open access articles on Nursing
theories and models
of Nursing Theories
Theories are a set of interrelated concepts
that give a systematic view of a phenomenon (an observable
fact or event) that is explanatory & predictive in
Theories are composed of concepts,
definitions, models, propositions & are based on
Theory gives planners tools for moving beyond intuition to
design and evaluate health behavior and health promotion
interventions based on understanding of behavior.[Robert T.
They are derived through two principal
methods; deductive reasoning and inductive reasoning.
Nursing theorists use both of these methods.
Theory is “a creative and rigorous
structuring of ideas that projects a tentative, purposeful,
and systematic view of phenomena”.
A theory makes it possible to “organize the
relationship among the concepts to describe, explain,
predict, and control practice”
Concepts - Concepts are basically vehicles
of thought that involve images. Concepts are words that
describe objects, properties, or events & are basic
components of theory.
Models are representations
of the interaction among and between the concepts showing
The terms ‘model’ and ‘theory’ are often wrongly used
interchangeably, which further confounds matters.
In nursing, models are often designed by theory
authors to depict the beliefs in their theory (Lancaster
and Lancaster 1981).
They provide an overview of the thinking behind the
theory and may demonstrate how theory can be introduced
into practice, for example, through specific methods of
Models are useful as they allow the concepts in
nursing theory to be successfully applied to nursing
practice (Lancaster and Lancaster 1981). Their main
limitation is that they are only as accurate or useful
as the underlying theory.
- are statements that explain the relationship between the
it is a series of actions, changes or functions intended to
bring about a desired result. During a process one takes
systemic & continuous steps to meet a goal & uses
both assessments & feedback to direct actions to the
framework - directs how these actions are carried
out. The delivery of nursing care within the nursing process
is directed by the way specific conceptual frameworks &
theories define the person (patient), the environment,
health & nursing.
of nursing theories
Nursing theory aims to describe, predict and explain the
phenomenon of nursing (Chinn and Jacobs1978).
It should provide the foundations of nursing practice,
help to generate further knowledge and indicate in which
direction nursing should develop in the future (Brown
Theory is important because it helps us to decide what we
know and what we need to know (Parsons1949).
It helps to distinguish what should form the basis of
practice by explicitly describing nursing.
The benefits of having a defined body of theory in
nursing include better patient care, enhanced professional
status for nurses, improved communication between nurses,
and guidance for research and education (Nolan 1996).
The main exponent of nursing – caring – cannot be
measured, it is vital to have the theory to analyze and
explain what nurses do.
As medicine tries to make a move towards adopting a more
multidisciplinary approach to health care, nursing
continues to strive to establish a unique body of
This can be seen as an attempt by the nursing profession
to maintain its professional boundaries.
characteristics of theories
interrelating concepts in such a way as to create a
different way of looking at a particular phenomenon.
logical in nature.
bases for hypotheses that can be tested.
increasing the general body of knowledge within the
discipline through the research implemented to validate
used by the practitioners to guide and improve their
consistent with other validated theories, laws, and
principles but will leave open unanswered questions that
need to be investigated.
in the development of nursing theories
Nursing theories are often based on &
influenced by broadly applicable processes & theories.
Following theories are basic to many nursing concepts.
General System Theory
It describes how to break whole things into parts & then
to learn how the parts work together in “systems”. These
concepts may be applied to different kinds of systems, e.g.
Molecules in chemistry, cultures in sociology, and organs in
Anatomy & Health in Nursing.
It defines adaptation as the adjustment of living matter to
other living things & to environmental conditions.
Adaptation is a continuously occurring process that effects
change & involves interaction & response.
Human adaptation occurs on three levels :
1. The internal (self)
2. The social (others) &
3. the physical (biochemical reactions)
It outlines the process of growth & development of
humans as orderly & predictable, beginning with
conception & ending with death.
The progress & behaviors of an individual within each
stage are unique.
The growth & development of an individual are
influenced by heredity, temperament, emotional, &
physical environment, life experiences & health
concepts in nursing theories
Four concepts common in nursing theory that
influence & determine nursing practice are:
The person (patient).
Nursing (goals, roles, functions)
Each of these concepts is usually defined &
described by a nursing theorist, often uniquely; although these
concepts are common to all nursing theories. Of the four
concepts, the most important is that of the person. The focus of
nursing, regardless of definition or theory, is the person.
perspectives and key concepts
Nightingale (1860): To facilitate “the body’s reparative
processes” by manipulating client’s environment
Henderson 1955: The needs often called Henderson’s 14
Abdellah 1960: The nursing theory developed by Faye
Abdellah et al (1960) emphasizes delivering nursing care
for the whole person to meet the physical, emotional,
intellectual, social, and spiritual needs of the client
Orlando 1962: To Ida Orlando (1960), the client is an
individual; with a need; that, when met, diminishes
distress, increases adequacy, or enhances well-being.
Johnson’s Theory 1968: Dorothy Johnson’s theory of
nursing 1968 focuses on how the client adapts to illness
and how actual or potential stress can affect the ability
to adapt. The goal of nursing to reduce stress so that;
the client can move more easily through recovery.
Rogers 1970: to maintain and promote health, prevent
illness, and care for and rehabilitate ill and disabled
client through “humanistic science of nursing”
Orem1971: This is self-care deficit theory. Nursing care
becomes necessary when client is unable to fulfill
biological, psychological, developmental, or social needs.
King 1971: To use communication to help client
reestablish positive adaptation to environment.
Neuman 1972: Stress reduction is goal of system model of
Roy 1979: This adaptation model is based on the
physiological, psychological, sociological and
dependence-independence adaptive modes.
Watson’s Theory 1979: Watson’s philosophy of caring 1979
attempts to define the outcome of nursing activity in
regard to the; humanistic aspects of life.
Classification of nursing
On Function (Polit et al 2001)
Descriptive-to identify the properties
and workings of a discipline
Explanatory-to examine how properties
relate and thus affect the discipline
relationships between properties and how they occur
identify under which conditions relationships occur
B. Depending on the
Generalisability of their principles
Metatheory: the theory
of theory. Identifies specific phenomena through abstract
Grand theory: provides a
conceptual framework under which the key concepts and
C. Principles of the
discipline can be identified.
Middle range theory: is
more precise and only analyses a particular situation with
a limited number of variables.
explores one particular situation found in nursing. It
identifies explicit goals and details how these goals will
D. Based on the
philosophical underpinnings of the theories
1. “Needs” theories
These theories are based around helping individuals to
fulfill their physical and mental needs. Needs theories have
been criticized for relying too much on the medical model of
health and placing the patient in an overtly dependent
As described by Peplau (1988), these theories revolve around
the relationships nurses form with patients.
Such theories have been criticized for largely ignoring
the medical model of health and not attending to basic
3. “Outcome” theories"
Outcome theories portray the nurse as the changing force,
who enables individuals to adapt to or cope with ill health.
Outcome theories have been criticized as too abstract and
difficult to implement in practice.
4. “Humanistic” Theories
Humanistic theories developed in response to the
psychoanalytic thought that a person’s destiny was determined
early in life.
Humanistic theories emphasize a person’s capacity for
Humanists believe that the person contains within himself
the potential for healthy & creative growth.
Carl Rogers developed a person –centered model of
psychotherapy that emphasizes the uniqueness of the
The major contribution that Rogers added to nursing
practice is the understandings that each client is a
unique individual, so, person-centered approach now
practice in nursing.
Theory and practice are related.
A theory presents a systematic way of understanding events
It is a set of concepts, definitions, and propositions that
explain or predict these events or situations by
illustrating the relationships between variables.
Theories must be applicable to a broad variety of
situations. They are, by nature, abstract, and don’t have a
specified content or topic area. Like empty coffee cups,
theories have shapes and boundaries, but nothing inside.
They become useful when filled with practical topics, goals,
and problems. [Robert T. Croyle (2005)]
Robert T. Croyle (2005). Theory at a
Glance: Application to Health Promotion and Health Behavior
(Second Edition). U.S. Department of Health and Human
Services, National Institutes of Health.
George B. Julia , Nursing Theories- The
base for professional Nursing Practice , 3rd ed. Norwalk,
Appleton & Lange.