Nursing
Theories
AKSHATA BANSODE

A set of concepts,
definitions, relationships,
and assumptions that
project a systematic view
of a phenomena
It may consist of one or
more relatively specific
and concrete concepts
and propositions that
purport to account for, or
organize some
phenomenon (Barnum,
1988)

According to American Nursing History,
Florence Nightingale is considered to
be the first nursing theorist and is often
called "the founder of modern nursing."
The Florence Nightingale nursing theory
she is perhaps best known for is her
Environmental Theory that is still
practiced today. This theory states that
effective nursing relies on the patient's
environment to assist them in recovery

Concepts – ideas and mental
images that help to describe
phenomena (Alligood and
Marriner-Tomey, 2002)
Definitions – convey the
general meaning of the
concepts
Assumptions – statements that
describe concepts
Phenomenon – aspect of reality
that can be consciously sensed or
experienced (Meleis, 1997).

It guides nursing
practice and
generates knowledge
It helps to describe or
explain nursing
Enables nurses to
know WHY they are
doing WHAT they are
doing

The view or
perspective of the
discipline
It contains the
subject, central
concepts, values and
beliefs, phenomena of
interest, and the
central problems of
the discipline

A model that explains
the linkages of
science, philosophy,
and theory accepted
and applied by the
discipline (Alligood
and Marriner – Tomey,
2002)

Nursing has identified
its domain in a
paradigm that
includes four linkages:
1) person/client
2) health
3) environment
4) nursing

1.Person: The person is at the center of
the four key concepts of nursing theory,
because person refers to the patient who
is being cared for. The person may also be
referred to as represent a group of
individuals, families or communities.
Since every human being different and
has unique experiences, it's important for
nurses to take into account individual
characteristics when making healthcare

2.Environment: A nursing environment is the
setting in which nursing healthcare is provided
affects both the patient and their ability to heal, as
well as the nursing team due to factors nursing
unit morale. A nursing environment can be affected
by issues such as noise level lighting, scent, the
amount of space in rooms and access to nature. In
nursing, the environment also extends beyond the
healthcare setting. It relates to the patient's
everyday life and social experience. The
environment metaparadigm in nursing includes
personal, social, national and global aspects, as
well as societal beliefs and customs

3.Health :Health in nursing relates to both improving a
patient's immediate healthcare state and helping them
maintain their overall health and well-being. Certain factors
in a nursing environment can improve a patient's health,
including cleanliness, preparedness and a sense caring. Basic
medical needs like food and clean water can also impact a
person's health. Heal impacts the entire lifespan. This
metaparadigm looks at the overall life of a client, including
physical as well as social, moral and aesthetic areas. Health is
contextual, relating to a human's current state in their
environment.
For example, how health is characterized in a theory related
to senior care will look different to how health is
characterized in a theory related to newborn babies.

Nursing: Finally, the nursing practice metaparadigm refers
to nursing as a practice professional and as an academic
discipline. At its core, nursing is a practice that promotes
health advocates for patients. It's a professional calling
that requires training and education to provide optimal
direct patient care. Nurses use nursing theory to inform
their decisions and to the critically to determine the best
treatment in any situation. Nursing is based on scientific
theory but it also takes into account the human element
to apply the best evidence-based care in d settings.
Nurses use logical analysis, research and nursing theories
to provide care that factors in human choice and
responsibility.

Grand Nursing Theories
Middle-Range Nursing Theories
Practice-Level Nursing Theories:

1.Grand Nursing Theories: Grand nursing theories are the
broadest category. They're the most abstract and complex
concepts and propositions that provide a general nursing care
framework. A grand nursing theory can apply to a variety of
nursing care environments and situations. An example of a
grand nursing theory is Ida Jean Orlando- Deliberative Nursing
Process Theory. This theory examines the definition of the
function of nursing and the interaction between the nurse and
the patient.
It explains how to use the nursing process to improve patient
outcomes. Using a broad theory like this one, nurses, nurse
educators and nurse researchers can apply the theory in a
variety of patient settings and use it with other more specific
nursing theories to determine the most optimal outcomes.

2 Middle-Range Nursing Theories: Middle-range nursing theories are more
specific in focus
compared to grand nursing theories, but they're broader than the more
specific practice-level nursing theories. Middle-range nursing theories
may derive from theories of similar disciplines, nursing research or
nursing practice. Since they're less abstract than grand nursing theories,
middle-range theories tend to be more verifiable through testing. These
theories attempt to explain, describe or predict specific issues in
clinical nursing practice.
An example of a middle-range nursing theory is Imogene King's Theory
of Goal Attainment. This theory focuses on the factors that affect the
attainment of certain life goals and explains how a nurse and a patient
can communicate, set goals together and take actions to achieve goals.
The theory examines how the personal system, the interpersonal
system and the social system affect goal attainment.

3. Practice-Level Nursing Theories:
Practice-level nursing theories are situation-specific.
They're the narrowest in scope and focus of the three levels
of nursing theories. They may be based on concepts from
grand nursing theories and middle-range nursing theory but
provide specific frameworks for specific nursing
interventions. Nurses and nurse researchers may apply a
practice-level nursing theory when it relates to a defined
patient population at a specific time. Since these theories
are more specific and unique, they may draw upon multiple
theories to create the optimal recommended practice for
that particular patient group.
For example, a nurse who is working with a patient who is
a mother may draw upon elements of middle-range nursing
theories like the Maternal Role Attainment Theory by
Ramona to provide optimal maternal patient care.

USE
• Helps nurses understand their purpose and role in the health care setting
• Guides knowledge development
• Directs education, research, and practice
• Recognizes what should set the foundation of practice by explicitly
describing nursing
• Provides the foundations of nursing practice
• Indicates in which direction nursing should develop in the future

• Gives nurses a sense of identity
• Helps patients, managers, and other health care professionals acknowledge a
understand the unique contribution nurses make to health care service
Allows the nursing profession to maintain professional limits boundaries

Everyday practice enriches
theory
Both practice and theory are
guided by values and beliefs
Theory helps to reframe our
thinking about nursing
Theory guides use of ideas and
techniques
Theory can close the gap
between theory and research
To envision potentialities
(Gordon, Parker, & Jester,
2001)

Organize patient data
Understand patient data
Analyze patient data
Make decisions about
nursing interventions
Plan patient care
Predict outcomes of care
Evaluate patient
outcomes
(Alligood, 2001)

By asking yourself two
very important
questions…..

Essential concepts common among nursing
theories:
Man
Health
Environment
Nursing

Often considered the first
nurse theorist
Defined nursing as “the act
of utilizing the environment of
the patient to assist him in his
recovery”.
Nightingale’s theory remains
an integral part of nursing and
healthcare today

1.Florence Nightingale's Environmental Theory: A
British nurse who served in the Crimean
War, Nightingale is considered the pioneer of
nursing. She established the Nightingale Training
School for Nurses in 1860. The Florence
Nightingale nursing theory on the environment
includes the idea that environmental factors such
as fresh air, pure water, efficient drainage,
cleanliness and direct sunlight affect health. Her
theory suggested that deficiency in any of these
factors could negatively impact patient health
outcomes.

5 Factors for a Healthy Environment:
Pure or fresh air
Pure water
Efficient drainage
Cleanliness
Light, especially directs unlight
Nightingale’s general concepts of Environmental Sanitation
includes:
Proper Ventilation
Adequate Lighting
Cleanliness
Adequate Warmth
Quiet
Diet

Nursing Practice :
The principles of Nursing Practice by FN are continuously used to this
very day. With the advent of technology and with it globalization,
comes threats from the environment.
➢ Global Warming
➢ Industrial Noise
➢ Air Pollution
➢ Fad Diets
➢ Vanity

Nurses of today still needs to:
Maintain Adequate Ventilation
Promote Adequate & Appropriate Nutrition
Maintain Normal Homeostatic Body Temperature
Observe Basic Hygiene
Comfort Measures including Environmental Sanitation

2. Dorothea Orem's Nursing Theory:
Credited with creating the Nursing Need Theory C
Dorothea Orem's nursing theory involves the interrelated
theory of self-care, theory of self-care deficit and theory
of nursing systems. The theory provides guidance for
nurses on how to help their patients perform self-care to
maintain their health and well-being. The theory suggests
patient recovery improves when patients have some
autonomy over self-care practices. If a patient is unable
to perform certain self-care duties, due to mobility
issues,
For example, a nurse can look for ways to help while also
promoting autonomy.

ROY,S Adaptation Model Nursing Theory
Sister Callista Roy's Adaptation Model Nursing
Theory: In her theory, Sister Callista Roy's
model sees the individual as a set of
interrelated systems that maintain a balance
between various stimuli. Roy conceptualizes
the person in a holistic perspective.
Individual aspects of parts act together to
form a unified being. The following are
Callista Roy's Adaptation Model's major
concepts, including the definition of the
nursing metaparadigm as defined by the
theory. They are Person, Environment,
Health, Nursing, Adaptation, Internal
Processes, Regulator and Cognator

Definition:-
“Assisting the individual, sick or well, in the performance
of those activities contributing to health or it’s recovery
(or to peaceful death) that an individual would perform
unaided if he had the necessary strength, will or
knowledge”.
Identified 14 basic needs :
1. Breathing normally
2. Eating and drinking adequately
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. Worshipping 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.

Bedside Nursing :
pt.’s ability to perform the 14 basic needs should be assessed
before considering the kind of nursing care function you will
administer. Essential to determine if the N will be performing as
a HELPER, DOER or a PARTNER
Nsg interventions are implemented according to the 14 basic
human needs of the patient. The degree of performance ,
involvement of the pt. and the level of nursing activity will be
dependent on the specific role the nurse will be playing

Focus is on PROPER IDENTIFICATION of the problem
Particularly about the proper NURSING DIAGNOSIS
Nurse-centered
Nursing is a comprehensive service that is based on the art and science and
aims to help people, sick or well, cope with their health needs.
21 Nursing Problems
To maintain good hygiene.
To promote optimal activity; exercise, rest and sleep.
To promote safety.
To maintain good body mechanics
To facilitate the maintenance of a supply of oxygen
To facilitate maintenance of nutrition

To facilitate maintenance of elimination
To facilitate the maintenance of fluid and electrolyte balance
To recognize the physiologic response of the body to disease conditions
To facilitate the maintenance of regulatory mechanisms and functions
To facilitate the maintenance of sensory functions
To identify and accept positive and negative expressions, feelings and
reactions
To identify and accept the interrelatedness of emotions and illness.

To facilitate the maintenance of effective verbal and non-verbal
communication
To promote the development of productive interpersonal relationship
To facilitate progress toward achievement of personal spiritual goals
To create and maintain a therapeutic environment
To facilitate awareness of self as an individual with varying needs.
To accept the optimum possible goals
To use community resources as an aid in resolving problems arising from
illness.
To understand the role of social problems as influencing factors

Bedside Nursing :
The N’s ability to address &effectively manage the 21 Nursing
problems will spell the patient’s state of health – whether he
fully recovers well & fast, or deteriorate further with devastating
consequences
Ns therefore, have very important role to play. By adhering to
these nursing problems, the work of a N becomes More Definite

Nursing is a HUMANISTIC and SCIENTIFIC mode of
helping through CULTURE-SPECIFIC PROCESS
Emphasizes human caring varies among cultures
-
Culture Care Preservation and Maintenance
Culture Care Accommodation and Negotiation
Culture Care Restructuring and Repatterning

Application:
Important esp because of the rapid expansion of knowledge &
increasing globalization with the advent of advances in ICT .
Working Overseas :
Impt to learn the cultures of other people because each culture
has its own sets of patterns, expressions & values of caring .
Getting acquainted with the culture of a country you are
seeking employment as a professional nurse will be a good
steppingstone towards a more fulfilling career in nursing

Nursing is an art and science that is humanistic and
humanitarian. It is directed toward the unitary
human and is concerned with the nature and
direction of human development. The goal of nurses
is to participate in the process of change..
Nursing interventions seek to promote harmonious
interaction between persons and their environment,
strengthen the wholeness of the Individual and
redirect human and environmental patterns or
organization to achieve maximum health.

5 basic assumptions:
■ The human being is a unified whole, possessing individual integrity and
manifesting characteristics that are more than and different from the
sum of parts.
■ The individual and the environment are continuously exchanging matter
and energy with each other
■ The life processes of human beings evolve irreversibly and
unidirectionally along a space-time continuum
■ Patterns identify human being and reflect their innovative wholeness
■ The individual is characterized by the capacity for abstraction and
imagery, language and thought, sensation and emotion

Patient has THREE 3 interacting systems –
1. Individuals /Personalsystems :
How the nurse views and integrates self basedfrom personal goals and
beliefs.
2. Groupsystems / Interpersonalsystems :
How the N interrelates w/ a co-workers or pt.particularly in N-Pt.
Relationship
3. Socialsystems :
how the N interacts w/ co-workers, superiors,subordinates & the
ct. environment in general

Action :
A means of behaviour or activities that are towards the
accomplishment of certain act. It is both PHYSICAL & MENTAL
.
Mental (POA)
Action (Goal Setting w/ Ct.)
Perform Achieve Goal

Reaction
A form of reacting or response to a certain Stimuli.
Interaction
Any situation wherein the N relates & deals With a ct. or pt.
Transaction
Application:
Provides enough direction to how nurses should be able to behave
or act in the presence of pts. Since majority of nursing activities
involves direct interaction w/ pts., Ns should understand the basic
implications of the Action-Reaction-Interaction-Transaction model
of the N- Pt . Relationship.

Peplau is a psychiatric nurse
–Focus :Therapeutic process
–Attained through: Healthy Nurse-Patient Relationship
Four (4) Phases of Nurse-Patient Interaction
1. Orientation
Nurse and patient test therole each one assumes
Prepares patient for termination
Patient identifies areas of difficulty

2. Identification Phase :
•Patient identifies with the personnel who can
satisfy his needs
3. Exploitation Phase:
•Nurse maximizes all there sources to
the patient
benefit
4. Resolution Phase or Termination Phase :
• Occurs when patient’s needs have been met

Application :
Significant in terms of the different phases of the N-Pt.
interaction & the different ROLES the N can play in giving
nursing care to pts.
It thus becomes important for nurses to understand the
principles behind each of these concepts so that clinical nsg
will be more meaningful for the nurse. Eventually , this will
translate to pt. outcomes like :
Improved health
Prevention of Disease pr
Enhancement of care faculties

Nursing is concerned with promotion health, preventing illness,
caring for the sick, and restoring health.
Nursing is a human science of persons and human health-illness
experiences that are mediated by professional, personal, scientific,
esthetic and ethical human care transactions
She defined caring as a nurturant way or responding to a valued
client towards whom the nurse feels a personal sense of
commitment and responsibility. It is only demonstrated
interpersonally that results in the satisfaction of certain human
needs. Caring accepts the person as what he/she may become in a
caring environment

Carative Factors:
■ The promotion of a humanistic-altruistic system of values
■ Instillation of faith-hope
■ The cultivation of sensitivity to one’s self and others
■ The development and acceptance of the expression of positive and
negative feelings.
■ The systemic use of the scientific problem-solving method for decision
making
■ The promotion of interpersonal teaching-learning
■ The provision for supportive, protective and corrective mental, physical,
socio-cultural and spiritual environment
■ Assistance with the gratification of human needs
■ The allowance for existential phenomenological forces

The Nursing Process is an interaction of Three Basic Elements:
1. Patient’s Behaviour
2. Nurse’s reaction
3. Nursing Actions – designed for the patient’s benefit
The Role of the Nurse is to find out & meet the Pt’s stat need for
help. Ns should use his perception, thoughts about the perception
or the feeling engendered from their thoughts to explore with
patients the meaning of their behaviour
The use of the theory keeps the N’s focus on the patient

Application:
The Theory increases the Therapeutic Effectiveness
of nurses by the expression of Empathy, Warmth &
Genuineness esp in the light of addressing the Stat
Need of the Patient for help.
This framework will be important for Ns who
are assigned in special clinical areas that requires
quick decision making & critical thinking skills .
If the patient’s condition improved, then the
intervention is effective and the patient moves on to
new problems

Greatly emphasized on the
Therapeutic Human Relationship between the Nurse & the Patient.
Her model emphasizes:
Empathy
Sympathy
Rapport &
the Emotional aspects of Nursing
4 Interlocking Phases that precedes RAPPORT And the establishment of
N-Pt . Relationship:
Original Encounter
Emerging Identities
Empathy
Sympathy

Application:
The theory describes the various stages of interpersonal relations that
occur bet a Patient and a N. It thus becomes important for Ns to fully
understand the phases and its effects to the patient’s welfare.
Due consideration should be given to the pt’s inherent personal
characteristics to interact w/ other people, most especially Ns & other
members of the healthcare professions.
The key concept of Empthy ,Sympathy, Rapport & Emotional
Understanding are very important for the Ns of today

Focuses on 10 Categories of determinants of health-
Promoting Behaviours.
Views a person’s health-promoting behaviour in the
light of his individual characteristics & experiences

The10 Determinants are :
Prior related behaviour
Perceived benefits of action
Perceived barriers of action
Perceived self-efficacy
Activity related effect
Interpersonal Influences (family, friends, providers) norms, support & models
Situational Influences ( options, demand characteristics, aesthetics)–
Immediate competing demands (low control) and preferences (high demand)
Commitment to a plan of action–
Personal Factors ( Biological, Psychological, Sociocultural)

Application:
Health Promotion Activities are the major Focus of Hx
Care Organizations . In order for Patients to take on the Behaviour we, Hx
care professionals , advise them to take, we should carefully looked into a
host of factors that can influence his decision to really adopt the
behaviour.
It is important for Ns to be ROLE MODELS for the pts.

The model is based on the Person’s Relationship to Stress ,his
Reaction to it and Reconstitution factors that are dynamic in nature
The concern of nursing is to PREVENT STRESS INVASION
Person is viewed as an Open System composed of Basic Structure of
Energy Resources which includes:
• Physiologic
• Psychologic
• Sociocultural
• Developmental
• Spiritual

Basic Structure/Central Core-
surrounded by 2 concentric boundaries or Rings called Lines Of
Resistance Which represents the internal factors that AID the person
Defend against a Stressor .
Lines of Resistance –
further surrounded by 2 lines of Defense
1.Normal Line of Defense
2. Flexible Line of Defense
1.Normal Line of Defense :
person’s state of equilibrium or the state of adaptation developed &
maintained over time and which is considered normal for the person

2.Flexible Line of Defense-
dynamic and can be readily and rapidly changed over a short
period of time.- adjusts to situations that threatens the
imbalance w/in the client’s stability
Stressors:
Intrapersonal
Interpersonal
Extrapersonal
FOCUS of Nursing Interventions :-
keeping or maintaining the stability of the open system which
can be carried out on three levels of prevention

APPLICATION :-
Very comprehensive model of nsg that outlines the way
how Ns provide HOLISTIC NURSING CARE to pts. Emphasis
is on the management of Stress thru adequate
understanding of the complex client system . Strong
Advocate of Prevention Interventions which is congruent to
the aims of modern-day nsg & Hx care services. It is a
MUST that Ns perform thorough &comprehensive
assessment that includes ALL aspects of the Ct.

Man is a BIO PSYCHOSOCIAL BEING
Four (4) modes of Adaptation –
Physiologic Mode
Self Concept
Role Function
Interdependence
Her Model is best exemplified in the Nursing Process which includes
the following steps:
1. Assessment of Behaviour
2. Assessment of Stimuli
3. Nursing Diagnosis
4. Goal Setting
5. Intervention
6. Evaluation

APPLICATION :
Best applied in the performance of the Nursing Process which is cyclical in
nature . The Assessment component is the Stimuli or Input The Planning &
Implementation are the Through put process .
The Evaluation which provides necessary feedback to the Goal of care is
the Output
The N decides what necessary actions should betaken next in the light
of the patient’s response to the Nursing Interventions. This action by the N
is Adaptation in its simplest terms Patients adopt too.
The Nursing interventions we perform ultimately elicits a response from
them. Depending on the nature & extent of the nursing interventions, pts
may or may not actually adopt according to our expectations

Defined Nursing: “The act of assisting others in the provision
and management of self-care to maintain/improve human
functioning at home level of effectiveness.”
Focuses on activities that adult individuals perform on their own
behalf to maintain life, health and well-being.
Has a strong health promotion and maintenance focus.
Identified 3 related concepts:
1. Self-care - activities an Individual performs independently
throughout life to promote and maintain personal well-being.
2.Self-care deficit - results when self-care agency (Individual’s
ability) is not adequate to meet the known self-care needs.

3.Nursing System - nursing interventions needed when Individual is
unable to perform the necessary self-care activities:
𝗈 Wholly compensatory - nurse provides entire self-care for the client.
● Example: care of a new born, care of client recovering from surgery
in a post-anesthesia care unit
Partial compensatory - nurse and client perform care, client can
perform selected self-care activities, but also accepts care done by
the nurse for needs the client cannot meet independently.
● Example: Nurse can assist post operative client to ambulate, Nurse
can bring a meal tray for client who can feed himself
Supportive-educative - nurse’s actions are to help the client
develop/learn their own self-care abilities through knowledge,
support and encouragement.
𝗈
𝗈

Theory provides direction
for nursing research
Relationships of
components in a theory
help to drive the research
questions for
understanding nursing
Chinn and Kramer (2004),
indicate a spiral
relationship between the
two

Medical science
Nursing education
Professional nursing
organizations
Evolving research
approaches
Global concerns
Consumer demands
Technologies