A theory is a belief, a policy or a procedure followed or proposed as a basis of action. Nursing theories are organized concepts and purposes of framework developed to guide nurses in their practice. The first theories in this field appeared in 1800s in a time when people emphasized on nursing education. The main purpose of developing nursing theories is to explain and to describe the nursing care, to guide the nursing practice and to offer a clinical decision-making foundation.
- What is a Nursing Theory?
- Who Should Develop These Theories?
- Virginia Henderson Theory
- Martha Rogers Theory
- Dorothea E. Orem Theory
- Betty Neumann System Model Nursing Theory
- Hildegard Peplau Interpersonal Theory
- Madeleine Leininger Theory
- Patricia Benner – From Novice to Expert
- Parse’s Human Becoming Theory
- Watson’s Human Caring Theory
- Roy’s Adaptation Theory
- King’s Goal Attainment Theory
- Nursing Theory and Nursing Practice
- Nursing Theory and Nursing Process
Nurses develop most of these theories but at times, some other health professionals including physicians may assist in the development of the theories. Nurses may develop theories individually or even in collaboration with the other nurses. Most nurse theorists explain, predict and also describe the nursing care and practice elements. They mostly draw from academic and clinical experiences any time they are formulating theories.
Nurses who are still active in the practice and who are aware of the healthcare environment current state developed most of the applicable theories. The works of previous nursing theorists may also influence nurse theorists. Nurses also incorporate parts of other theories into their own.
Nursing theories are among the most forgettable parts of nursing education experience. There are several different types of these theories. The following are some of the most prominent, as well as the nurses who developed them.
This theory is often referred to as the Nightingale of Modern Nursing. Henderson is a noted nursing author and educator whose Need Theory was actually based on practice and her nursing education. She highly emphasized on increasing the client’s independence to promote their extended healing process after hospitalization.
This author also came up with a nursing definition that was among the first to mark a difference between medicine and nursing. Her definition stated that the unequaled function of a nurse is to help a sick or well person in performing the activities that contribute to health and recovery or the peaceful death if they had the necessary will, strength and knowledge. According to the definition, the nurse should also help the patient gain independence as fast as possible. For them to know what each and every patient needs, nurses should get into their skin.
Henderson developed the nursing definition with an effort of regulating the practice of nurses through licensure. Even though today every state has licensure regulations for nursing practice, the definition had a greater impact. The 14 components fundamental nursing care increases the nursing definition to offer an overall guide to nursing practice. The 14 basic needs which Henderson conceptualized for the role of a nurse include:
- Breathing normally
- Eating and drinking enough
- Eliminating body wastes
- Moving and maintaining the desirable position
- Sleeping and resting
- Maintain body temperature in the normal range by modifying the environment and adjusting clothing
- Keeping the body well groomed and clean to protect the integument
- Avoiding the environmental dangers and injuring others
- Communicating with the others in expressing needs, emotions, opinions or fear
- Worshiping according to the individual’s faith
- Working in a way that someone feels an accomplishment sense
- Participating or playing in different recreation forms
- Discovering, learning or satisfying one’s curiosity which leads to the normal health and development and utilizing the available health facilities
Rogers developed her theory through very many years of schooling. In addition to being a diploma nurse, she also held a Master’s of Public Health from Hopkins University. Moreover, she completed her Doctorate of Nursing in the same university. According to her theory, nursing is both an art and a science. This theory is 0that of Unitary Human Beings. According to the theory, nursing attempts to promote symphonic interaction between the person and the environment, to strengthen their integrity and coherence and to direct and redirect the interactions between the person and the environment with an aim of facilitating the realization of the maximum health. Rogers’s early grounding in arts and her background in science alongside her keen interest in space highly influenced the development of her abstract.
E. Orem’s theory is commonly known as the Self Care Theory. Her vision of health is characterized by developed human structures wholeness and the wholeness of the mental and bodily functioning. This includes the physical, interpersonal, psychological and social aspects. In this theory, her major assumptions include that individuals should be responsible and self-reliant and also responsible for their own care and care of the other people in their families. In her theory, she stated that people’s knowledge about their potential health problems is important in self-care behaviors promotion. She also defined nursing as a helping service, an art and a technology.
Betty Neumann System Model highly focuses on the response of a client system to potential or actual environmental stressors and use of various nursing prevention intervention for attainment, retention and maintenance of optimal client system wellness. Betty defines nursing concern as preventing stress invasion. If a client doesn’t prevent stress, then a nurse should work to protect their basic structure, obtain or maintain the maximum wellness level. Nurses generally provide care to their patients through primary, secondary and tertiary modes of prevention.
There are four phases that define Peplau’s theory. Peplau defines the nurse and patient relationship which evolve through orientation, identification, resolution and exploitation. She also sees nursing as a maturing force which is realized as a personality, develops through therapeutic, educational and interpersonal processes. A nurse enters into a personal relationship with a person if a felt need exists. Including today, her theory is very popular among clinicians particularly those working with patients having psychological problems.
This is among the newest nursing theories. The Transcultural Nursing theory first appeared in 1978 and according to Leininger, the main purpose of nursing is to offer care that is congruent with cultural beliefs, values and practices. Leininger states that the essence of nursing is care and the distinctive, dominant and unifying feature. She continues to state that without caring there cannot be the cure but there can be caring with curing. Health care practitioners should work to understand values, the lifestyles, and health beliefs of various cultures which form the basis for offering culture-specific care.
This one is perhaps the easiest nursing theory for anyone to understand. In the theory, Benner described five levels of nursing experience which include “novice, advanced beginner, competent proficient and expert.” These four levels reflect the movement from the reliance on abstract principle to use of past concrete experience. Benner proposed that nurses could get knowledge and necessary skills without learning the related theory. Every step builds on the former one while the learners gain the clinical expertise. In other words, Benner says that experience is the requirement for becoming an expert.
Rosemarie Rizzo Parse is known for developing this theory ( theory of Human Becoming) which is today known or referred to as the Human Becoming School of Thought through combining concepts from existential phenomenological thought with concepts from Martha Rogers. The theory has nine assumptions based on three primary themes of transcendence, meaning rhythmicity. Each and every theme leads to a principle:
- Rhythmicity relates to enabling-limiting, revealing-concealing, and connecting-separating
- Transcendence relates to transforming and powering
- Meaning relates to valuing, imagining and languaging
Jean Watson (1979) believed that caring practice is fundamental to nursing and, therefore, it is the unifying focus of this practice. The science of caring encompasses human science orientation, a humanitarian, experiences and phenomena. Caring science perspective has its ground on unity and contentedness world view of all and relational ontology of being-in-relation.
Transpersonal Caring recognizes connections which move in caring centric circles and unity of life – from an individual to the others, to the world, to the planet earth and to the universe. Investigations of caring science embrace inquiries which are subjective, reflective and interpretative. They are also objective-empirical. The caring science inquiry consists of philosophical, ontological, historical inquiry, ethical and studies.
Moreover, caring science consists of inquiry epistemological approaches which include empirical and clinical approaches, but it is also open to moving into newer inquiry areas which explore some other ways of knowing. A quick example: poetic, aesthetic, personal, narrative, intuitive, evolving consciousness, personal, intentionality, kinesthetic metaphysical spiritual and moral ethical knowing. This theory shows that caring is fundamental to nursing processes.
Sister Callista Roy came up with the Roy Adaptation Model which she based on a belief that human beings are an open system. The open system responds to some environmental stimuli via the regulator and cognator coping mechanisms for the individuals, the groups’ stabilizer and innovator control mechanisms. These responses take place at any rate of one of four modes of role function, interdependence, and self-concept-group and modes-physiological-physical-self-concept-group identity.
Responses in the models are mostly visible to the others and they can identify them as ineffective or adaptive. The analysis of adaptive behaviors requiring support and the ineffective behaviors follows to identify the related stimuli and the focal stimulus is the primary stimulus that causes one of the behaviors. The other stimuli verified as being involved are contextual while the stimuli which might be involved in causing the behaviors but aren’t verified are residual. Nursing care mainly focuses on strengthening or altering adaptive processes to lead to adaptive behaviors.
Imogene M. King is the one who developed this general systems framework and a goal attainment theory. This framework talks to three different levels of systems which include personal or individual, interpersonal or group and the social or society. The goal attainment theory focuses on the benefits of interaction, communication, perception, transaction, role, self, stress, time, growth and development and the personal space. In the theory, King emphasized that both the nurse and the client should bring important information and knowledge to their relationship and they should also work together to achieve their goal.
Research has also supported that the moment a nurse and the client work together toward a mutually accepted goal, they’re more likely to attain this goal. Nurses can utilize this theory in their practice by knowing that they will attain the goal together with their client after the interaction. Several factors that can affect the interaction include personal space, growth and development, stress, time, judgment and perception.
The theories of nursing have a big impact on the day to day nursing practice. Many nurses have to employ several theories in their practice and avoid using a single theory exclusively. Using several nursing theories in a given day may allow a nurse to select the best theory and one that will fit a particular situation. In any ideal settings, the theories serve to offer underpinnings to nursing care in all patient encounters. They assist nurses to use analytical skills, critical thinking skills and to improve their concept comprehension. Typically, the theories of nursing improve the care of patients, the patient outcomes and the nurse-patient communication. Use of these theories in nursing practice helps in gleaning of new data and knowledge which can influence the nursing practice in the future.
Nursing process is generally a scientific method which is used to assure quality patient care which was described for the first time in 1950s. By then, the nursing process involved only three steps but today it has six steps which include assessment, diagnosis, outcome identification, planning, implementation and the evaluation. All the steps in the nursing process are further divided into several individual steps which have a common goal of improving the care of a patient.
Most nursing theories incorporate nursing process within their foundation. There are other theories which expand upon the processes of nursing and may add some extra steps. The theories of nursing are helpful in all nursing process stages and guide nurses to make particular decisions and to perform specific actions when caring for a patient.
Theories of nursing are a newer nursing profession component and despite their most recent appearance, they have made a stronger and lasting effect on training, education and the development of professional nurses. These theories have also affected patient care and the day to day nursing practice. While the nursing profession is still evolving and defining itself, there is a need for new nursing theories that will guide nurses in their practices and caring for patients. Any future nursing theorist should remain true to clinical roots and ensure that theories are applicable to nursing practice in the changing healthcare landscape.