Introduction:

Over the years, nursing has incorporated theories from non-nursing sources, including theories of
systems, human needs, change, problem solving, and decision making.

Barnum defines theory as “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:
• It guides nurses in their practice knowing what is nursing and what is not nursing.
• It helps in the formulations of standards, policies and laws.
• It 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

Nurses have developed various theories that provide different explanations of the nursing
discipline. All theories, however, share four central concepts: Person, refers to all human beings. People
are the recipients of nursing care; they include individuals, families, communities, and groups.
Environment includes factors that affect individuals internally and externally. It means not only in the
everyday surroundings but all setting where nursing care is provided. Health generally addresses the
person’s state of well-being. The concept of Nursing is central to all nursing theories. Definitions of
nursing describe what nursing is, what nurses do, and how nurses interact with clients. Most nursing
theories address each of the four central concepts implicitly or explicitly.

Overview of Major Nursing Theorists

Theorist Focus / Development Views of Components

Florence Developed and described the first theory of Person: An individual with vital
Nightingale (1860), nursing. She focused the on changing and reparative processes to deal with
Notes on Nursing: manipulating the environment in order to put disease.
What It Is, What It Is the patient in best possible conditions for Environment: External conditions that
Not nature to act. affect life and individuals
development.
She believed that in the nurturing Health: Focus is on the reparative
environment, the body could repair itself. process of getting well
Client’s environment is manipulated to Nursing: Goal is to place the individual
include appropriate noise, nutrition, hygiene, in the best condition for good
light, comfort, socialization and hope healthcare
Hildegard Peplau She identifies four phases of the nurse-client P: An organism striving to reduce
(1952), relationship namely: tension generated by needs
Interpersonal ORIENTATION, IDENTIFICATION, E: The interpersonal process is always
Relations in Nursing EXPLOITATION, RESOLUTION included, and psychodynamic milieu
receives attention, with emphasis on
the client’s culture and mores.
H: Ongoing human process that
implies forward movement of
personality and other ongoing human
processes in the direction of creative,
constructive, productive, personal, and
community living.
N: Interpersonal therapeutic process
that “functions cooperatively with
others human processes that make
health possible for individuals in
communities. Nursing is an educative
instrument, a maturing force that aims
 to promote forward movement of
personality.
She identified fourteen basic needs. She
Virginia Henderson postulated that the unique function of the P: Individual requiring assistance to
(1955) nurse is to assist the clients, sick or well, in achieve health and independence or a
The Nature of the performance of those activities peaceful death. Mind and body are
Nursing contributing to health or its recovery, that inseparable.
clients would perform unaided if they had the E: All external conditions and
necessary strength, will or knowledge. influences that affect life and
development.
H: Equated with independence, viewed
in terms of the client’s ability to
perform 14 components of nursing
care unaided: breathing, eating,
drinking, maintaining comfort,
sleeping, resting clothing, maintaining
body temperature, ensuring safety,
communicating, worshiping, working,
recreation, and continuing
development.
N: Assists and supports the individual
in life activities and the attainment of
independence.
Faye Glenn To deliver nursing care for the whole P: The recipients of nursing care
Abdellah (1960), individual having physical, emotional, and
Patient Centered sociologic needs that may be overt or
Approaches to covert.
Nursing E: Not clearly defined. Some
discussion indicates that clients
interact with their environment, of
which nurse is a part.
H: a state when the individual has no
unmet needs and no anticipated or
actual impairment.
N: Broadly grouped in “21 nursing
problems,” which center around needs
for hygiene, comfort, activity, rest,
safety, oxygen, nutrition, elimination,
hydration, physical and emotional
health promotion, interpersonal
relationships, and development of self-
awareness. Nursing care is doing
something for an individual
Ida Jean Orlando She believed that the nurse helps patients P: Unique individual behaving verbally
(1961) meet a perceived needs that the patient nonverbally. Assumption is that
The Dynamic Nurse- cannot meet for themselves. individuals are at times able to meet
Patient Relationship To interact with clients to meet immediate their own needs and at other times
needs by identifying client behaviors, nurse’s unable to do so
reactions, and nursing actions to take E: Not defined
H: Not defined. Assumption is that
being without emotional or physical
discomfort and having a sense of well-
being contribute to a healthy state.
N: Professional nursing is
conceptualized as finding out and
meeting the client’s immediate need
for help.
Lydia Hall (1964), To provide professional nursing care to people P: Client is composed of body,
Nursing: What Is It? past the acute stage of illness. She pathology, and person. People set
 conceptualized three components of Nursing:
CARE, CORE, and CURE. Care represents
nurturance and is exclusive to nursing. Core
involves the therapeutic use of self and
emphasizes the use of reflection. Cure
focuses on nursing related to the physician’s
order
Ernestine To assist the individuals in overcoming
Wiedenbach (1964), obstacles that prevent meeting healthcare
Clinical Nursing – A needs. She advocated that the nurse’s
Helping Art individual philosophy or central purpose lends
credence to nursing care. She believed that
nurses meet the individual’s need for help
through identification of needs,
administration of help, and validation that
actions were helpful. Components of clinical
practice: Philosophy, Purpose, Practice and an
Art.
Joyce Travelbee To assist individuals, families, communities,
(1966, 1971), and groups to prevent or cope with illness,
Interpersonal Aspects regain health, finding meaning in illness, or
of Nursing maintaining, maximal degree of health. She
further viewed that interpersonal process is a
human-to-human relationship formed during
illness and “experience of suffering”.
Martha Rogers To assist the client in achieving a maximum
(1970), level of wellness. To Rogers, unitary man is
The Science of an energy field in constant interaction with
Unitary Man the environment. She asserted that human
beings are more than and different from the
sum if their parts; the distinctive properties
of the whole are significantly different from
its parts. Furthermore, she believed that
human being is characterized by the capacity
for abstraction and imagery, language and
thought, sensation and emotion.
Imogene M. King To communication to help the client
(1971, 1981), reestablish a positive adaptation to his or her
Open Systems Model, environment. She described nursing as a
Goal Attainment helping profession that assists individuals and
Theory groups in society to attain, maintain, and
their own goals and are capable of
learning and growing.
E: Should facilitate achievement of the
client’s personal goals.
H: Development of a mature self-
identity that assists in the conscious
selection of actions that facilitate
growth.
N: Caring is the nurse’s primary
function. Professional nursing is most
important during the recuperative
period.
P: Any individual who is receiving help
from a member of the health
profession or from a worker in the
field of health.
E: Not specifically addressed
H: Concepts of nursing, client, and
need for help and their relationships
imply health-related concerns in the
nurse—client relationship..
N: the nurse is a functional human
being who acts, thinks, and feels. All
actions, thoughts, and feelings
underlie what the nurse does.
P: A unique, irreplaceable individual
who is in a continuous process of
becoming, evolving, and changing.
E: Not defined
H: Heath includes the individual’s
perceptions of health and the absence
of disease.
N: An interpersonal process whereby
the professional nurse practitioner
assists an individual, family, or
community to prevent or cope with
the experience of illness and suffering,
and if necessary, to find meaning in
these experiences.
P: Unitary man, a four-dimensional
energy field.
E: Encompasses all that is outside any
given human field. Person exchanging
matter and energy.
H: Not specifically addressed, but
emerges out of interaction between
human and environment, moves
forward, and maximizes human
potential.
N: A learned profession that is both
science and art. The professional
practice of nursing is creative and
imaginative and exists to serve
people.
P: Biopsychosocial being
E: Internal and external environment
continually interacts to assist in
adjustments to change.
H: A dynamic life experience with
 restore health. If this is not possible, nurses
help individuals die with dignity.
In addition, King viewed nursing as an
interaction process between client and nurse
whereby during perceiving, setting goals, and
acting on them, transactions occur and goals
are achieved
Betty Neuman (1972, To address the effects of stress and reactions
1982, 1989, 1992) to it on the development and maintenance of
The Neuman System health. The concern of nursing is to prevent
Model or Health Care stress invasion, to protect the client’s basic
System Model. structure and to obtain or maintain a
maximum level of wellness. The nurse helps
the client, through primary, secondary, and
tertiary prevention modes, to adjust to
environmental stressors and maintain client
stability.
Myra Estrin Levine To use conservation activities aimed at
(1973), optimal use of client’s resources. She
Conservation Model advocated that nursing is a human interaction
and proposed 4 conservation principles of
nursing which are concerned with the unity
and integrity of the individual.
FOUR CONSERVATION PRINCIPLES:
1. Conservation of energy
2. Conservation of structural integrity
3. Conservation of personal integrity
4. Conservation of social integrity.
Sister Callista Roy To identify the types and demands placed on
(1979) a client and client’s adaptation to the
Adaptation Model demands.
Jean Watson (1979) To focus on curative factors derived from a
Nursing: Human humanistic perspective and from scientific
Science and Human knowledge.
Care
Human Caring Model
continued goal attainment and
adjustment to stressors.
N: Perceiving, thinking, relating,
judging, and acting with an individual
who comes to a nursing situations
P: A client system that is composed of
physiologic, psychological,
sociocultural, and environmental
variables.
E: Internal and external forces
surrounding humans at any time.
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 with all the
variables affecting an individual’s
response to stressors.
P: a holistic being
E: Broadly, includes all the individual’s
experiences
H: The maintenance of the client’s
unity and integrity
N: A discipline rooted in the organic
dependency of the individual human
being on his or her relationship with
others
P: Biopsychological beign and the
recipient of nursing care.
E: All conditions, circumstances, and
influences surrounding and affecting
the development of an organism or
groups of organisms
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
P: A valued being to be cared for,
respected, nurtured, understood, and
assisted, a fully functional, integrated
self
E: Social environment, caring and the
culture of caring affect health
H: Physical, mental, and social
wellness
N: A human science of people and
human health; illness experiences that
are mediated by professional,
personal, scientific, aesthetic, and
ethical human care transactions.
Dorothy E. Johnson To reduce stress so the client can recover as
(1980), quickly as possible. According to Johnson,
The Behavioral each person as a behavioral system is
System Model for composed of seven subsystems namely:
Nursing INGESTIVE, ELIMINATIVE, AFFILIATIVE,
AGGRESSIVE, DEPENDENCE, ACHIEVEMENT,
and SEXUAL AND ROLE IDENTITY.
In addition, she viewed that each person
strives to achieve balance and stability both
internally and externally and to function
effectively by adjusting and adapting to
environmental forces through learned pattern
of response. Furthermore, She believed that
the patient strives to become a person whose
behavior is commensurate with social
demands; who is able to modify his behavior
in ways that support biologic imperatives;
who is able to benefit to the fullest extent
during illness from the health care
professional’s knowledge and skills; and
whose behavior does not give evidence of
unnecessary trauma as a consequence of
illness.
Rosemarie Rizzo To focus on human as living unity and
Parse (1981), human’s qualitative participation with health
Man-Living-Health: experience. She emphasized free choice of
Theory of Nursing personal meaning in relating value priorities,
co-creating of rhythmical patterns, in
exchange with the environment and
Human Becoming contranscending in many dimensions as
Theory possibilities unfold. She also believed that
each choice opens certain opportunities while
closing others. Thus, referred to revealing-
concealing, enabling-limiting, and connecting-
separating. Since each individual makes his
or her own personal choices, the role of the
nurse is that of guide, not decision maker.
P: A system of interdependent parts
with patterned, repetitive, and
purposeful ways of behaving.
E: All forces that affect the person and
that influence the behavioral system
H: Focus on person, not ill ness.
Health is a dynamic state influenced
by biologic, psychological, and social
factors
N: Promotion of behavioral system,
balance and stability. An art and a
science providing external assistance
before and during balance
disturbances
P: A major reason for nursing
existence
E: Man and environment interchange
energy to create what is in the world,
and man chooses the meaning given
to the situations he creates
H: A lived experience that is a process
of being and becoming
N: Nursing Practice is directed toward
illuminating and mobilizing family
interrelationships in light of the
meaning assigned to health and its
possibilities as language in the
cocreated patterns of relating.