Nursing Theories –
Historical Perspective
and Concepts.
Nursing science provides the basis for professional nursing practice. Nursing theories provide the critical thinking structures to direct the clinical decision-making process of professional nursing practice.
Terms Used in Nursing Theories:
Theory: it is defined as a group of related concepts that explain existing phenomena and predict events. It is also defined as a construct that accounts for, or organizes some phenomenon.
A theory is a set of concepts, definitions and propositions that projects systematic view of phenomena by designing specific interrelationships among concepts for purpose of describing, explaining and predicting.
Concept: it is defined as labels given to ideas, objects or events, a summary of thoughts or a way to categorize thoughts or ideas. E.g. comfort, pain.
It is also defined as an idea, thought or notion conceived in the mind.
Paradigm: it is a conceptual diagram. It can be a large structure used to organize a theory.
Philosophy: it is a science comprising logics, ethics, aesthetics, metaphysics and epistiemeology. It is the investigation of causes and laws underlying reality and its inquiry into the nature of things based on logical reasoning rather than empirical methods.
Phenomenon: Phenomenon is any occurrence or fact that directly is perceptive by senses. It is based on the reality of what exists in the real world.
Definitions: Statements of the meaning of a word, phrase or term.
Research: it is the application of systematic methods to obtain reliable and valid knowledge about empirical reality.
Induction: it is a form of reasoning that moves from the specific to the general.
Deduction: it is a form of logical reasoning that progresses from general to specific.
Conceptual Framework or Model: it is defined as a set of concepts and the propositions that integrate them into a meaningful configuration.
Historical Journey of Nursing Theories:
Arts and Science of Humanistic Nursing:
It is started by Florence Nightingale, the founder of modern nursing, in her writings she explained nursing theories thus begun its development in theoretical thinking in Nursing.
She present her nursing theories as nursing notes, this became fundamental and continued to be the major framework for nurses.
In 1950’s, University of Columbia developed graduate programme to prepare nurses at the graduate level for administrative and faculty positions. The first theoretical conceptualization of nursing sciences came from these graduates. These graduates Peplau, Henderson, Hall and Abdellah given major contribution for Nursing theories. Columbian School focused primarily on the functional role of nurses.
In 1960’s, Yale school theorists focused more on the nurse-client relationship. Orlando, Levine and Wiednback have contributed more on nursing theories.
During 1970’s to 1980’s, numerous nursing theories are revised and started doing research studies and experiments.
All the nursing theories share four major concepts in nursing i.e., person, environment, health and nursing.
List of Contributors for Nursing Theories:
Florence Nightingale (1890) – Modern Nursing
Virginia Henderson (1955) – the definition of nursing.
Faye Glenn Abdellah (1960) – patient centered approaches in nursing.
Lydia E. Hall (1964) – Core, care and cure model.
Dorothea E. Orem (1971, 1980, 1985, 1991, 1995, 1997) – nursing concepts of practice and views of human beings specific to nursing.
Evelyn Adam – conceptual model of nursing.
Madeleine Leininger (1980) – Caring – A central focus of nursing and health care services.
1981 – The phenomenon of caring importance, research questions and theoretical considerations.
1985 – Transcultural care, diversity and universality – A theory of nursing.
1988 – Leninger’s theory of nursing culture care diversity of universality.
1996 – Culture care theory research and practice.
Jean Watson (1979) – Nursing – the philosophy and science of caring.
(1985 – 88) – Nursing human science and human care – A theory of nursing.
1989 – Watson’s philosophy and theory of human caring in nursing.
1997 – The theory of human caring – retrospective and prospective.
1999 – Postmodern nursing and beyond.
Rose Marie and Rizzo Parse (1981) – Man-living health-theory of nursing.
1987 – Nursing Science – major paradigms, theories, critiques.
1989 – Man-living-health- A theory of nursing.
1992 – Human becoming-Parse’s Theory of nursing.
1995 – Illumination-The human becoming.
1996 – The human becoming theory – the war, is and will be.
1998 – The human becoming school of thoughts.
Patricia Benner – From novice to expert excellence and power in clinical nursing practice.
J. Paterson and L.T. Zderoad (1976) – Humanistic Nursing.
Interpersonal Relationships:
Hildegard E. Pepalu (1952, 1997) – interpersonal relations in nursing.
Joyce Travelbee (1996, 1971) – Interpersonal aspects of nursing.
Ida Jean Orlando (1961) – The dynamic-nursing client relationship.
Ernestine Weidenbach (1964) – Clinical nursing – A helping art.
Joan Richl Sisca – Symbolic interactionism.
H. Erickson, E. Tomlin and M. Swain (1983) – Modeling and role modeling.
Kathryn E. Barnard – Parent-child-interaction model.
Ramona T. Mercer – Maternal role attainment.
Systems Theory:
Dorothy E. Johnson (1980) – Behavioural system model of nursing.
Sister Callista Roy (1976) – An introduction to nursing – An adaptation model.
(1980) – The Roy adaptation model.
(1981) – Theory construction in nursing. An adaptation model.
(1984) – An introduction to nursing an adaptation model- 2nd edition.
(1989) – The Roy adaptation model.
Imogene M. King (1971) – Towards a theory of nursing. General concepts of human behavior.
(1981) – A theory of nursing systems concepts. Process.
(1989) – Kings general system – framework and theory.
(1995) – The theory of goal attainment. The theory of goal attainment in research and practice.
Betty Neuman (1972) – A model for teaching total person approach to client problems.
(1974) – Betty Neuman health care system model. A total person approach to client problems.
(1982) – The Neuman system model.
(1989) – The Neuman system model, 2nd edition.
(1995) – The Neuman system model, 3rd edition.
(1996) – The Neuman system model in research and practice.
Energy Fields:
Myra Estrin Levine (1973) – Introduction to clinical nursing.
(1989) – Conservation principles-Twenty years later.
(1996) – Conservatin principles – A retrospective.
Martha E. Rogers (1970) – An introduction to the theortical basis of nursing.
(1980) – Nursing – A science of unitary man.
(1983) – A science of unitary human being – a paradigm for nursing.
(1989) – Nursing – A science of unitary human beings.
(1990) – Nursing – Science of unitary, irreducible human beings: update.
(1992) – Nursing science and the space of age.
M. Newman (1979) – Theory development in nursing.
(1983) – Newman’s health theory.
(1986) – Health as expanding consciousness.
(1994) – Health as expanding consciousness, 2nd edition.
(1998) – Evolution of theory of health as expanding consciousness.
Joyce J. Fitzpartick (1983) – Life Perspective model.
Advantage of Nursing Theory in Clinical Practice:
As a framework for practice by the nurses themselves.
It can be used in the nursing process developed by the individual theorist.
It can be used within the nursing process to guide and structure each phase of the nursing process.
It can be used in the clinical practice methodology.
Theory helps to provide knowledge for improving practice by describing, explaining, predicting and controlling phenomena.
Through theoretical knowledge, the power of nurses increase because systemically developed methods are more likely to be successful.
Theory provides professional autonomy by guiding the practice, education and research functions of the profession.
Study of the theory helps to develop analytical skills, challenge thinking, and clarify values and assumptions.
Study of theory also helps to determine purpose of nursing practice education and research.
Nightingale’s Theory:
It focused on the environment. She described about ventilation, warmth, light diet, cleanliness and noise and explain factors can prevent, suppress, or contribute to disease, accidents or death.
She emphasizes five essential points in securing health of houses. 1. Pure air, 2. Pure water, 3. Efficient drainage, 4. Cleanliness and 5. Light.
Virginia Henderson – Definition of Nursing:
Henderson defines nursing in functional terms as “the unique function of the nurse is to assist the individual, sick or well in the performance of those activities contributing to health or its recovery that would perform unaided, if he had the necessary strength, will or knowledge.
Henderson identifies the 14 basic needs of a client as follows:
1. Breaths normally.
2. Eats and drinks adequately.
3. Moves and maintains desirable position.
4. Selects suitable cloth – dresses and undresses.
5. Maintains the body temperature within normal range by adjusting clothing and modifying the environment.
6. Keeps the body clean and well groomed and protects the integument.
7. Avoids dangers in the environment and avoids injuring others.
8. Communicates with others in expressing emotions, needs, fears and opinions.
9. Worships according to one’s faith.
10. Works in such a way that there is a sense of achievement.
11. Plays or participates in various forms of recreation.
12. Learns, discovers or satisfies the curiosity that leads to normal development and health and use’s the available health facilities.
13. Sleeps and rests.
14. Eliminate body waste.
Faye Glenn Abdellah – Problem Solving Method:
Abdellah states that nursing is both an art and a science that moulds the attitude, intellectual competence and technical skills of the individual nurse into the desire and ability to help people whether ill or not, and cope with their health needs.
Nursing Problems:
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity, exercise, rest and sleep.
3. To promote safety through prevention of accident, injury or other trauma and the spread of infection.
4. To maintain good body mechanics and prevent and correct deformity.
5. To facilitate the maintenance of oxygen supply to all body cells.
6. To facilitate the maintenance of nutrition to all body cells.
7. To facilitate the maintenance of fluid electrolyte balance.
8. To recognize the physiological responses of the body to the disease condition-pathological, physiological and compensatory.
9. To facilitate the maintenance of regulatory mechanism and function.
10. To facilitate the maintenance of sensory function.
11. To identify and accept positive and negative expressions, feelings and reactions.
12. To identify and accept interrelatedness of emotions and organic illness.
13. To facilitate the maintenance of elimination.
14. To facilitate the maintenance of verbal and non-verbal communication.
15. To promote the development of productive interpersonal relationship.
16. To facilitate progress towards the achievement of personal and spiritual goals.
17. To create and/or maintain therapeutic environment.
18. To facilitate self awareness as an individual with varying physical, emotional and developmental needs.
19. To accept the optimum possible goals in the light of limitations, physical and emotional.
20. To use community resources as an aid in resolving problems arising from illness.
21. To understand the role of social problems as influencing factors in the cause of illness.
Dorothea Orem – Self Care Deficit Theory of Nursing:
Orem developed the self-care deficit theory of nursing which is composed of three interrelated theories.
1. The theory of self care.
2. The theory of self-care deficit.
3. The theory of nursing systems.
Self care is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being.
Betty Neuman – Systems Model:
According to Betty, nursing is considered as a system because nursing practice contains elements in interaction with one another.
Sister Callista Roy-Adaptation Model:
Roy adaptation model has much influence in the nursing field. The four major concepts of the Roy adaptation Model are
1. Human as adaptive system as both individual and group.
2. The environment.
3. The health.
4. The goal of nursing.