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Nursing Theories & Theorists Explained

What is nursing theory.

• Nursing Theory Users
• Metaparadigms

Nursing Theorists

Nursing theory in practice.

Nursing theory is "a creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomena," per the book  Integrated Theory and Knowledge Development in Nursing.

Nursing theory provides the foundational knowledge that enables nurses to care for their patients and guides their actions. Theories are in place, regardless of nursing specialization, to establish guidelines for both broad and specific nursing practices.

Nursing theory is heavily influenced by Florence Nightingale's pioneering work, which significantly influenced the modern  nursing definition . Nightingale's Environmental Theory 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.” 

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By identifying potential risk factors for illness or conditions that would exacerbate an illness and potentially lead to death, Nightingale saw the importance of a patient’s environment to their overall health and well-being. As a result, healthcare professionals, including nurses, began to treat patients differently and the start of population health and public health is seen. 

In Florence Nightingale’s Environmental Theory, she identified five environmental factors: 

• Efficient drainage 
• Cleanliness or sanitation
• Light or direct sunlight

These factors were essential to decrease the spread of contagious diseases and decreasing mortality and morbidity. 

While Florence Nightingale may have introduced the first nursing theory in 1860, it is still extremely relevant today. In countries where fresh air, pure water, efficient drainage, cleanliness or sanitation, and light or direct sunlight are not present, morbidity and mortality are increased. 

What are Nursing Theories Used For?

Nursing theories provide the foundation for nursing practice and are essential to the care of patients. Academic hospitals and Magnet hospitals will consistently ensure that nursing theories are incorporated into their policies and procedures to ensure best practice is being used. 

Most nurses and institutions will employ a variety of nursing theories within their everyday practice versus just one theory. Most do it unknowingly. 

Nursing theories help bedside nurses evaluate patient care and base nursing interventions on the evaluation of the findings. 

The theories can also provide nurses with the rationale to make certain decisions. An example of a nursing theory in use is seen in the care of a Jehovah’s Witnesses patient that does not believe in blood transfusions. While the patient may need a blood transfusion, Dorothea Orem’s Self-Care theory provides nurses with a solid basis for assisting their patients and giving them the opportunity to express independence and control in caring for themselves. While the nurse may not agree with the patient’s decision to not receive a blood transfusion, Orem’s theory suggests the importance of allowing the patient to make the decision and respecting it as their own choice. 

Oftentimes, the integration of nursing theory is not as obvious as in the aforementioned example. However, it is important for nurses and nursing students to understand and respect the importance of nursing theories and their impact on modern-day nursing and healthcare. 

Who are Nursing Theories Used By?

While all nurses, regardless of position and specialty, utilize nursing theories in their practice, not all nurses are aware of their implications. Generally speaking, most nursing theories are used by nurse educators and nurse researchers. 

Nurse educators will utilize nursing theories in designing course curriculums based on educational principles, research, and theories to provide nursing students with the knowledge and skills needed to provide care to their patients. 

Nurse researchers will conduct theory-guided research in order to create best practices and to predict potential clinical problems or explain existing knowledge. 

Nursing Metaparadigms

There have been countless nursing theories introduced since Florence Nightingale's Environmental Theory, including Imogene King‘s Theory of Goal and Dorothy Johnson’s Behavioral System Model. What they all have in common is they center around the nursing metaparadigm.

A metaparadigm is a set of theories or ideas that provide structure for how a discipline should function. Nursing metaparadigms were first classified by Fawcett into four specific categories, 

• Environment

These four concepts are fundamental to all nursing theories and without identification of them and their relevance to the theory, it is incomplete.

Furthermore, these four basic nursing metaparadigms point to the holistic care of a patient and their medical health is interconnected to the four concepts. 

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The Four Main Concepts of Nursing Theory

Fawcett’s four specific concepts help define nursing and set it apart from other disciplines and professions. These four concepts have been used to define the context and content of the nursing profession. The person is the most important concept in nursing theory, but each theorist's interpretation of the other concepts is how to differentiate between them. 

Person (also referred to as Client or Human Being) is the recipient of nursing care and may include individuals, patients, groups, families, and communities.

2. Environment

Environment or situation is defined as the internal and external surroundings that affect the patient. 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 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.

The attributes, characteristics, and actions of the nurse providing care on behalf of or in conjunction with, the client. 

Levels of Nursing Theory

Nursing theories are categorized into three levels including, 

• Grand Nursing Theories
• Mid-range Nursing Theories
• Nursing Practice Theories

Grand Nursing Theories 

These are theories based on broad, abstract, and complex concepts. They provide the general framework for nursing ideas pertaining to components such as people and health. These theories typically stem from a nurse theorist’s own experience.

Mid-Range Nursing Theories 

These are theories that drill down into specific areas of nursing rather than deal with sweeping concepts. They can emerge from nursing practice, research, or from the theories of similar disciplines.

Nursing Practice Theories 

These are theories that narrow their focus even further, specifically focusing on concepts concerning a defined patient population. These theories tend to directly affect patients more than the other two types of theories. Bedside nurses will often use these theories in their everyday practice. 

We talked about Nightingale and Orems' role as nursing theorists and reviewed their respective theories. Let's explore the work of some other notable nursing theorists and how their work helps nurses and other healthcare providers give better patient care.

Virginia Henderson: Nursing Need Theory

Virginia Henderson's Nursing Need Theory centers around the concept of basic human needs. Henderson believed that the role of a nurse is to assist individuals in meeting their fundamental needs and help them increase their independence. 

Her theory emphasizes the nurse's role in supporting patients in activities such as:

Maintaining desired postures

Dress and undress

Cleanliness

Communicating fears, opinions, and needs, and

Worshiping according to their faith

Jean Watson:  Theory of Human Caring

Jean Watson is a contemporary nursing theorist renowned for her Theory of Human Caring . Watson emphasizes the importance of creating a caring and compassionate relationship between the nurse and the patient. 

Her theory focuses on  ten factors:

Upholding humanistic-altruistic values by practicing kindness and compassion

Being genuinely present and fostering faith, hope, and belief systems while respecting the subjective experiences of oneself and others

Cultivating self-awareness and spiritual practices, transcending ego-centeredness to achieve a transpersonal presence.

Developing and nurturing loving, trusting, and caring relationships

Encouraging the expression of both positive and negative emotions, actively listening to others' stories without judgment

Applying creative problem-solving through the caring-healing process

Engaging in transpersonal teaching and learning within a caring relationship, adapting to the individual's perspective and transitioning towards a coaching approach for enhanced health

Creating a healing environment on various levels, fostering an atmosphere of authentic caring presence at an energetic and subtle level.

Acknowledging the interconnectedness of mind, body, and spirit while upholding human dignity

Embracing the spiritual, mysterious, and unknown aspects of life

Madeleine Leininger: Transcultural Nursing Theory

Leininger's Transcultural Nursing Theory , also called Culture Care Theory, focuses on providing culturally congruent care by understanding and respecting the values, beliefs, and practices of diverse individuals and groups.

Hildegard Peplau: Interpersonal Relations Theory

Peplau's Interpersonal Theory of Interpersonal Relations emphasizes that the journey of nurse-patient relationships involves three pivotal stages that are essential for their success: 

The initial orientation

A dynamic working phase, and

A  thoughtful termination process

According to Peplau, the nurse's role is to facilitate the patient's growth and development by utilizing therapeutic communication, empathy, and understanding.

Betty Neuman: Neuman Systems Model

The Neuman Systems Model focuses on identifying stressors that have the potential to negatively impact an individual's health and overall well-being. It incorporates various factors such as physiological, psychological, sociocultural, and developmental aspects. 

The theory also provides a flexible structure for assessment, intervention, and evaluation in nursing practice. 

Sister Callista Roy: Adaptation Model

The Roy Adaptation Model is based on the belief that individuals are adaptive systems, constantly interacting with their environment to maintain their physiological and psychosocial integrity. It views the person as a holistic being, consisting of four interconnected adaptive modes:

Physiological Mode: Deals with physical and biological aspects of adaptation, including the body's response to stressors, maintaining homeostasis, and meeting basic physiological needs.

Self-Concept Mode: Focuses on individuals' perception of themselves, including self-esteem and self-image.

Role Function Mode: Considers the roles people have in their lives, such as spouse, parent, employee, or student. 

Interdependence Mode: Emphasizes the importance of social relationships and how individuals interact with others, such as support from social networks.

Martha Rogers: Science of Unitary Human Being

Rogers' Science of Unitary Human Beings believed that nursing should focus on promoting harmony and balance within the individual and their environment. 

Her theory emphasizes the interconnectedness of human beings with their surroundings and the importance of energy fields in health and healing. Spoken another way, patients cannot be considered as “separate” from their environment.

Patricia Benner: Novice to Expert Theory

Benner's Novice to Expert Theory describes the stages of nursing skill from novice to advanced beginner, and finally, to competent. 

She emphasizes the importance of practical experience and clinical judgment in nursing practice and highlights that expertise develops over time through practice and reflection.

Imogene King: Theory of Goal Attainment

King's Theory of Goal Attainment focuses on the nurse-patient relationship and the mutual goal-setting process. Her theory emphasizes that nurses and patients should collaborate to establish goals that promote the patient's well-being and health.

Katharine Kolcaba: Comfort Theory

Kolcaba's Comfort Theory highlights the significance of providing comfort to patients as a central goal of nursing care. 

Her theory defines comfort as the immediate experience of being strengthened in physical, psychospiritual, environmental, and sociocultural dimensions.

Kolcalba’s framework proposes that healthcare providers:

Assess if patient’s comfort needs are not being met

Create interventions to meet those needs

Measure comfort prior to and after the interventions

Nursing theories are used every day in practice even if nurses aren’t aware of their use. Theories help guide evidence-based research which then leads to best practices and policies. These policies and procedures keep patients safe, while providing the best care possible. 

Nursing theories also allow nurses to positively influence the health and well-being of their patients beyond taking care of them at the bedside. Nursing theory-guided practice helps improve the quality of care delivered and helps continue to move the nursing profession forward into the 21st century. 

Most bedside nurses will not necessarily know the theories behind their practice so their usefulness is often dismissed. Advanced practice nurses, nurse scholars, nurse educators, and nurse researchers are most likely going to be up to date on current nursing theories and their impact on the nursing profession. 

Nursing theories should continue to guide nursing practice both in academia and at the bedside. It allows nurses to provide current best-practice care to their patients while also impacting them beyond the bedside. Florence Nightingale’s Environmental Theory was groundbreaking during the 1860s and helped change the course of nursing and healthcare while changing the outcomes of patients through the identification of environmental factors that may hinder their health and well-being. 

Nursing Theory FAQs

What are the major nursing theories .

• All nursing theories encompass person, environment, health, and the nurse and are categorized into three hierarchies: grand nursing theories, middle-range nursing theories, and practice level nursing theories.  

What are examples of nursing theory? 

• Some examples of nursing theories include the Environmental Theory, the Casey Model of Nursing, the Martha Rogers Theory, the Tidal Model, and the Cultural Care Theory. 

What is the Casey model of nursing?

• The Casey Model of Nursing is a model of nursing designed to encompass the child-health relationship with five focuses: child, family, health, environment, and the nurse. 

What is Martha Roger's Theory?

• The Martha Rogers Theory of nursing looks at people as “unitary” human beings that can’t be divided into parts and nursing as a blend of both art and science. 

What is a partnership model in nursing?

• It’s a patient and family-centered care system that focuses on partnership between the two, along with education, support, communication, and collaborative practice.

What are the principles of the tidal model? 

• The tidal model of nursing has 6 principles: curiosity, virtue, mystery investigation, respect of the person, crisis as an opportunity, possessing goals, and pursuit of elegance.

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Nursing Theories and Theorists: The Definitive Guide for Nurses

In this guide for nursing theories and nursing theorists , we aim 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.

Table of Contents

• What are Nursing Theories?

Defining Terms

History of nursing theories, environment, definitions, relational statements, assumptions, why are nursing theories important, in academic discipline, in research, in the profession, grand nursing theories, middle-range nursing theories, practice-level nursing theories, factor-isolating theory, explanatory theory, prescriptive theories, other ways of classifying nursing theories, florence nightingale, hildegard e. peplau, virginia henderson, faye glenn abdellah, ernestine wiedenbach, lydia e. hall, joyce travelbee, kathryn e. barnard, evelyn adam, nancy roper, winifred logan, and alison j. tierney, ida jean orlando, jean watson.

• Marilyn Anne Ray 

Patricia Benner

Kari martinsen, katie eriksson, myra estrin levine, martha e. rogers, dorothea e. orem, imogene m. king, betty neuman, sister callista roy, dorothy e. johnson, anne boykin and savina o. schoenhofer, afaf ibrahim meleis, nola j. pender, madeleine m. leininger, margaret a. newman, rosemarie rizzo parse, helen c. erickson, evelyn m. tomlin, and mary ann p. swain, gladys l. husted and james h. husted, ramona t. mercer, merle h. mishel, pamela g. reed, carolyn l. wiener and marylin j. dodd, georgene gaskill eakes, mary lermann burke, and margaret a. hainsworth, phil barker, katharine kolcaba, cheryl tatano beck, kristen m. swanson, cornelia m. ruland and shirley m. moore, wanda de aguiar horta, recommended resources, 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.

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.

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 .

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 (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 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.

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:

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.

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.

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 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 define the relationships between two or more concepts. They are the chains that link concepts to one another.

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.

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.
• Nursing theories can help guide research and informing evidence-based practice.
• Provide a common language and terminology for nurses to use in communication and practice.
• Serves as a basis for the development of nursing education and training programs.
• 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 essential for the development and advancement of the nursing profession. 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.

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.

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.

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.

• 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.
• 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 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 .
• Also known as category-formulating or labeling theory.
• Theories under this category describe the properties and dimensions of phenomena.
• Explanatory theories describe and explain the nature of relationships of certain phenomena to other phenomena.
• 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.

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.

See Also: Florence Nightingale: Environmental Theory and Biography

• 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.

See Also: Hildegard Peplau: Interpersonal Relations Theory

• 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.

See Also: 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.”

See Also: 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.
• 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.

See Also: 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.
• 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.
• 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.
• 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.
• 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 .

See Also: 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.

See Also: 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.
• 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.
• 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.
• 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.

See Also: 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.

See Also: 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.

See Also: 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.

See Also: 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.

See Also: 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.

See Also: 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.

See Also: 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.
• 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.”
• 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.

See Also: 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.

See Also:  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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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 .
• 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.
• 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.
• Also known as Wanda Horta, she introduced the concepts of nursing that are accepted in Brazil.
• Wrote the book Nursing Process which presents relevance to the various fields of Nursing practice for providing a holistic view of the patient.
• Her work was recognized in all the teaching institutions called the Theory of Basic Human Needs . It is based on Maslow’s Theory of Human Motivation, whose primary concept is the hierarchy of Basic Human Needs (BHN).
• Horta’s Theory of Basic Human Needs is considered the highest point of her work, and the summary of all her research concludes sickness as a science and art of assisting a human being in meeting basic human needs, making the patient independent of this assistance through education in recovery, maintenance, and health promotion .
• Classified basic human needs into three main dimensions – psychobiological, psychosocial and psychospiritual – and establishes a relationship between the concepts of human being, environment, and nursing.
• The theory describes nursing as an element of a healthcare team and states that it can function efficiently through a scientific method. Horta referred this method as the nursing process .
• She defined the nursing process as the dynamics of systematic and interrelated actions to assist human beings. It is characterized by six phases: nursing history, nursing diagnosis , assistance plan, care plan or nursing prescription, evolution, and prognosis.

Recommended books and resources to learn more about nursing theory:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

• Nursing Theorists and Their Work (10th Edition) by Alligood Nursing Theorists and Their Work, 10th Edition provides a clear, in-depth look at nursing theories of historical and international significance. Each chapter presents a key nursing theory or philosophy, showing how systematic theoretical evidence can enhance decision making, professionalism, and quality of care.
• Knowledge Development in Nursing: Theory and Process (11th Edition) Use the five patterns of knowing to help you develop sound clinical judgment. This edition reflects the latest thinking in nursing knowledge development and adds emphasis to real-world application. The content in this edition aligns with the new 2021 AACN Essentials for Nursing Education.
• Nursing Knowledge and Theory Innovation, Second Edition: Advancing the Science of Practice (2nd Edition) This text for graduate-level nursing students focuses on the science and philosophy of nursing knowledge development. It is distinguished by its focus on practical applications of theory for scholarly, evidence-based approaches. The second edition features important updates and a reorganization of information to better highlight the roles of theory and major philosophical perspectives.
• Nursing Theories and Nursing Practice (5th Edition) The only nursing research and theory book with primary works by the original theorists. Explore the historical and contemporary theories that are the foundation of nursing practice today. The 5th Edition, continues to meet the needs of today’s students with an expanded focus on the middle range theories and practice models.
• Strategies for Theory Construction in Nursing (6th Edition) The clearest, most useful introduction to theory development methods. Reflecting vast changes in nursing practice, it covers advances both in theory development and in strategies for concept, statement, and theory development. It also builds further connections between nursing theory and evidence-based practice.
• Middle Range Theory for Nursing (4th Edition) This nursing book’s ability to break down complex ideas is part of what made this book a three-time recipient of the AJN Book of the Year award. This edition includes five completely new chapters of content essential for nursing books. New exemplars linking middle range theory to advanced nursing practice make it even more useful and expand the content to make it better.
• Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice This book offers balanced coverage of both qualitative and quantitative research methodologies. This edition features new content on trending topics, including the Next-Generation NCLEX® Exam (NGN).
• Nursing Research (11th Edition) AJN award-winning authors Denise Polit and Cheryl Beck detail the latest methodologic innovations in nursing, medicine, and the social sciences. The updated 11th Edition adds two new chapters designed to help students ensure the accuracy and effectiveness of research methods. Extensively revised content throughout strengthens students’ ability to locate and rank clinical evidence.

Recommended site resources related to nursing theory:

• Nursing Theories and Theorists: The Definitive Guide for Nurses MUST READ! In this guide for nursing theories, we aim 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.

Other resources related to nursing theory:

• Betty Neuman: Neuman Systems Model
• Dorothea Orem: Self-Care Deficit Theory
• Dorothy Johnson: Behavioral System Model
• Faye Abdellah: 21 Nursing Problems Theory
• Florence Nightingale: Environmental Theory
• Hildegard Peplau: Interpersonal Relations Theory
• Ida Jean Orlando: Deliberative Nursing Process Theory
• Imogene King: Theory of Goal Attainment
• Jean Watson: Theory of Human Caring
• Lydia Hall: Care, Cure, Core Nursing Theory
• Madeleine Leininger: Transcultural Nursing Theory
• Martha Rogers: Science of Unitary Human Beings
• Myra Estrin Levine: The Conservation Model of Nursing
• Nola Pender: Health Promotion Model
• Sister Callista Roy: Adaptation Model of Nursing
• Virginia Henderson: Nursing Need Theory

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.
• Camacho, A. C. L. F., & Joaquim, F. L. (2017). Reflections based on Wanda Horta on the basic instruments of nursing. Rev Enferm UFPE [Internet], 11(12), 5432-8.
• 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.
• Perão, O. F., Zandonadi, G. C., Rodríguez, A. H., Fontes, M. S., Nascimento, E. L. P., & Santos, E. K. A. (2017). Patient safety in an intensive care unit according to Wanda Horta’s theory. Cogitare Enfermagem, 22(3), e45657.
• 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.

48 thoughts on “Nursing Theories and Theorists: The Definitive Guide for Nurses”

Great work indeed

Amazing and simple post I have ever come across about nursing theories.

Thank you for the simplicity

where do i find the reference page in apa format?

The reference listed below the article is in APA format.

i love this. insightful. Comprehensive ,Well researched .

Thank you for these theories they are a life saver and simplified. My school require us to write about 2 nursing theorist from memory for a Comprehensive exam in which if you do not pass it you are required to wait for a year to retake the exam.

Merci beaucoup, puisque je suis très satisfait.

I’m pleased to congratulate you about your work! I really appreciate it! From: Cameroon

An entire’s semester worth of a nursing theory class, expertly and succinctly summarized in one paper. I wish my instructor were as easy to understand. Good work.

I thought this was in a chronological order based on their published works date? Then why Orlando’s theory comes at the later part? Can someone englighten me please because I am making a timeline for our project.

Great job. Very clear and succinct.

I like it. Well explained!

easy to understand and very helpful

thankyou very much.

The article was beneficial to me to understand nursing theories

This is amazing and I love it so enriching!

Thanks for the article may God bless you more Plus More Power and Protection

Thanks so much

Please can someone help me with a nursing theory related to “teamwork” please

Thank you so much !

I loved the text and saw that the nursing theorist Wanda Aguiar Horta, a Brazilian nurse and great theorist regarding basic human needs, was not included.

I suggest reviewing and including it to be more complete.

If you need, I can help with inclusion!

Best Regards

Hi João Carlos, we’d love to hear about her work. Please send us the details via our contact page: https://nurseslabs.com/contact/

Excellent study guide! Detailed, Informative and Valued! Thank you!

hi can someone help me which theorist can relate in Ear, Nose, Throat nursing care.

Wonderful contribution of shared knowledge- now how do we get the word out for nurses that are not able to afford a BSN?

Thanks for the work. It’s very helpful

This has helped me understand theories a bit better, however, there is one that is eluding me. Where does the normative theory fit in?

very educative.I have understood theories more than before.Thanks

hard work. great work in deed

I love reading your material, plain concise and easy

Very informative, more knowledgeable about the theorist

Thank you for your information. This material is great and when I have looked for material for nursing theory. I got is material with complete

A big hand of applause 👏🏿 This is a treasure for nurses of the world. Thank you so much

Hi G. ALex,

Wow, thanks for the awesome feedback! 😊 Super glad you found it to be a treasure. Just curious, was there a particular section that stood out to you or something you’d love to see more of? Always keen to hear what resonates with fellow nurses!

This is really hard work put together in a very easy to understand way.Thank you so much.It came handy

Hi Sigala, Thanks a ton for noticing the effort! 😊 Super happy to hear it came in handy for you. If you ever have suggestions or topics you’d like to see, give me a shout. Cheers to making things understandable!

Absolutely helpful. Thank you.

So glad to hear the nursing theories guide was a hit for you! 😊 If you have any other topics or questions in mind, just give a shout. Always here to help. Keep rocking your studies! Thanks Ishe!

Am happy, to read these theories, very educating. Am going to make use of it when caring for my patients. GREAT NURSES GREAT! I LOVE YOU ALL.

Hi Eboh, I’m thrilled to hear you’re excited about applying these nursing theories in practice! They can really enhance the care we provide. It’s all about putting that knowledge to good use. By the way, which theory resonated with you the most, or which do you see being most applicable in your day-to-day patient care?

How do I relate one of the theories to effective management of intravenous lines? Which theory and how to relate to the above?

Hi wanted to ask you who wrote this page who is the autor because i need to write them on footnotes and i can’t find autor of the page,neither the year it was published. Thank you. Btw this article was really helpful i never understood nursing theories this good.

Hey there Innaya, I’m glad to hear the article on nursing theories was so helpful to you! Here’s how you can cite it in APA format:

Vera, M. (2019, September 11). Nursing Theories and Theorists: The Definitive Guide for Nurses Nurseslabs. https://nurseslabs.com/nursing-theories/

If you need any more help with citations or have other questions, feel free to ask. Happy to assist!

Please is there an app I could download all these from?

Hi Felicia, Thanks for your interest! As of now, we don’t have a dedicated app for downloading our content. However, our website is mobile-friendly, so you can easily access all our resources from your smartphone or tablet browser.

wonderful insights, and very precise and easy to understand, I even got to know and learn about other new theorists of Nursing I didn’t know before.

Thank you so much for this wonderful work.

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Usefulness of nursing theory-guided practice: an integrative review

Affiliations.

• 1 School of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada.
• 2 Shifa College of Nursing, Islamabad, Pakistan.
• 3 Clinical Nursing Instructor, Nipissing University, North Bay, ON, Canada.
• PMID: 30866078
• DOI: 10.1111/scs.12670

Background: Nursing theory-guided practice helps improve the quality of nursing care because it allows nurses to articulate what they do for patients and why they do it. However, the usefulness of nursing theory-guided practice has been questioned and more emphasis has been placed on evidence-based nursing and traditional practice. Therefore, an examination of experimental studies was undertaken to analyse the extent of use and usefulness of nursing theories in guiding practice. We reviewed experimental studies because in this era of evidence-based practice, these designs are given more weightage over other research designs. This examination would corroborate the usefulness of nursing theory-guided practice compared to traditional practice.

Methods: An integrative review was conducted. Literature search was performed within multiple databases, and 35 studies were reviewed and appraised.

Results: Majority of the studies were from Iran, the United States and Turkey and used Orem's self-care model, Roy's adaptation model and Peplau's theory of interpersonal relations. The effect of theory-guided interventions was evaluated in improving quality of life, self-efficacy, self-care and stress of patients with chronic, acute, cardiac and psychological illnesses. The quality rating was judged to be strong for three studies, moderate for 25 studies and weak for seven studies. All of the strongly rated studies found nursing theory-guided interventions useful. Overall, nursing theory-guided interventions improved all of studied outcomes in 26 studies and at least one outcome in nine studies. None of the studies reported that nursing theory-guided interventions as not useful.

Conclusion: Nursing theories have guided practice in both eastern and Western countries, and theory-guided practice has been found useful compared to traditional nursing practice. Therefore, nurses should continue to guide their nursing practice through the lens of nursing theories and should continue to evaluate the effectiveness of nursing theory-guided practice.

Keywords: experimental studies; nursing theories; nursing theory-guided practice.

© 2019 Nordic College of Caring Science.

Publication types

• Systematic Review
• Attitude of Health Personnel
• Evidence-Based Nursing / methods*
• Middle Aged
• Models, Nursing
• Nurse-Patient Relations
• Nursing Care / psychology*
• Nursing Staff, Hospital / psychology*
• Nursing Theory*

12 Vital Nursing Theories & Important Nurse Theorists

Nursing theories are something you learn in nursing school. But don’t just glaze over this part. Understanding these theories and the nurse theorists that created them can greatly impact your nursing job.

Table of Contents

What are nursing theories.

Nursing theories are basically a philosophy or a way of looking at the nursing profession. There have been hundreds of authors and nursing pioneers who have helped to construct how we view nursing today. Some of the theories help us understand how to communicate with patients, care for them, and encourage healing.

A paper published by the University Hospital Wales states that a nursing theory “helps nurses to understand their purpose and role in the healthcare setting.”

What are Nursing Models?

Nursing models provide structured frameworks that help organize a nurse’s scope of care. Grounded in nursing theories and scientific evidence, these models guide patient care, practice, research, and education. Some notable examples include Roy’s Adaptation Model, Roper-Logan-Tierney’s Model, Rogers’ Theory, Peplau’s Theory, and Parse’s Theory, each offering a unique perspective on nursing care and the nurse-patient relationship.

These models serve as a navigational tool for nurses amidst the multifaceted healthcare environment, offering a defined scope of practice. Nursing models help nurses in their daily interactions with patients by translating theoretical concepts into practical guidelines, as explained by the University of Wisconsin–Madison . They simplify complex phenomena, offering a more precise understanding and organization of nursing practice.

Furthermore, nursing models can be categorized into traditional and contemporary types. Traditional models like total patient care, functional nursing, team nursing, and primary nursing have been longstanding. On the other hand, current models, like patient-centered care, focus on evolving healthcare needs and patient empowerment. Each with its unique advantages, disadvantages, and impacts on quality outcomes, as detailed on ScienceDirect . Through these models, nursing professionals can better comprehend and navigate the diverse landscape of patient care, contributing to improved healthcare delivery and patient outcomes.

Nursing Theories vs Nursing Models

Nursing theories and models are integral in guiding nursing practice, yet they serve distinct roles. Nursing theories offer a conceptual framework that defines and describes nursing, explaining the underlying principles that guide nursing practice and research. They provide a systematic view of nursing by organizing the relationships between concepts to describe, explain, predict, and control nursing practice. On the other hand, nursing models are structured frameworks derived from these theories, providing a more practical approach to nursing care. They translate the abstract concepts from nursing theories into actionable guidelines that nurses can follow in their day-to-day interactions with patients.

While nursing theories delve into the abstract and conceptual aspects of nursing, offering a broad understanding, nursing models provide a more focused and structured approach to patient care. They apply the general principles outlined in nursing theories in a practical setting, ensuring that the care provided aligns with the underlying theoretical foundations. By doing so, nursing models help organize and deliver care, emphasizing the systematic application of nursing theories to real-world practice, and ensuring a cohesive and comprehensive approach to patient care. Nursing theories and models contribute to nursing practice’s ongoing evolution and improvement through this symbiotic relationship.

Types of Nursing Theories

There are three primary types of nursing theories, each with a different scope and level of abstraction. They are:

• Grand Nursing Theories: These theories are highly abstract and broad in scope, aiming to provide a conceptual framework for the entire nursing discipline. They explore the fundamental principles and concepts of nursing and are often not directly testable due to their level of abstraction. Examples include Orem’s Self-Care Theory and Roy’s Adaptation Model .
• Middle-Range Nursing Theories: These theories are less abstract than grand theories and focus on specific phenomena or concepts within nursing. They are more easily applied to practice and are often developed through research.
• Practice (or Situation-Specific) Nursing Theories: These theories are the most concrete and narrowly focused, often developed for a specific type of patient or a narrowly defined group of situations. They are derived from grand and middle-range theories but are designed to guide practice directly. Examples might include a theory on managing pain in pediatric patients, or coping with chronic illness.

Each of these types of theories plays a crucial role in advancing nursing knowledge, guiding practice, and improving patient care. While grand theories provide a broad perspective and foundation for the nursing profession, middle-range theories offer a closer look at specific nursing phenomena , and practice theories provide actionable guidelines for specific situations within nursing practice.

12 Essential Nursing Theories & Nurse Theorists

While there are enough nursing theories out there to fill a book, I picked out the 12 most applicable and useful nursing theories. These are some of the main ones that nurses still use today. Learning about them could give you a clearer view of your job as a nurse and help you discover new motivation and purpose.

Read through these theories and ask yourself how they can apply to your job and help you become a better nurse.

1. Environmental Theory – Florence Nightingale

Florence Nightingale created this theory back in 1859. It states the extreme importance and influence of the environment in the health and healing of patients.

According to Florence Nightingale, this theory “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.”

Following this method means you try to make the patient’s room a place of healing. It also means keeping it clean, ensuring they are eating right, and helping them have access to plenty of light and fresh air. It also means the patient has a voice and a say in all of this. Listen to them and help them understand why you administer care the way you do.

2. Theory of Interpersonal Relations – Hildegard E. Peplau

Hildegard E. Peplau developed her theory in 1952. It looks closely at the effect of the nurse’s interactions with the sick and how they heal.

According to the Nursing Theory website , it is comprised of four parts.

The four components of the theory are: person, which is a developing organism that tries to reduce anxiety caused by needs; environment, which consists of existing forces outside of the person and put in the context of culture; health, which is a word symbol that implies forward movement of personality and other human processes toward creative, constructive, productive, personal, and community living.

This theory is used a lot in psychiatric nursing. You can put it into practice by understanding how the environment and the patient’s needs affect their overall health.

3. Maternal Role Attainment Theory – Ramona Mercer

Ramona Mercer created this theory about nursing care and interventions for mothers. It looks closely at the bond mothers have with their newborn babies and how nurses can help facilitate it. She did most of her studies in the 1970s, learning about parenting in low and high-risk situations.

This is a very important theory to know if you want to be a neonatal nurse or work on the labor and delivery floor.

4. Nursing Process Theory – Ida Jean Orlando

We can thank Ida Jean Orlando for developing this theory. Because of it, we now understand the importance of a nursing care plan for different scenarios.

This theory not only establishes the necessity of nursing care plans , but it also establishes the importance of communicating effectively with patients. According to her, patients have their own interpretations of their health and situation. Nurses ought to validate their analyses with the patient before drawing conclusions.

5. Tidal Modal Theory – Phil Barker

Another theory that deals mostly with mental health is the Tidal Modal Theory by Phil Barker.

People need to gain control of their lives for them to heal and improve. This theory gives a framework to explore the patient’s need for nursing care, and for how to create an individual care plan .

Like the nursing process theory, this one gives power and respect to the patients. They know what they are experiencing and they have the power to begin the healing journey. Nurses should be curious, asking lots of questions and learning all they can from the patient.

6. Nursing Need Theory – Virginia Henderson

Virginia Henderson, a distinguished nurse, author, and theorist, devised the Nursing Need Theory , which emphasizes aiding patients to attain self-sufficiency by addressing their fundamental needs. This approach enhances patients’ recovery rates and guides them towards health independence, or a peaceful demise when necessary. Henderson’s intent behind this theory was not to create a new nursing paradigm, but to elucidate the unique focus of nursing practice; defining nursing as aiding individuals in performing activities contributing to health or its restoration, as detailed in Nurseslabs .

The essence of Henderson’s theory bridges the gap between patient needs and self-sufficiency, shedding light on nurses’ crucial role in healthcare. By understanding and applying the principles of the Nursing Need Theory, nursing professionals can better address patient needs, thereby enhancing healthcare delivery and patient outcomes. Through this theoretical lens, Henderson has imparted a lasting insight that resonates in contemporary nursing practice, facilitating a better comprehension of the interplay between patient needs and nursing care.

7. Philosophy and Theory of Transpersonal Caring – Jean Watson

In 1979, Jean Watson created the theory of transpersonal caring. This theory looks beyond treating disease to promoting overall health and preventing disease.

It looks at how nurses care for patients and how those care plans can promote overall health and wellness, prevent disease, and restore health.

If you prefer the more humanistic approach to nursing, you will love this theory. She taught that caring for people holistically promotes better health than a simple medical cure. The word you will read over and over as you study Jean Watson’s theory is caring . Caring is essential to nursing. A caring environment accepts people as they are and helps them become healthier.

8. Advancing Patient-Centered Nursing – Faye Abdellah

Faye Abdellah pioneered the “Twenty-One Nursing Problems Theory,” marking a significant paradigm shift in nursing. Her theory introduced the concept of nursing diagnosis, suggesting that nurses could actively contribute to this process through their job responsibilities, as detailed in Nursing Theory and Health Research Funding sources.

Abdellah’s theory emphasized a patient-centered approach, advocating a shift from a disease-centered to a patient-centered model. This framework laid a foundation for nurses to identify a patient’s problems and develop care plans, guiding them to look beyond medical diagnoses, and focus on fulfilling patients’ comprehensive health needs, as highlighted by Nurse Labs and Bradley University Online .

9. Neuman Systems Model – Betty Neuman

Betty Neuman is a notable nursing theorist known for developing the Neuman Systems Model , which adopts a holistic view of patients and their interactions with external and internal environmental stressors. At the heart of Neuman’s theory is the idea of energy resources enveloped by three defensive lines:

• the normal line of defense symbolizing the patient’s equilibrium
• the flexible line of defense representing the adaptive and response capacity
• and several lines of resistance depicting internal factors aiding against stressors, as detailed on Nursing Theory .

Neuman’s model visualizes individuals as open systems in a state of constant interaction with environmental forces, striving for systemic stability. This model encapsulates a comprehensive, holistic, and system-based approach to nursing, offering a structured yet adaptable framework. Through the Neuman Systems Model, nursing professionals can better manage the complexities entailed in patient care, thus enhancing the quality and effectiveness of nursing practice by providing a better understanding and organization of nursing care in response to patients’ diverse needs and conditions.

10. Science of Unitary Human Beings – Martha Rogers

The Science of Unitary Human Beings is a distinctive nursing theory crafted by Martha E. Rogers, embodying both the scientific and humanitarian aspects of nursing. This theory views patients as “unitary human beings” who are indivisible and should be perceived holistically. Rogers proposed that patients have the agency to consciously partake in the change process, underlining an intrinsic connection between individuals and their environments.

Martha Rogers emphasized that nursing is a blend of science and art, with its uniqueness in the phenomena it focuses on. The overarching goal is to promote health and well-being for individuals, irrespective of their circumstances. Rogers meticulously articulated these theoretical insights in her landmark book, “An Introduction to the Theoretical Basis of Nursing.” Through the Science of Unitary Human Beings theory, Rogers has provided a robust foundation that continues to guide and inspire the nursing community in delivering holistic and patient-centric care.

11. Transcultural Nursing Theory – Madeleine Leininger

The Transcultural Nursing Theory , devised by Madeleine Leininger, underscores the importance of cultural awareness in healthcare. Also known as Culture Care Theory, it advocates for culturally congruent nursing care, aligning care practices with an individual’s or group’s cultural beliefs, values, and lifestyle. This theory is pivotal in a globalized world, promoting cultural competence among healthcare providers to ensure effective and respectful care across diverse cultural settings.

Leininger’s groundbreaking work has also pioneered Transcultural Nursing as a distinct discipline during her tenure at the University of Washington in the early 1970s. Her theory enhances therapeutic nurse-patient relationships and improves healthcare outcomes by ensuring culturally tailored care practices, thus promoting patient satisfaction and adherence to care plans.

12. Theory of Goal Attainment – Imogene King

Imogene King pioneered the Theory of Goal Attainment in the early 1960s. This pivotal time was when nursing veered from a task-oriented to a more patient-centered approach. This theory posits a dynamic, interpersonal relationship where patients grow and develop to attain life goals, with nurses and patients collaborating to achieve mutually agreed-upon goals. The Theory of Goal Attainment elucidates factors like roles, stress, space, and time, which can impact goal achievement, aiding nurses in fostering a nurturing nurse-patient relationship to help patients meet their health goals.

Imogene’s insightful work provided a theoretical scaffold and significantly contributed to nursing theory development . Her theories, including the interacting systems theory of nursing, have been integral in every significant nursing theory text, showcasing her extensive impact on the nursing profession and education. Through her Theory of Goal Attainment, King has facilitated a deeper understanding and appreciation of the patient-nurse relationship, enhancing the effectiveness and quality of nursing care.

Nursing Theories Shape Your Role as a Nurse

As you study more nursing theories, you’ll discover more about yourself as a nurse. Do you feel more comfortable thinking about numbers and figures, or are you drawn to caring for the whole person? Defining your own nursing theory can help you understand how to better help people who come to you for help.

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The Most Common Nursing Theories to Know

There are no ifs, ands, or buts about it: Nursing theories are important to understand both in practice and during study for key nursing exams while enrolled in a nursing school.

Nursing theories serve as the foundation of clinical decision-making from what nursing is to what and why nurses do what they do. And because nursing practices have evolved alongside nursing science, nursing theories continue to emerge to provide valuable insights.

Each nursing theory organizes a particular philosophy and framework of nursing that helps identify what nurses should do and the purpose of their actions in treating clients. The application of nursing theory in clinical practice can improve their professional nursing decision-making skills by following these system processes.

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• Education-Related Nursing Abbreviations

What is nursing theory?

The 4 main concepts of nursing theory, change theory, environmental theory, patient-centered approach to nursing, casey’s model of nursing, theory of comfort, tidal model, self-care deficit theory, cultural care theory, theory of interpersonal relations, adaptation theory, nursing need theory.

We’ll walk you through what you need to know about these theories.

Nursing theories are the cornerstone of quality nursing practice. They’ve been used for a long time — since Florence Nightingale introduced the first nursing theory around 1860. In short, a nursing theory outlines clients’ needs and explains how nurses should respond to different situations. Over the years, different nursing theorists have created guidelines for understanding the nursing role, the relationship between a nurse and their client, and the best treatment options for clients. These different theories reflect nursing research and work to improve clients’ overall well-being.

What is the nursing metaparadigm?

The nursing metaparadigm is the idea that four main components interact, and are generally interrelated when treating clients. The metaparadigm provides structure and key areas of focus that help define how nurses should evaluate a client and their needs and then determine the appropriate nursing care.

The metaparadigm is reflected in the different nursing systems. When nurses use all four components when evaluating and treating clients, they provide holistic care. The major components of the metaparadigm look at the client’s health from all angles.

Those interested in the nursing profession should make sure they understand the four components.

The nursing metaparadigm identifies four main concepts of nursing theory — first named by Jacqueline Fawcett — that outline how nurses need to evaluate their patients and provide care.

We’ll walk you through these four main components so you can see how they interact to create the full picture of a patient’s health and needs.

What Are the 4 Nursing Theories?

In a nursing theory, the Person can also be referred to as a Patient or Human Being. These terms all reference the patient or other people receiving care offered by the nurse.

For example, when caring for a patient in a hospital, the patient will have the title of Person. If the nurse offers HIV education programs in a community health center, on the other hand, the group would receive this classification.

When nurses work to define who the person is receiving their care, they should take a holistic look at the individual or the group. This means considering their social, spiritual, and physical needs.

Environment

The Environment can also be referred to as the Situation. You can define this classification by looking at all the different surroundings and conditions that impact the patient or people receiving care.

For example, the Environment includes the physical place where the person is and the people in their lives that impact their health. All of these environmental factors should be recognized in the conceptual framework of each nursing theory.

Health describes the current physical health of the person receiving care. This classification looks at the overall wellness of the person or people in question. Looking at the patient’s overall health requires not only collecting vitals but also looking at their emotional health and even their social conditions.

The Nursing classification describes the actions the nurse takes to provide care to the person or people in question. This might take the form of nursing care in a clinical setting, such as putting in an IV, or educational care that nurses provide to community members or family members of patients.

There are a variety of nursing theories that nurses consult to help them better understand their patients and provide optimal care. Most theories fall under three main categories, though.

Grand Nursing Theories  

Grand Nursing Theories describe abstract nursing theories that focus on providing frameworks for understanding nursing behavior and don’t have too many details.

• Abstract and complex frameworks that require further research for clarification.
• Offer general conceptualizations of nursing phenomena without prescribing specific interventions.
• Developed based on personal experiences and historical contexts, addressing key components of the nursing metaparadigm.

Middle-Range Nursing Theories

Middle-Range Nursing Theories are slightly more specific than Grand Nursing Theories and provide more details about behavior and specific patient populations that each theory focuses on.

• Focus on specific nursing phenomena with less complexity than grand theories.
• Proposed as more testable alternatives to grand theories, bridging the gap between theory and practice.
• Often derived from existing grand theories or empirical research in nursing or related disciplines.

Practice-Level Nursing Theories

Practice-Level Nursing Theories provide more minute details about specific types of patients and situations.

• Narrow in scope and tailored to specific patient populations and contexts.
• Offer practical frameworks for nursing interventions and predict outcomes of nursing practices.
• Directly impact nursing practice and are informed by concepts from middle-range and grand theories.

Let’s now explore some of the most common nursing theories you can expect to encounter as you begin your nursing career.

Change theory is a set of principles and concepts that explain how change occurs in individuals and organizations. It provides a roadmap for understanding the change process and the factors that influence it. Change theory is based on the idea that change is a process, not an event. It involves a series of stages that individuals and organizations go through as they adopt new behaviors or practices.

The Environmental Nursing Theory is the first framework developed by Florence Nightingale during the Crimean War. Nightingale discovered connections between the environment in which the patient was situated and their recovery and health.

Nightingale focused on the importance of providing patients with five key requirements:

• Efficient drainage
• Sanitation or cleanliness
• Light or direct sunlight

The Patient-Centered Approach to Nursing theory was developed in the 1940s by Faye Abdellah. The goal of this approach lies in guiding the care that nurses provide in hospitals and clinical settings.

This approach walks nurses through 10 specific steps:

• Get to know the patient and their health problems and needs.
• Gather data and sort out the most relevant information.
• Use past experiences and insights into the nursing profession to compare the patient with other patients who have presented similarly.
• Create a therapeutic plan to treat the patient.
• Create tests and run them to see how the patient compares and what new generalizations need to be made.
• Speak with the patient about what they view as their nursing problems.
• Observe the patient throughout the treatment period to see if there are any changes in their behavior.
• Observe how the patient and their loved ones react to the nursing treatment plan.
• Determine the nurse’s perceptions of the nursing problems facing the patient.
• Create a comprehensive nursing care plan based on the information gathered throughout this process.

Anne Casey’s Model of Nursing emerged in the late 1980s and focused on nursing as it pertains to children. It helps nurses connect with both the pediatric patient and their family to provide optimal care. At the core of this theory is the idea that children are cared for best by their family members while receiving help from health care professionals.

The Theory of Comfort emerged in the 1990s by Katherine Kolcaba. With this theory, nurses focus on providing clients with comfort as their primary objective. The idea behind this focus is that if the client’s basic needs are met, the client will naturally experience some relief, which is the first step in the three stages of comfort.

After relief comes to ease and then transcendence.

The Tidal Model also emerged in the 1990s. It was spearheaded by Phil Barker, who worked to combine nursing with psychiatry by helping people through experiences of distress. This model helps patients navigate these negative moments through the 10 Commitments of:

• Valuing the voice and experiences of the patient
• Respecting the language used by the patient
• Having a true curiosity about the patient and their experiences
• Having an outlook like an apprentice to learn
• Using the tools available to help the patient
• Helping the patient see the next step
• Helping the patient understand and experience the gift of time
• Using personal insights and wisdom
• Understanding that the only thing constant in life is change
• Being transparent throughout the process

Dorothea Orem developed the Self-Care Deficit Nursing Theory throughout her career from the early 1950s to 2001. Under this understanding of nursing, patients want to care for themselves but need assistance sometimes.

In the Theory of Self-Care Deficit, nurses can help patients by empowering them to do as much as they can independently. According to Orem’s self-care model, as the patient improves, the nurse encourages the transition for the patient to do even more by themselves.

The Cultural Care Theory, created by Madeleine Leininger, states that nursing care needs to align closely with the patient’s personal beliefs. In other words, the individual’s religious beliefs, cultural practices, and values should play an important role in the nursing interventions the patient receives.

This can be particularly important for those working in transcultural nursing and can help nurses put their nursing knowledge to use in a way that benefits the patient directly.

The Theory of Interpersonal Relations arose from the work of Hildegard Peplau. Peplau believed that nursing should revolve around the back and forth in the relationship between the patient and the nurse.

Instead of seeing the nurse as simply fulfilling the doctor’s orders and the patient simply receiving treatment, this modern nursing theory shifts the role of nurses by emphasizing the relationship between the nurse and the patient.

The Adaptation Theory was developed by Sister Callista Roy, and focuses on the interconnected systems that a patient experiences as part of the nursing process. The interrelated systems of patients within their families and social groups, as well as various human life processes, form the focus of this nursing theory.

In the adaptation model, nurses help patients navigate and maintain balance in spite of these different conditions.

The Nursing Need Theory emerged from works by Virginia Henderson. Henderson and the Need Theory focused on the patient’s basic human needs and encouraged their independence throughout their time in the hospital.

The hope is that by following this model, patients don’t need to be hospitalized longer than necessary and that progress in the patient’s condition isn’t delayed.

Study Smarter for Nursing Exams Like the NCLEX

These nursing models will play an important role in your nursing education, so you’ll want to carefully review them when studying for exams.

Graduating from a nursing program — whether you’ve earned a BSN to become an RN or earned an MSN to become a nurse practitioner — is just one part of the process.

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Nursing Theory

Grand Nursing Theories

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What makes it Grand ?

These nursing theories have the broadest scope for addressing a variety of concepts and propositions that nurses may encounter in the practice of care. They tend to be oriented around models and conceptual frameworks for defining practice in a variety of situations and care environments and ways of examining phenomena based on these perspectives.

Grand Theories of Nursing

• General Systems Theory - Imogene King
• Modeling and Role Modeling Theory - Erickson, Tomlin, and Swain
• Transcultural Nursing (formerly Culture-Care) - Madeleine Leininger
• Conservation Model - Myra Estrine Levine
• Health as Expanding Consciousness - Margaret Newman
• Nursing Process Theory - Ida Jean Orlando
• Theory of Human Becoming - Rosemarie Rizzo Parse
• Humanistic Nursing - Josephine Paterson and Loretta Zderad
• Interpersonal Relations Model - Hildegard E Peplau
• Science of Unitary Human Beings - Martha E Rogers
• Roy Adaptation Model - Sister Callista Roy
• Philosophy and Theory of Transpersonal Caring - Jean Watson
• Emancipated Decision Making in Health Care - Wittman-Price
• Self-Care Theory - Dorothea Orem

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Nursing Theories and Models

Introductory readings, sister callista roy: adaptation model of nursing, dorothea orem: self-care deficit nursing theory, synergy model (aacn), patricia benner: professional advancement model, jean watson: theory of human caring, madeleine leininger: cultural care diversity & universality, anne boykin & savina schoenhofer: nursing as caring, hildegard peplau: interpersonal relations model, ida jean orlando: theory of the deliberative nursing process, florence nightingale: what nursing is, virginia henderson: henderson nursing model, nola pender: health promotion model, kate lorig: chronic disease self-management, merle mishel: uncertainty in illness theory, afaf meleis: nursing transitions, theory of unpleasant symptoms, theory of symptom management, nursing role effectiveness model, joanne duffy: quality caring model.

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• Anne Boykin & Savina Schoenhofer: Nursing as Caring

• Roy Adaptation Association Review Newsletter archives

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• Alspach, J. (2006). Extending the synergy model to preceptorship: A preliminary proposal. Critical Care Nurse, 26(2), 10-14.

• AACN Synergy Model for Patient Care (AACN Standards)
• American Association of Critical-Care Nurses (AACN)

• Davis, A., & Maisano, P. (2016). Patricia Benner: Novice to expert -- A concept whose time has come (again). Oklahoma Nurse, 61(3), 13-15.
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• Nola J. Pender - University of Michigan

• Kate Lorig - Stanford University
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• Mishel, M. H. (1990). Reconceptualization of the uncertainty in illness theory. Journal of Nursing Scholarship, 22(4), 256-262.

• Afaf I. Meleis - University of Pennsylvania
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• Liehr, P. (2005). Looking at symptoms with a middle-range theory lens. Advanced Studies in Nursing, 3(5), 152-157.

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Exploring the World of Nursing Theories

This article was written in collaboration with Christine T. and ChatGPT, our little helper developed by OpenAI.

Nursing theories play a critical role in guiding nursing practice, education, and research. Nursing theories are developed by theorists seeking to explain, predict, and improve nursing practice. Exploring nursing theories can be a fascinating journey into the history and evolution of nursing as a profession. It can better understand how nurses care for their patients and the importance of evidence-based practice. When applying nursing theories in practice, it is important to thoroughly understand their implications and impact on patient care. However, exploring nursing theories can also be a great starting point for debating various nursing topics for discussion among healthcare professionals, such as the role of nurses in patient advocacy and healthcare policy. These discussions can enhance critical thinking skills and promote evidence-based practice in nursing. Over time, nursing theories have evolved to address changing healthcare needs and challenges. In this article, we will provide an overview of nursing theories, their historical development, and their contemporary applications. We will also explore the different types of nursing theories, their application in practice, and the process of evaluating and critiquing nursing theories. Finally, we will discuss the importance of nursing theories in advancing nursing knowledge and practice and their relevance in improving patient care and outcomes.

Historical Overview of Nursing Theories

The development of nursing theories began in the early 20th century, with Florence Nightingale’s pioneering work on the importance of maintaining a clean and healthy environment for patient recovery. Her work during the Crimean War transformed nursing into a respected profession and laid the foundation for modern nursing education.

In the early 1900s, nursing theorists such as Virginia Henderson began to explore other aspects of nursing practice, including the concept of the nurse-patient relationship and the definition of nursing as assisting individuals in activities that contribute to health or recovery.

In the 1950s and 1960s, nursing theories continued to evolve, with the emergence of grand theories that aimed to provide a comprehensive framework for understanding nursing practice. Martha Rogers developed the theory of unitary human beings, which emphasized the interconnectedness of all things and the importance of the nurse-patient relationship in promoting healing. Dorothy Johnson developed the behavioral system model, which focused on the role of the nurse in helping patients adapt to changes in their environment.

Hildegard Peplau was another influential nursing theorist who developed the theory of interpersonal relations. Her work laid the foundation for patient-centered care, in which the nurse serves as a guide and resource for the patient’s personal growth and development.

Nursing theories continued to evolve throughout the 20th century, influenced by developments in psychology, sociology, and anthropology. Abraham Maslow’s work on human motivation, for example, influenced the development of nursing theories such as Maslow’s hierarchy of needs.

Overall, the historical overview of nursing theories highlights the significant role that nursing theorists have played in shaping the nursing profession and advancing nursing practice. Their work continues to influence nursing education and patient care to this day.

Types of Nursing Theories

Nursing theories are frameworks or models that provide a conceptual understanding of the nursing profession. These theories help to guide nursing practice, research, education, and administration. Over the years, nursing scholars and theorists have developed several types of nursing theories, each with its unique perspective and purpose. Here are the main types of nursing theories:

Grand Nursing Theories

Grand theories are comprehensive and abstract and provide a broad framework for understanding nursing practice. They often incorporate multiple aspects of nursing practice and focus on the relationship between individuals and their environment.

Some examples of grand nursing theories include:

• The Roy Adaptation Model:

Developed by Sister Callista Roy, this theory posits that the goal of nursing is to promote adaptation in patients and that nursing interventions should be tailored to the patient’s adaptive needs. The model describes how patients adapt to their environment and how nursing interventions can support or modify this process.

• The Humanistic Nursing Theory:

Developed by Josephine Paterson and Loretta Zderad, this theory emphasizes the importance of human relationships in nursing practice. The theory suggests that nurses should approach patients as unique individuals with their own experiences, emotions, and values and that the nurse-patient relationship should be based on mutual respect and understanding.

• The Theory of Transpersonal Caring:

Developed by Jean Watson, this theory emphasizes the importance of caring in nursing practice. The theory suggests that caring is a fundamental component of nursing practice and that nurses should approach patients with a sense of compassion and understanding.

Middle-range nursing theories

Middle-range theories are more specific and focus on a particular aspect of nursing practice or a particular patient population. They are often more practical and guide nursing practice and research.

Some examples of middle-range nursing theories include:

• The Health Promotion Model:

Developed by Nola Pender, this theory posits that health is a positive dynamic state that is influenced by individual characteristics, behavior, and the environment. The model emphasizes the importance of promoting healthy behaviors and attitudes, and it provides a framework for understanding how individuals can be motivated to take action to improve their health.

• The Theory of Chronic Sorrow:

Developed by Eakes, Burke, and Hainsworth, this theory addresses the phenomenon of chronic sorrow, which is the ongoing grief experienced by individuals who are caring for loved ones with chronic illnesses. The theory provides a framework for understanding the emotional and psychological impact of chronic illness on caregivers, and it suggests interventions to support them.

• The Theory of Comfort:

Developed by Katharine Kolcaba, this theory addresses the importance of comfort in nursing practice. The theory suggests that nurses should focus on providing physical, emotional, and spiritual comfort to patients to promote healing and well-being.

Practice nursing theories

Practice theories are developed from specific nursing situations and are often grounded in the practical experiences of nurses. They are focused on improving nursing practice and can be used to guide clinical decision-making. Practice theories may also be used to develop standardized protocols for specific nursing interventions.

Some examples of practice nursing theories include:

• The Theory of Self-Care:

Developed by Dorothea Orem, this theory addresses the role of the patient in managing their health and wellness. The theory suggests that patients should be empowered to take an active role in their care, and that nurses should support them in developing self-care skills and strategies.

• The Theory of Basic Needs:

Developed by Virginia Henderson, this theory addresses the fundamental needs of patients and the role of nurses in meeting those needs. The theory suggests that nurses should focus on meeting patients’ physiological, psychological, and social needs to promote health and well-being.

• The Theory of Caring:

Developed by Kristen Swanson, this theory addresses the importance of caring in nursing practice. The theory suggests that nurses should approach patients with compassion and empathy and that caring is a fundamental component of nursing practice.

Descriptive nursing theories

Descriptive theories describe the nursing practice and focus on the observation and analysis of nursing behaviors and experiences. They aim to provide a comprehensive understanding of the nursing practice and can be used to identify areas for improvement in nursing care.

Some examples of descriptive nursing theories include:

• The Theory of Transition:

Developed by Afaf Meleis, this theory addresses the experience of transition in healthcare, including transitions between healthcare settings and the experience of chronic illness. The theory suggests that transitions are a complex and multifaceted process that can have significant impacts on the health and well-being of patients and their families.

• The Theory of Uncertainty in Illness:

Developed by Merle Mishel, this theory addresses the experience of uncertainty among patients with chronic illness. The theory suggests that uncertainty can have significant psychological and emotional impacts on patients and their families and that nurses can play a role in helping patients to manage uncertainty and cope with the challenges of chronic illness.

• The Theory of Cultural Care Diversity and Universality:

Developed by Madeleine Leininger, this theory addresses the impact of culture on nursing practice and the provision of healthcare. The theory suggests that nurses should be aware of the cultural beliefs, values, and practices of their patients, and that cultural competence is an essential component of nursing practice. To learn more about Leininger’s Culture Care Theory, visit our resource page on Leininger’s Culture Care Theory .

Application of Nursing Theories in Practice

Application of Nursing Theories in Practice Nursing theories are used to inform and guide nursing practice, as well as to improve patient outcomes. Using nursing theories, nurses can identify patient needs, develop care plans, and evaluate the effectiveness of nursing interventions. For example, nurses can use the theory of self-care to help patients with chronic illnesses develop the skills and knowledge needed to manage their health. Using the theory of human caring, nurses can provide compassionate and holistic care that addresses patients’ physical, emotional, and spiritual needs.

Furthermore, nurses can be essential in identifying and managing mental health disorders, such as anxiety disorders. Understanding the anatomy and physiology of anxiety disorder, hereditary factors, and statistical facts can help nurses provide more effective care to their patients. You can learn more about anxiety disorder and its implications for patient care by visiting our resource on anxiety disorder .

Evaluation and Critique of Nursing Theories

While nursing theories have been developed and refined over many years, they are not without their limitations and criticisms. Some critics argue that nursing theories are often too abstract and do not provide practical guidance for nursing practice. They also suggest that many nursing theories are not adequately tested and lack empirical evidence to support their claims.

Others argue that some nursing theories may be too prescriptive and do not take into account the unique needs and experiences of individual patients. Additionally, some critics suggest that nursing theories may not adequately address issues of social justice and equity in healthcare.

Despite these critiques, nursing theories continue to play an important role in the development of nursing practice and the advancement of the nursing profession. While nursing theories may not provide all the answers to the complex challenges facing healthcare today, they can provide a valuable framework for understanding the role of nursing in promoting health, preventing illness, and improving patient outcomes.

It is important for nurses to critically evaluate nursing theories and apply them appropriately in their practice. Nurses should also be open to new theories and developments in nursing practice, and be willing to adapt their practice as new evidence emerges.

In conclusion, nursing theories have played a vital role in shaping the nursing profession and improving patient outcomes. While they are not without their limitations, nursing theories continue to provide a valuable framework for understanding nursing practice and promoting the delivery of high-quality patient care. It is important for nurses to continue to critically evaluate and apply nursing theories in their practice, and to remain open to new developments and advancements in nursing practice.

Contemporary Nursing Theories

Contemporary nursing theories have emerged in response to changing healthcare needs and patient populations. These theories are often interdisciplinary, drawing on fields such as psychology, sociology, and anthropology to develop a more comprehensive understanding of the complex factors that influence health and illness. Contemporary nursing theories also often address issues related to health disparities, social justice, and cultural competence in nursing practice.

One example of a contemporary nursing theory is the Social Determinants of Health Theory, which examines the social, economic, and environmental factors that contribute to health disparities among different populations. This theory emphasizes the need for nurses to be aware of these factors and to advocate for policies and interventions that promote health equity.

Another contemporary nursing theory is the Theory of Health as Expanding Consciousness, developed by Margaret Newman. This theory posits that health is a process of expanding consciousness and becoming more aware of one’s self and environment. It emphasizes the importance of holistic and patient-centered care and encourages nurses to focus on promoting health and well-being rather than simply treating illness.

Importance of Nursing Theories in Education and Research

Nursing theories play a critical role in nursing education and research. They provide a framework for understanding and interpreting nursing phenomena, as well as for guiding clinical practice. The use of nursing theories in education helps to ensure that nurses have a strong theoretical foundation that they can use to guide their clinical decision-making and practice.

In research, nursing theories serve as a basis for the development of research questions, the design of studies, and the interpretation of findings. By using nursing theories as a guide, researchers can explore the relationships between various nursing concepts and better understand the complex nature of nursing phenomena.

Furthermore, nursing theories provide a language for nurses to communicate and share their experiences and knowledge. They also promote professional autonomy and help nurses to advocate for the unique contribution of nursing to the healthcare system.

Overall, the importance of nursing theories in education and research cannot be overstated. They provide a theoretical foundation for nursing practice, guide research efforts, and promote the professional development of nurses.

Explore Nursing Research Topics

If you’re interested in exploring nursing research topics, you may find our resource page on Top Nursing Research Topics for Students and Professionals helpful. This page features a comprehensive list of research topics that you can use as a starting point for your next project or paper. From patient care to healthcare policies, there’s something for everyone to delve into. Some of the topics covered on the page include:

• The impact of nursing interventions on patient outcomes
• The role of nursing in reducing healthcare costs
• The effectiveness of different pain management strategies
• Ethical considerations in nursing research
• The influence of nursing leadership on patient care

And much more!

Whether you’re a nursing student, a healthcare professional, or a researcher, you’re bound to find some interesting topics to explore on our resource page. Click here to access the page and start exploring the world of nursing research topics today.

In conclusion, nursing theories are essential in the nursing profession as they provide a framework for understanding the complexities of patient care. These theories guide nurses in making informed decisions about patient care, help to improve patient outcomes, and enhance the overall quality of nursing practice. By understanding the key concepts and principles of nursing theories, nurses can effectively communicate and collaborate with other healthcare professionals to provide holistic care that addresses not only the physical needs of the patient but also their emotional, psychological, and spiritual well-being. As the nursing profession continues to evolve, nursing theories will play an increasingly important role in shaping the future of patient care and nursing practice.

📎 Related Articles

1. Nursing Theories & Theorists: The Definitive Guide for Nurses 2. Nursing Theories: An Overview 3. Understanding Nursing Theories 4. Nursing Theory 5. The Most Common Nursing Theories to Know 6. Nursing Theorists

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Knowledge, attitude and utilization of nursing theories among nursing personnel: A descriptive cross-sectional study

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Aim To assess knowledge, attitude and utilization of Nursing Theories among Nursing Personnel working in a tertiary care centre in India.

Methods A descriptive cross-sectional study was conducted using a proportionate stratified random sample of 350 nursing personnel in a tertiary care centre in east-central India. A self-structured tool to assess knowledge, practice and utilization was distributed to nursing personnel via Google forms between, March 2024-April 2024.

Results The results revealed that the mean scores for the knowledge, attitude, and utilization component being 2.58 ± 0.570, 53.64 ± 6.433, and 1.87 ± 0.740, respectively. Among the nursing personnel, the analysis does not show any significant (p-value > 0.05) difference in the mean scores of knowledge, attitude and utilization when comparing different designations, age groups, genders, levels of work experience, professional qualifications, and types of institutes, indicating that the observed differences could be due to chance. However, in utilization, when examining the nature of the job, a significant difference is observed.

Conclusions It is important to practice nursing theories in clinical setting for better patient care. Theories of nursing contribute to richness of the profession and provide an identity to the profession. Barriers in implementing nursing theories in practice must be examined and a particular focus to be given.

Competing Interest Statement

The authors have declared no competing interest.

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The Evolution of Nursing Research

Jacqueline m. stolley.

Trinity College of Nursing, Moline, Illinois

THE RESEARCH CULTURE in nursing has evolved in the last 150 years, beginning with Nightingale’s work in the mid-1850s and culminating in the creation of the National Institute of Nursing Research (NINR) at the National Institues of Health (NIH). This article highlights nursing’s efforts to facilitate the growth of the research culture by developing theory, establishing the importance of a research-based practice, advancing education, and providing avenues for dissemination of research. Similarities with the chiropractic profession are discussed, along with a commentary by Cheryl Hawk, D.C, Ph.D.

EVOLUTION OF NURSING RESEARCH

The development of a research culture in nursing in many ways parallels that of chiropractic, and by reviewing key aspects of the evolution of the science of nursing, there are lessons to be learned, and mistakes to be avoided. Nursing research has changed dramatically in the past 150 years, beginning with Florence Nightingale in the 19th century. Clearly, nursing research has not always had the influence and significance it holds today. In fact, for a number of years after Nightingale’s work, little is found in the literature concerning nursing research. This is perhaps due to the past perception of nursing as an apprenticeship in a task-oriented caring profession ( 1 ). Although research was conducted with respect to nursing education and administration in the first half of the 20th century, it was not until the 1950s that nursing research began the advancement that has been seen in the past three decades. This is due to many factors: an increase in the number of nurses with advanced academic preparation, the establishment of vehicles for dissemination of nursing research, federal funding and support for nursing research, and the upgrading of research skills in faculty and students. This article provides a brief review of the development of research in nursing, and along with it, the theory that has guided that process.

NURSING THEORY DEVELOPMENT

As with other practice professions, nursing requires a knowledge foundation that is based on theory and derived from systematic research. The first nursing theorist, Florence Nightingale, created detailed reports of both medical and nursing matters as chief nurse for the British in the Crimean War in the mid-1850s. Nightingale noted that “… apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion” (p. 6) ( 2 ). As a result, Nightingale’s conceptualization of nursing included the need to have an understanding of the laws of nature, the prevention of disease, and the use of personal power. She viewed persons as both physical and spiritual beings, emphasizing the importance of the environment and the need to care for the patient, not the disease. With her emphasis on the environment, changes in nutrition, hydration, and sanitation resulted, and mortality rates dropped drastically during the Crimean War ( 3 ). In subsequent years, Nightingale developed “laws of nursing” that formed the basis for nursing science and guided nursing education in the United States from 1850 to the 1950s ( 4 ).

In the 1960s, nursing theory was used to guide teaching rather than research or practice. This was a natural outgrowth of nursing’s earlier focus on education and professional identity. Additionally, the National League for Nursing (the professional accrediting body) stipulated a conceptual framework for curriculum. Paradigmatic concepts integral to nursing were identified as person, environment, health , and nursing ( 5 – 7 ), and scientific energies were spent developing curriculum that corresponded to existing theories ( 7 ). At this point in time, nurse educators began to urge students to “care for the whole person” and textbooks underscored the importance of “holism” in nursing, with subtitles such as “The Biopsychosocial Approach.” Nurse authors acknowledged multiple causality in human illness, but all too often research, curricula, and textbooks reflected linear cause-and-effect models rather than multivariate approaches.

The 1950s and 1960s saw the development of theories explaining the art and science of nursing. Hildegard Peplau published Interpersonal Relations in Nursing ( 8 ) in 1952, based on her work as a psychiatric nurse. Other theories. included Levine’s Conservation Principles of Nursing ( 9 ) in, 1967; Roger’s Introduction to the Theoretical Basis of Nursing ( 10 ) in 1970, and The Science of Unitary Man ( 11 ) in 1980, followed by The Science of Unitary Human Beings, a Paradigm for Nursing ( 12 ) in 1983. Imogene King published A Theory for Nursing: Systems, Concepts, Process ( 13 ) in 1981, and Sister Calista Roy published her adaptation model ( 14 ) in 1980. These “grand” theories were complex and key concepts were hard to measure empirically. Thus it was difficult to test these early nursing theories through research. With the emphasis on clinical nursing research, the recent trend has been to develop and test midrange theories that describe patient problems and nursing practice.

NURSING RESEARCH DEVELOPMENT

In 1859, Nightingale used the battlefield hospitals of the Crimean War as her research laboratory, using an epidemiological process to describe the morbidity and mortality of sick and injured soldiers. Her pioneering epidemiological research and statistical methodology (documenting the relationship between the environment and health status of soldiers) was the hallmark of scientific investigation in nursing ( 4 , 15 ).

An historical review from 1900 to 1949 reveals that nursing research in the United States (see Table 1 ) was in its infancy, focusing on nursing education, nurses, nursing students, and ways to organize nurses’ work. As noted earlier, at this time, nursing theory was discussed solely as a means of developing and organizing educational curriculum. Early educators were unable to develop educational programs that both represented a nursing perspective and helped students focus on nursing concepts and problems rather than medical concepts and problems. In the first half of this century, groups were formed to answer such questions as: what is nursing, what do nurses do, and how unique is nursing from other health science disciplines? Professional debates raged as to whether nursing was merely a “poor stepsister” of medicine or whether it was part of the biological, natural, or physical sciences ( 4 ). Research during this period was essentially nonexistent in terms of nursing practice.

Nursing: Historical Developments in Nursing Theory and Research

It was not until the 1980s that nursing devoted a sizeable portion of its research effort to patients and patient behavior, an emphasis that emerged logically as nurses began to recognize the interplay between behavior and rehabilitation or recovery from illness. Historically, nurses searched for single causative agents when promoting health or preventing illness, even as they acknowledged the contributions of multiple other factors. Predominant modes of inquiry relied on early in the development of a culture of nursing research were empirical (logical positivist). Nurse researchers modeled themselves after colleagues in the basic and biomedical sciences, perhaps in an effort to seek scientific validation. Only during the 1980s and 1990s did nurses increasingly use qualitative research methods, such as phenomenology and ethnography, to explain complex human phenomena. Therefore, nurse researchers are just beginning to respond to the need to view human problems in less reductionistic terms when the research questions call for a holistic combination of quantitative and qualitative research methodologies ( 16 ). Over the past two decades, many nurses have pursued further education, consultation, or research to enhance their understanding and ability to respond constructively to patient behavior. For example, by the mid-1980s, there was a sizable increase in nursing studies of individuals and families experiencing developmental, environmental, or illness-generated crisis situations involving both acute and long-term stress responses ( 17 – 20 ).

During the 1990s, nursing practice underwent a clinical revolution in response to societal, medical, scientific, and technologic advances. Changes in nursing practice began to result from nursing research (e.g., research-based practice guidelines) as the efforts of individuals both in and outside of nursing (e.g., National Academy of Science, National Institute for Nursing Research, and major foundations) coalesced to stimulate and support clinical nursing research. Concurrently, there was a new surge of interest among nurses themselves in redefining the problems of their practice and delineating the gaps in knowledge underpinning their practice base. As noted earlier, the current decade has been marked by interest in multiple modes of inquiry (qualitative and quantitative) for a practice discipline which must address complex human phenomena. In the past, the type of research questions most often addressed through nursing research were of a descriptive or exploratory nature. However, nurse researchers are now going beyond “what is” and “how” questions and are addressing more explanatory or predictive-level questions using methodologically rigorous experimental and quasi-experimental designs as they redefine clinical problems and systematically address gaps in their knowledge base. After becoming established in the research arena, nursing researchers have expanded to incorporate and collaborate on interdisciplinary studies, health care systems and health services research, and taxonomies such as Nursing Intervention Classification (NIC) ( 21 ) and Nursing Outcomes Classification (NOC) ( 22 ). The taxonomies represent efforts to define what nurses do and outcomes sensitive to nursing interventions.

The culture of nursing research has now advanced to the point where consideration can be given not just to the conduct of research, but also to its application in practice. The conduct of research is not the end, but rather a means through which practice is improved by utilizing research findings. Research utilization is the process of conveying and applying research-based knowledge to impact or change existing practices in the health care system ( 23 ). The primary components of research utilization involve summarizing knowledge generated through research; imparting the research knowledge to nurses, other health professionals, policymakers, and consumers of health care; and accomplishing desired outcomes for patients, their families, and health care providers and agencies. Models for research utilization were developed in the 1970s, beginning with the Western Interstate Commission for Higher Education in Nursing (WCHEN) Regional Program for Nursing Development ( 24 ). Other models include the Conduct and Utilization of Research in Nursing (CURN) project ( 25 ), the Stetler/Marram model ( 26 ), the retrieval and application of research in nursing (RARIN) model ( 27 ) and the Iowa model of research in practice ( 28 ). The primary goal of research utilization programs is to make research findings an integral part of nursing practice, assuring research-based care delivery models. Research utilization is an excellent model for application of research findings to practice by advanced practice nurses.

An important trend is the use of research findings to serve as the basis for treatment decision making called evidence-based practice ( 29 ). Using this process, a question involving treatment is developed, and determination of the adequacy of current research is made. If the research base is adequate, it is synthesized, protocols are developed and applied, and evaluation is completed. Through these efforts, the nursing profession, in partnership with other professions, bridges the gap between research and practice to improve patient care.

EDUCATIONAL ADVANCEMENT

Early nursing education took place in hospital training programs (nursing diploma), modeled on Florence Nightingale’s work in the United Kingdom ( 30 ). In 1915, nursing’s educational accrediting body, the National League for Nursing (NLN) called for university-level education. Baccalaureate programs in nursing emerged in 1923 at Yale University and Western Reserve University, but the majority of nursing education took place in hospital-based diploma programs. In 1971, the first community college programs for nursing education opened, providing graduates with an associate degree in nursing. Today, entry into nursing practice takes place primarily in associate degree programs, with baccalaureate programs second. Gradually, diploma programs have decreased in number, and few exist today. Associate degree programs may introduce nursing students to research, but baccalaureate programs included nursing research in the upper division curriculum. From 1900 to the 1960s, most nursing leaders obtained their graduate-level preparation in schools of education ( 30 ). For many years, the Master’s degree was considered the terminal degree in nursing.

The number of nurses whose career was devoted to research was miniscule in the 1960s. Indeed, even by the 1970s only about 400 nurses in the United States held a doctoral degree ( 31 ). In 1955, the Nursing Research Grants and Fellowship Program of the Division of Nursing, United States Public Health Service (USPHS) was established. This program awarded grants for nursing research projects, nursing research fellowships, and nurse-scientist graduate training ( 32 ). Early funding was for nurses to obtain their doctorates in fields outside of nursing, because there were no nursing doctoral programs available. As a result, nurse-physiologists, nurse-anthropologists, and so forth emerged in the field. They were educated to conduct research, but often stayed in the field of their doctorate and did not apply their research efforts to nursing care problems.The emphasis during this period continued to be on establishing nursing’s rightful place in the academic setting of the university. As nursing became integrated into university life during the 1970s, nursing faculty became aware of their responsibility to develop new knowledge, and in many university-based schools of nursing, faculty members began to prepare both themselves and their students to become investigators ( 33 ).

Currently, three types of doctoral degrees in nursing are available. A Nursing Doctorate (ND), first established at Case Western Reserve University in 1979, was designed to be equivalent to the Doctor of Medicine degree, providing students preparation for the practice of generalized nursing and future leadership, but not for advanced practice. Professional doctorates, Doctor of Nursing Science (DNS, DNSc, DSN), emphasized advanced clinical, administrative, or policy-related practice and leadership. The Doctor of Nursing Science degree focuses on applied rather than basic research, and on applying and testing new knowledge in practice. Although the Doctor of Philosophy (PhD) was first available to nurses at Teachers College at Columbia University in the 1920s, interest in doctoral education was rekindled in the 1970s. The number of doctoral programs in nursing has increased from zero in the 1950s to over 65 institutions, three-fourths of which are academic doctorates (PhD) that prepare graduates for a lifetime of scholarship and research ( 34 ). More recently, nurses in academic settings have been encouraged to obtain postdoctoral research training with support available through both individual (F32) and institutional (T32) traineeships through the National Institutes of Health (NIH).

RESEARCH FUNDING AND SUPPORT

Several factors stimulated the growth of nursing research in the 1980s and 1990s. Perhaps the most important factor was the creation in 1986 of the National Center for Nursing Research (NCNR) in the United States Public Health Service (USPHS). The development of this Center resulted from intense political action by the American Nurses’ Association (ANA) ( 23 ). The primary aim of the NCNR was “the conduct, support, and dissemination of information regarding basic and clinical nursing research, training and other programs in patient care research” (p. 2) ( 35 ). Prior to the establishment of the NCNR, most of the federal funds supporting research were designated for medical studies that concentrated on the diagnosis and cure of disease. Thus, creation of the NCNR was a major achievement for nurse researchers. In 1993, the NCNR became the National Institute of Nursing Research (NINR), strengthening nursing’s position by giving the Center institute status within the NIH. This advance served to put nursing into the mainstream of research activities and on more equal status with scientists and other health professions. With the establishment of the Center and then the Institute, federal funding for nursing research has grown. In 1986, the NCNR had a budget of $16.2 million. In 1996, the budget for the NINR was about $55 million ( 1 ), more than a threefold increase over a decade. The NINR elected to foster five research priorities for 1995 through 1999: community-based nursing models, effectiveness of nursing interventions in HIV/AIDS, cognitive impairment, living with chronic illness, and biobehavioral factors related to immunocompetence ( 22 ).

The NINR’s strategic plan for the next millenium includes funding nursing research on chronic illnesses (e.g., improving adherence to chemotherapy, pain relief), quality and cost effectiveness of care, health promotion and disease prevention, management of symptoms (e.g., gender differences in response to therapeutics, managing the pain cycle), health disparities (e.g., cultural sensitivity), adaptation to new technologies (e.g., transplants), and palliative care at the end of life. Special allocations and Requests for Applications (RFA) have facilitated research in these target areas, although investigator-initiated research topics are funded if they are significant to nursing or patient care. The projected budget for NINR for the year 2000 is over $70 million, which is approximately distributed as follows: 73% for extramural research project grants; 8% for pre- and postdoctoral training; 3.5% for career development; 3.5% for Core Centers in specialized areas of research inquiry; 3% for the intramural program. Planning research for the next 5 years and into the next century is a welcome challenge for the NINR and the scientific community ( 36 ).

RESEARCH DISSEMINATION

Significant milestones in the development of nursing science began in the mid-1950s (see Table 1 ). From 1950 to 1959, there was growing emphasis on the need to identify a body of knowledge for the developing profession of nursing in order to justify its presence in post-World War II universities ( 37 ). Not only was the first journal of Nursing Research established in 1952; several textbooks related to nursing research were also published. Another critical step in the evolution of the culture of nursing science was the establishment of the American Nurses Foundation by the American Nurses Association specifically to promote nursing research. During the 1950s, regional research conferences were instituted for the first time, and federal support of nursing research began ( 4 , 33 , 37 ). All these elements were essential to the development of a science of nursing.

Several new nursing research journals, including Applied Nursing Research (ANR), were instituted in the late 1980s. ANR publishes research reports of special significance to nurse clinicians ( 1 ). Increasingly, clinical specialty (i.e., Heart and Lung, Journal of Gerontological Nursing ) journals are publishing data-based articles as well.

Another important event in the development and dissemination of nursing theory and research was the creation of the Annual Review of Nursing Research in 1983. This publication includes critical analyses of research pertinent to nursing and health, including nursing practice, nursing care delivery, nursing education, and the nursing profession. Chapters systematically assess knowledge development in nursing, encourage the use of research findings in practice, and provide direction for future research ( 22 ). More recently, scholars have joined to create the Encyclopedia of Nursing Research ( 38 ), a publication that provides a comprehensive overview of research studies, the history of nursing research, and the evolution of theory development in nursing.

The next century challenges nursing research with critical imperatives for improving health care. Changes in our nation’s population and their needs and expectations will impact the direction of nursing research. Consumers are becoming more involved in managing their own health care, and practitioners are continually adjusting to new technologies as well as innovative health care systems. The broad spectrum of nursing research encompasses both clinical and basic investigations with the patient as the central focus. Nursing must concentrate on making certain that our valuable scientific findings are incorporated into practice and focus on developing the next generation of nurse researchers ( 36 ).

The research culture in chiropractic is similar to where nursing research was in its early years. To move chiropractic research forward will require many of the same changes that occurred in nursing, such as educational advancement, collaboration in academic settings, federal acknowledgement and support, and development of more avenues for research dissemination to practitioners. Just as nursing had to overcome significant barriers such as attitudes and low educational and professional status, so, too, will the chiropractic profession have to strive to develop a research tradition in order to integrate research as part of its practice culture.