Overview of current nursing theories: Florence Nightingale, Virginia Henderson, Dorothea Orem,

This guide for nursing theories, aims to help you understand what comprises a nursing theory and its
importance, purpose, history, types, or classifications, and give you an overview through summaries of
selected nursing theories.

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.

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

The development of nursing theory demands an understanding of selected terminologies, definitions,

and assumptions.

Philosophy. These are 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 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.

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.

History of Nursing Theories

The first nursing theories appeared in the late 1800s when a strong emphasis was placed on nursing
education.

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.

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.
In 1979, Jean Watson developed the philosophy of caring, highlighted humanistic aspects of nursing as
they intertwine with scientific knowledge and nursing practice.

The Nursing Metaparadigm

Four major concepts are frequently interrelated and fundamental to nursing theory: person,
environment, health, and nursing. These four are collectively referred to as metaparadigm for nursing.

Nursing Metaparadigm in Nursing Theories

Person, Nursing, Environment, and Health – the four main concepts that make up the nursing
metaparadigm.

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 surroundings 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 nurse’s attributes, characteristics, and actions provide 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 by their orientation, nursing experience, and
different factors that affect the theorist’s nursing view. 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:
Nursing Metaparadigm of Different Nursing Theories

An overview of the nursing metaparadigm of different nursing theories. (Click to enlarge)

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.

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.

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 independently 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 statements explain the
nature of concepts, definitions, purpose, relationships, and structure of a theory.
Why are Nursing Theories Important?

Nursing theories are the basis of nursing practice today. In many cases, nursing theory guides knowledge
development and directs education, research, and practice. Historically, nursing was not recognized as
an academic discipline or as a profession we view today. Before nursing theories were developed,
nursing was considered to be a task-oriented occupation. The training and function of nurses were
under the direction and control of the medical profession. Let’s take a look at the importance of nursing
theory and its significance to nursing practice:

Nursing theories help recognize what should set the foundation of practice by explicitly describing
nursing.

By defining nursing, a nursing theory also helps nurses understand their purpose and role in the
healthcare setting.

Theories serve as a rationale or scientific reasons for nursing interventions and give nurses the
knowledge base necessary for acting and responding appropriately in nursing care situations.

Nursing theories provide the foundations of nursing practice, generate further knowledge, and indicate
which direction nursing should develop in the future (Brown, 1964).

By providing nurses a sense of identity, nursing theory can help patients, managers, and other
healthcare professionals to acknowledge and understand the unique contribution that nurses make to
the healthcare service (Draper, 1990).

Nursing theories prepare the nurses to reflect on the assumptions and question the nursing values, thus
further defining nursing and increasing the knowledge base.

Nursing theories aim to define, predict, and demonstrate nursing phenomenon (Chinn and Jacobs,
1978).

It can be regarded as an attempt by the nursing profession to maintain and preserve its professional
limits and boundaries.

In many cases, nursing theories guide knowledge development and directs education, research, and
practice, although each influences the others. (Fitzpatrick and Whall, 2005).

Purposes of Nursing Theories

The primary purpose of theory in nursing is to improve practice by positively influencing the health and
quality of life of patients. Nursing theories are also developed to define and describe nursing care, guide
nursing practice, and provide a basis for clinical decision-making. In the past, the accomplishments of
nursing led to the recognition of nursing in an academic discipline, research, and profession.
In Academic Discipline

Much of the earlier nursing programs identified the major concepts in one or two nursing models,
organized the concepts, and build an entire nursing curriculum around the created framework. These
models’ unique language was typically introduced into program objectives, course objectives, course
descriptions, and clinical performance criteria. The purpose was to explain the fundamental implications
of the profession and enhance the profession’s status.

In Research

The development of theory is fundamental to the research process, where it is necessary to use theory
as a framework to provide perspective and guidance to the research study. Theory can also be used to
guide the research process by creating and testing phenomena of interest. To improve the nursing
profession’s ability to meet societal duties and responsibilities, there needs to be a continuous
reciprocal and cyclical connection with theory, practice, and research. This will help connect the
perceived “gap” between theory and practice and promote the theory-guided practice.

In Profession

Clinical practice generates research questions and knowledge for theory. In a clinical setting, its primary
contribution has been the facilitation of reflecting, questioning, and thinking about what nurses do.
Because nurses and nursing practice are often subordinate to powerful institutional forces and
traditions, introducing any framework that encourages nurses to reflect on, question, and think about
what they do provide an invaluable service.

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.
Levels of Nursing Theory According to Abstraction

Grand Nursing Theories

Grand theories are abstract, broad in scope, and complex, therefore requiring further research for
clarification.

Grand nursing theories do not guide specific nursing interventions but rather provide a general
framework and nursing ideas.

Grand nursing theorists develop their works based on their own experiences and their time, 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 (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 a grand theorist’s works, 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 than 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.

Other Ways of Classifying Nursing Theories

Classification According to Meleis

Afaf Ibrahim Meleis (2011), in her book Theoretical Nursing: Development and Progress, organizes the
major nurse theories and models using the following headings: needs theories, interaction theories, and
outcome theories. These categories indicate the basic philosophical underpinnings of the theories.

Needs-Based Theories. The needs theorists were the first group of nurses who thought of giving nursing
care a conceptual order. Theories under this group are based on helping individuals to fulfill their
physical and mental needs. Theories of Orem, Henderson, and Abdella are categorized under this group.
Need theories are criticized for relying too much on the medical model of health and placing the patient
in an overtly dependent position.

Interaction Theories. These theories emphasized nursing on the establishment and maintenance of
relationships. They highlighted the impact of nursing on patients and how they interact with the
environment, people, and situations. Theories of King, Orlando, and Travelbee are grouped under this
category.

Outcome Theories. These theories describe the nurse as controlling and directing patient care using
their knowledge of the human physiological and behavioral systems. The nursing theories of Johnson,
Levine, Rogers, and Roy belong to this group.

Classification According to Alligood

In her book, Nursing Theorists and Their Work, Raile Alligood (2017) categorized nursing theories into
four headings: nursing philosophy, nursing conceptual models, nursing theories and grand theories, and
middle-range nursing theories.

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.

List of Nursing Theories and Theorists

You’ve learned from the previous sections the definition of nursing theory, its significance in nursing,
and its purpose in generating a nursing knowledge base. This section will give you an overview and
summary of the various published works in nursing theory (in chronological order). Deep dive into
learning about the theory by clicking on the links provided for their biography and comprehensive
review of their work.

Florence Nightingale

Florence Nightingale: Environmental Theory

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.

Virginia Henderson

Virginia Henderson: Nursing Need Theory

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 the result of
the nurse’s creativity in planning for care.”

Faye Glenn Abdellah

Faye Glenn Abdellah: 21 Nursing Problems Theory

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 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

Lydia Hall: Care, Cure, Core Theory

Developed the Care, Cure, Core Theory is 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 to facilitate the
development of the core.

The “care” circle defines a professional nurse’s primary role, such as providing bodily care for the
patient. The “core” is the patient receiving nursing care. The “cure” is the aspect of nursing that 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 profession’s goal, 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

Ida Jean Orlando: Nursing Process Theory

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 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

Jean Watson: Theory of Human Caring

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 with 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 when nurses are rewarded more for
efficiency, technical skills, and measurable outcomes.

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, the nurse must be
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 it as the basis of research, education, and clinical
practice.

Myra Estrin Levine

Myra Estrin Levine: Conservation Model for Nursing

According to the Conservation Model, “Nursing is human interaction.”

Provides a framework within which to teach beginning nursing students.

Logically congruent, externally and internally consistent, has breadth and depth, and is understood, with
few exceptions, by professionals and consumers of health care.
Martha E. Rogers

Martha Rogers: 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 nursing creatively to help better the lives of the patient.

A patient can’t be separated from his or her environment when addressing health and treatment.

Dorothea E. Orem

Dorothea E. Orem: Self-Care Theory

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 the 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

Imogene M. King: Theory of Goal Attainment

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 good health goals.

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

Betty Neuman: Neuman’s Systems Model

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). It is conceptualized as an inner core (basic energy resources) surrounded by concentric circles
that include lines of resistance, a normal defense line, and a flexible line of defense.

Sister Callista Roy

Sister Callista Roy: Adaptation Model of Nursing

In Adaptation Model, Roy defined nursing as a “health care profession that focuses on human life
processes and patterns and emphasizes the promotion of health for individuals, families, groups, and
society as a whole.”

Views the individual as a set of interrelated systems that strives to maintain a balance between various
stimuli.

Inspired the development of many middle-range nursing theories and adaptation instruments.

Dorothy E. Johnson

Dorothy E. Johnson: Behavioral Systems Model

The Behavioral System Model defined Nursing as “an external regulatory force that acts to preserve the
organization and integrate 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 to foster 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.
Nursing’s focus and aim as a discipline of knowledge and a professional service are “nurturing persons
living to care 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

It began with observations of experiences faced as people deal with changes related to health, well-
being, and the 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

Nola Pender: Health Promotion Model

Health Promotion Model

Describes the interaction between the nurse and the consumer while considering the role of the health
promotion environment.

It 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

Madeleine M. Leininger: Transcultural Nursing Theory

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
to provide 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 regarding nursing and health-illness caring
practices, beliefs, and values to implement significant and efficient nursing care services to people
according to their cultural values and health-illness context.
It 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 is inseparable
and that nursing is a human science and art that uses an abstract body of knowledge to help people.

It 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 non-aggression among
rational people 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. The
mother becomes attached to her infant, acquires competence in the caretaking tasks involved in the
role, and expresses pleasure and gratification. (Mercer, 1986).

Provides proper health care interventions for nontraditional mothers for them to favorably adopt a
strong maternal identity.

Merle H. Mishel

Uncertainty in Illness Theory

Presents a comprehensive structure to view the experience of acute and chronic illness and 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 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 care organization.

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.

It focuses on nursing’s fundamental care processes, 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 moments 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. Also, 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.

References

Suggested readings and resources for this study guide:

Alligood, M., & Tomey, A. (2010). Nursing theorists and their work, seventh edition (No ed.). Maryland
Heights: Mosby-Elsevier.

Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book. Elsevier Health Sciences.

Barnard, K. E. (1984). Nursing research related to infants and young children. In Annual review of nursing
research (pp. 3-25). Springer, Berlin, Heidelberg.

Brown, H. I. (1979). Perception, theory, and commitment: The new philosophy of science. University of
Chicago Press. [Link]

Brown M (1964) Research in the development of nursing theory: the importance of a theoretical
framework in nursing research. Nursing Research.

Chinn, P. L., & Jacobs, M. K. (1978). A model for theory development in nursing. Advances in Nursing
Science, 1(1), 1-12. [Link]

Colley, S. (2003). Nursing theory: its importance to practice. Nursing Standard (through 2013), 17(46),
33. [Link]

Fawcett, J. (2005). Criteria for evaluation of theory. Nursing science quarterly, 18(2), 131-135. [Link]
Fitzpatrick, J. J., & Whall, A. L. (Eds.). (1996). Conceptual models of nursing: Analysis and application.
Connecticut, Norwalk: Appleton & Lange.

Kaplan, A. (2017). The conduct of inquiry: Methodology for behavioural science. Routledge. [Link]

Meleis, A. I. (2011). Theoretical nursing: Development and progress. Lippincott Williams & Wilkins.

Neuman, B. M., & Fawcett, J. (2002). The Neuman systems model.

Nightingale F (1860) Notes on Nursing. New York NY, Appleton.

Peplau H (1988) The art and science of nursing: similarities, differences, and relations. Nursing Science
Quarterly

Rogers M (1970) An Introduction to the Theoretical Basis of Nursing. Philadelphia PA, FA Davis.

CategoriesTheorists & Theories

TagsDorothea Orem, Faye Glenn Abdellah, Florence Nightingale, Hildegard E. Peplau, Ida Jean Orlando,
Imogene King, Jean Watson, Joyce Travelbee, Madeleine Leininger, Martha E. Rogers, nursing theorists,
nursing theory, Sister Callista Roy, Virginia Henderson

Post navigation

Madeleine Leininger: Transcultural Nursing Theory