NURSING THEORIES

Florence Nightingale (mid-1800) - “Environmental Model”

Developed and described the first theory of nursing, “Environmental Model”
(“Notes on Nursing: What It Is, What It Is Not’). She focused on Changing and
manipulating the environment in order to put the patient in the best possible conditions
for nature to act (nursing and the patient environment relationships).
She believed that in the nurturing environment, the body could repair itself.
Client’s environment is manipulated to include appropriate noise, nutrition, hygiene,
light, comfort, socialization and hope.
She provided the nursing profession the “Legacy of Caring‟‟.

Virginia Henderson (1955) - Definitions And Components Of Nursing/ 14

Components Of Basic Nursing
Introduced the “Nature of Nursing Model” („definitions and components of
nursing‟). She identified fourteen basic needs on which nursing care is based. She
postulated that the unique function of the nurse is to assist the clients, sick or well, in
the performance of those activities contributing to health or its recovery, that clients
would perform unaided if they had the necessary strength, will or knowledge. She
further believed that nursing involves assisting the client in gaining independence as
rapidly as possible, or assisting him achieved peaceful death if recovery is no longer
possible.

Faye Abdellah (1960) - Twenty-One Nursing Problems

Introduced “patient-centered approaches to nursing model”. She identified

twenty-one nursing problems which determine nursing care. She defined nursing as
service to individuals and families; therefore to society. Furthermore, she
conceptualized nursing as an art and a 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, and cope with their health needs.

Dorothy E. Johnson (1960, 1980) - “Behavioral System Model”

Conceptualized the “Behavioral System Model, According to Johnson”, each
person as a behavioral system is composed of seven subsystems namely.
1. Ingestive. Taking In nourishment in socially and culturally acceptable ways.
 2. Eliminative. Ridding the body or waste in socially and culturally acceptable
ways.
3. Affiliative. Security seeking behavior.
4. Aggressive. Self- protective behavior.
5. Dependence. Nurturance – seeking behavior.
6. Achievement. Master of oneself and one’s environment according to internalized
standards of excellence.
7. Sexual and role identity behavior.
Disturbances in these subsystems cause nursing problems.
In addition, she viewed that each person strives to achieve balance and stability
both internally and externally and to function effectively by adjusting and adapting to
environmental forces through learned patterns of response.
Furthermore, Johnson believed that the patient strives to become a person
whose behavior is commensurate with social demands; who is able to modify his
behavior in ways that support biologic imperatives; who is able to benefit to the fullest
extent during illness from the health care professional’s knowledge and skills; and
whose behavior does not give evidence of unnecessary trauma as a consequence of
illness.

Imogene King (1971, 1981) – “Goal Attainment Theory”

Postulated the systems Framework and Goal Attainment Theory She described
nursing as a helping profession that assists individuals and groups in society to attain,
maintain, and restore health. If this is not possible nurses help individuals die with
dignity.
In addition, King viewed nursing as an interaction process between client and
nurse whereby during perceiving setting goals, and acting on to them transactions occur
and goals are achieved.

Madeleine Leininger (1978-1984) – “Theory of Culture Care Diversity and

Universality Transcultural Nursing Model”
Developed the “Theory of Culture Care Diversity and Universality”
(Transcultural Nursing Model). She advocated that nursing is a humanistic and
scientific mode of helping a client through specific cultural caring processes (cultural
values, denes and practices) to improve or maintain a health condition.
Advocated that caring is universal and varies transculturally. Major concepts
include care, caring culture, cultural values and cultural variations.
 Furthermore, Leininger believed that caring serves to ameliorate or improve
human conditions and life base. And that care is the essence and the dominant,
distinctive and unifying feature of nursing.

Myra Estrin Levine (1973) - “Conservation Principles: A Model for Health”

Described the “Conservation Principles: A Model for Health She Advocated that
nursing is a human interaction and proposed four conservation Principles of nursing
which are concerned with the unity and integrity of the Individual. Holism is maintained
by conserving integrity. The four conservation principles are as follows:

1. Conservation of energy. The human body functions by utilizing energy. The

human body needs energy producing input (food, oxygen, fluids) to allow energy
utilization as output.
2. Conservation of structural integrity. The human body has physical boundaries
(skin and mucous membrane) that must be maintained to facilitate health and
prevent harmful agents from entering the body
3. Conservation of personal integrity. The nursing interventions are based on the
conservation of the individual client’s personality. Every individual has a sense of
identity, self-worth and self-esteem, which must be preserved and enhanced by
nurses.
4. Conservation of social integrity. The social integrity of the client reflects the family
and the community in which the client functions. Health care institutions may
separate individuals from their family. It is important for nurses to consider the
individual in the context of the family.

Betty Neuman (1982, 1989, 1992) - “Health Care Systems Model”

Proposed the “Health Care Systems Model”. She asserted that nursing is a
unique profession in that it is concerned with all the variables affection individual‟s
response to stresses, which are intra- (within the individual) inter- (between one or more
other people), and intrapersonal (outside the individual) in nature. The concern of
nursing is to prevent stress invasion protect the client’s basic structure and to obtain or
maintain a maximum level of wellness. The nurse helps the client, through primary,
secondary and tertiary prevention modes, to adjust to environmental stressors and
maintain client stability.
Dorothea Orem (1970, 1985)- “Self- Care and Self-Care Deficit Nursing Theory”
Developed the “Self-Care and Self-Care Deficit Nursing Theory”. She defined
self-care as “the practice of activities that individuals initiate and perform and their own
behalf in maintaining life, health and well-being. She Conceptualized three nursing
systems as follows:
 Wholly compensatory: when the nurse is expected to accomplish all the
patient’s therapeutic self-care or to compensate for the patient’s inability to
engage in self-care or when the patient needs continuous guidance in self-care
 Partialy compensatory: when both nurse and patient engage in meeting self-
care need;
 Supportive-educative: the system that requires assistance in decision making,
behavior control and acquisition of knowledge and skills to learn self- care.

Hildegard Peplau (1952) - “Interpersonal Relations in Nursing Model”

Introduced the “Interpersonal Relations in Nursing Model”(psychodynamic
nursing model). She defined nursing as an interpersonal process of therapeutic
interactions between an individual who is sick or in need of health services and a nurse
especially educated to recognize and respond of the need for help. She identified four
phases of the nurse-client relationship namely:
1. Orientation: the nurse and the client initially do not know each other’s goals and
testing. The role each will assume. The client attempts to identify difficulties and
the amount of nursing help that is needed
2. Identification: the client responds to the professionals or ne significant others
who can meet the identified needs. Both the client and the nurse plan together an
appropriate program to foster health;
3. Exploitation: the client utilizes all available resources to move toward a goal of
maximum health or functionality
4. Resolution: refers to the termination phase of the nurse client relationship. It
occurs when the client’s needs are met and he/she can move toward a new goal.
Peplau further assumed that nurse client relationship fosters growth in both the
client and the nurse.
Peplau stated that there are six nursing roles which are as follows: stranger,
resource person, teacher, leader, surrogate, and counselor.

Martha Rogers (1970) - “Science of Unitary Human Beings”

Conceptualized the “Science of Unitary Human Beings”. To Rogers, unitary man
is an energy field in constant interaction with the environment she asserted that human
beings are more than and different from the sum or their parts; the distinctive properties
of the whole are significantly different from those or its parts. Furthermore, she believed
that human being characterized by the capacity for abstraction and imagery, language
and thought, sensation and emotion.

Sister Callista Roy (1979, 1984)- “Adaptation Model”

Presented the “Adaptation Model”. She viewed each person as a unified
biopsychosocial system in constant interaction with a changing environment. She
contended that the person as an adaptive system, functions as a whole through
interdependence of its parts. The system consists of input, control processes, output
and feedback. In addition, she advocated that all people have certain needs which they
endeavor to meet in order to maintain integrity. These needs are divided into four
different modes, the physiological, self-concept, role function, and interdependence.
Accordingly, Roy believed that adaptive human behavior is directed as an attempt to
maintain homeostasis or integrity of the individual by conserving energy and promoting
the survival, growth, reproduction and mastery of human system.

Jean Watson (1979-1985)- “Transpersonal Caring Model”

Conceptualized the “Transpersonal Caring Model” (nursing: human science and
human care). She emphasized that nursing is the application of the art and human
science through transpersonal caring transactions to help persons achieve mind-body-
soul harmony, which generates self – knowledge, self-control, self – care, and self –
healing. She included health promotion and treatment or illness in nursing. She believed
that a person is a valued being to be cared tor, respected, nurtured, understood and
assisted; a fully functional integrated self.
Watson identified 10 carative factors in nursing. These are as follows:
 Forming humanistic – altruistic value system
 Instilling faith – hope
 Cultivating sensitivity to self and others
 Developing helping-trust relationship
 Promoting expression of feelings
 Using problem-solving for decision making
 Promoting teaching – learning
 Promoting supportive environment
 Assisting with gratification of human needs
 Allowing for existential – phenomenological forces
Joyce Travelbee (1966, 1971)-“Interpersonal Aspects of Nursing Model”
She postulated the “interpersonal aspects of nursing model”. She advocated that
the goal of nursing is to assist individual or family in preventive or coping with illness,
regaining health, finding meaning in illness, or maintaining maximal degree of health.
She further viewed that interpersonal process is a therapeutic human-to-human
relationship formed during illness and “experience of suffering”. She believed that a
person is a unique, irreplaceable individual who is in a continuous process of becoming,
evolving and changing nurses and patients go through several stages to achieve the
goal of established nurse-patient relationships. Each stage has certain tasks, and a
healthy development of the relationship is accomplished by mastering each task. The
stages are:
1. Phase of the original encounter: emotional knowledge colors impressions and
perceptions of both nurse and patient during initial encounters. The task is “to
break the bond of categorization in order to perceive the human being in the
patient” and vice versa (travelbee, 1966, p. 133).
2. Phase of emerging identities: both nurse and patient begin to transcend their
respective roles and perceive uniqueness in each other. Tasks include
separating oneself and one’s experiences from others and avoiding using oneself
as a yardstick” by which to evaluate others barriers to such tasks may be due to
role envy, lack of interest in others, inability to transcend the self, or refusal to
initiate emotional investment
3. Phase of empathy: this phase involves sharing another’s psycnoog state but
standing apart and not sharing feelings. It is characterized oy the ability to predict
the behavior of another” (travelbee, 1966, p.143).
4. Phase of sympathy: sharing, feeling, and experiencing what others are feeling
and experiencing is accomplished. This phase demonstrates emotional
involvement and discredits objectivity as dehumanizing. The task of the nurse is
to translate sympathy into helpful nursing actions (travelbee, 1964).
5. Phase of rapport: all previous phases culminate into rapport, defined as all
those experiences, thoughts, feelings and patient undergo and are able to
perceive, share, and communicate (travelbee, 1963, 1966, pp.133-162)

Patricia Benner (1989)-“ From novice to expert” “Primacy of Caring Model”

Proposed the “Primacy Of Caring Model”. She believed that caring is central to
the essence of nursing. Caring creates the possibilities for coping and creates
possibilities for connecting with and concern for others. Benner described systematically
five stages of skill acquisition in nursing practice- novice, advanced beginner,
competent, proficient and expert from novice to expert model).
 Novice. A nursing student who has not experienced enough real situations to
make judgments about them. Performance is limited.
 Advanced beginner. Has marginally acceptable performance. Has
 Experienced enough real situations to make a judgment. Consciously and
deliberately plans nursing care.
 Competent has been in a similar job situation for 2 to 3 years. Has
Organizational and planning activities
 Proficient has 3 to 5 years experiences in a similar job situation. Has Holistic
understanding and perception of the client. Perceives Situation as a whole.
 Expert has intuitive and analytic ability in new situations. Performance is fluid. Is
flexible. No longer requires rules or Guidelines to understand current situation.