming. client's of the world and adaptations to stressors.

N: Nursing Practice is directed toward illuminating and

mobilizing family interrelationships in light of the Margaret Newman
meaning assigned to health and its possibilities as
language in the co created patterns of relating
✓ Focused on health as expanding consciousness.
✓ humans are unitary beings in whom disease is a
manifestation of the pattern of health.
✓ consciousness as the information capability of the
system which is influenced by time, space, and
movement and is ever-expanding.
✓ Change occurs through transformation.

✓ Nursing is involved with human beings who have

reached choice points and found that their old ways are
no longer effective.
✓ Caring is a moral imperative for nursing.
✓ The nurse is a partner with the client rather than the
goal setter and outcome predictor.

Patricia Benner

✓ Benner's Philosophy

✓ "proposed that a nurse could gain knowledge

and skills without actually learning a theory"
Described as "knowing how” without "knowing that"

✓ Development of knowledge in nursing is "a

combination of knowledge through research and
understanding through clinical experience