What is Nursing Theory?
Nursing theory is a structured framework that explains, describes, predicts, or prescribes nursing care and human health experiences. Nursing theory provides the foundation for nursing knowledge by defining the relationships among key nursing concepts, person, environment, health, and nursing, often referred to as the metaparadigm of nursing.
Nursing theories guide nurses in making clinical decisions, improving patient outcomes, and understanding why certain nursing interventions work. They bridge the gap between nursing research, education, and practice, ensuring that nursing care is evidence-based and patient-centered.
In short, nursing theories help define what nursing is, what nurses do, and why they do it.
Defining Terms in Nursing Theories in Practice
The development of nursing theory demands an understanding of selected terminologies, definitions, and assumptions. These terms form the foundation of theoretical thinking in nursing and help clarify how ideas are organized, related, and applied in research and practice.
Philosophy
A philosophy represents the beliefs, values, and principles that define a way of thinking within a discipline. In nursing, philosophy reflects the moral and ethical commitments of the profession such as respect for human dignity, compassion, and advocacy. Philosophical beliefs shape how nurses perceive health, illness, and the human experience, forming the intellectual foundation for theory development.
Theory
A theory is a logical group of related statements or propositions that explain, describe, predict, or control phenomena. It serves as a foundation for understanding nursing actions and outcomes. In practice, nursing theories help organize complex patient situations into meaningful frameworks that guide assessment, intervention, and evaluation.
Concept
A concept is an abstract idea or mental image that represents a phenomenon or aspect of reality. Concepts are often called the building blocks of theories, as they provide the structure for formulating relationships and understanding experiences. Examples of common nursing concepts include pain, comfort, adaptation, and caring.
Model
A model is a symbolic or schematic representation of how concepts within a theory interact. Models illustrate the patterns, relationships, or processes described by a theory, offering a visual or conceptual overview. They help nurses see how theoretical ideas can be translated into clinical practice.
Conceptual Framework
A conceptual framework is a structured group of related ideas, statements, or concepts that together provide a comprehensive perspective on a topic. It is often used interchangeably with conceptual model or grand theory. Conceptual frameworks in nursing offer direction for practice, education, and research by linking theoretical ideas to nursing phenomena.
Proposition
A proposition is a statement that expresses the relationship between two or more concepts. Propositions provide the testable connections that form the basis for empirical research and theory validation. For example, a proposition may state that increased patient education leads to improved self-care behaviors.
Domain
The domain refers to the perspective, boundaries, or territory of a discipline. In nursing, the domain encompasses the body of knowledge, values, and practical applications that define the profession. It outlines what constitutes nursing’s unique focus caring for individuals, families, and communities in response to health experiences.
Process
A process is a series of organized steps, functions, or activities designed to produce a specific outcome. In nursing, processes are central to both theory and practice. For instance, the nursing process assessment, diagnosis, planning, implementation, and evaluation serves as a systematic approach to delivering patient-centered care.
Paradigm
A paradigm is a pattern of shared understanding, assumptions, and worldviews that guide how members of a discipline perceive reality. In nursing, paradigms shape how health, human beings, and care are understood. Examples include the totality paradigm (focusing on biological and behavioral systems) and the simultaneity paradigm (emphasizing holistic human experiences).
Metaparadigm
A metaparadigm is the broadest conceptual framework within a discipline. It defines the most general statements about the field and organizes all theoretical work within it. The nursing metaparadigm identifies four primary concepts person, environment, health, and nursing and describes how these elements interrelate. These concepts serve as the foundation for most nursing theories, reflecting the holistic and human-centered nature of the profession.
Chronological Development of Nursing Theories in Nursing Practice, Nursing Research, and Nursing Care
The development of nursing theories reflects the profession’s evolution from task-oriented care to a discipline grounded in science, philosophy, and evidence-based practice. Nursing theory emerged as a response to the need for a distinct body of nursing knowledge and continues to shape education, research, and clinical practice today.
Late 1800s – The Foundations of Nursing Theory in Nursing Practice
1860 – Florence Nightingale: Environmental Theory
Florence Nightingale is recognized as the founder of modern nursing theory. In her Environmental Theory, she defined nursing as “the act of utilizing the patient’s environment to assist him in his recovery.” Nightingale emphasized the importance of a clean, well-ventilated, and quiet environment, adequate nutrition, and light to promote healing. Her work established nursing as both an art and a science grounded in observation and environmental manipulation.
1950s – The Era of Conceptualization
By the 1950s, nursing scholars sought to define nursing’s unique function and establish its scientific foundation. This period marked the beginning of formal theory development.
1952 – Hildegard Peplau: Interpersonal Relations Theory
Peplau introduced one of the first significant nursing theories, focusing on the nurse–patient relationship as the core of nursing practice. Her theory identified phases of the therapeutic relationship orientation, working, and termination and emphasized communication, empathy, and interpersonal understanding as central to patient care.
1955 – Virginia Henderson: Nursing Need Theory
Henderson defined nursing as assisting individuals, sick or well, to perform activities that contribute to health or recovery activities they would perform unaided if they had the strength, will, or knowledge. Her Need Theory identified 14 fundamental human needs and positioned nurses as facilitators of independence.
1960 – Faye Abdellah: Typology of 21 Nursing Problems
Abdellah advanced nursing from a disease-centered model to a patient-centered approach. Her theory outlined 21 nursing problems that provided a systematic method for identifying patient needs and delivering individualized care.
1962 – Ida Jean Orlando: Nursing Process Theory
Orlando emphasized the reciprocal relationship between nurse and patient. Her theory viewed nursing’s professional function as identifying and meeting the patient’s immediate need for help, forming the foundation for the modern nursing process (assessment, planning, implementation, and evaluation).
1960s–1970s – The Expansion of Theoretical Frameworks and Models
During this period, nursing theory evolved rapidly, with scholars conceptualizing nursing as a distinct discipline integrating human behavior, systems theory, and adaptation.
1968 – Dorothy Johnson: Behavioral System Model
Johnson viewed the patient as a behavioral system with interrelated subsystems that function to maintain balance and stability. Nursing’s role, she proposed, is to foster efficient and effective behavioral functioning to prevent illness and promote health.
1970 – Martha Rogers: Science of Unitary Human Beings
Rogers conceptualized nursing as both a science and an art that focuses on the unitary human being a unified whole in constant interaction with the environment. She emphasized energy fields, patterns, and openness, shaping holistic and energy-based approaches to nursing.
1971 – Dorothea Orem: Self-Care Deficit Theory
Orem identified when nursing care becomes necessary specifically, when an individual is unable to meet self-care needs. Her model includes three interrelated theories: self-care, self-care deficit, and nursing systems, emphasizing patient autonomy and self-management.
1971 – Imogene King: Theory of Goal Attainment
King proposed that health is achieved through mutual goal setting between nurse and patient within an interpersonal system. Her Goal Attainment Theory highlights communication, interaction, and transaction as key processes in achieving positive health outcomes.
1972 – Betty Neuman: Systems Model
Neuman viewed individuals as open systems interacting with internal and external stressors. Her Systems Model focuses on stress reduction and maintaining system stability through primary, secondary, and tertiary prevention.
1979 – Sister Callista Roy: Adaptation Model
Roy described individuals as adaptive systems responding to environmental stimuli through physiological, self-concept, role function, and interdependence modes. The nurse’s role is to promote positive adaptation to achieve health and well-being.
1979 – Jean Watson: Theory of Human Caring
Watson introduced a humanistic, philosophical perspective of nursing that integrates science and compassion. Her Theory of Human Caring emphasizes transpersonal caring relationships, the promotion of dignity, and the moral ideal of nursing as a healing art.
Summary of Theoretical Progression for Nursing Students
| Era | Theorist | Theory | Focus |
| 1860 | Florence Nightingale | Environmental Theory | Environment and healing |
| 1952 | Hildegard Peplau | Interpersonal Relations | Nurse–patient relationship |
| 1955 | Virginia Henderson | Need Theory | Patient independence and needs |
| 1960 | Faye Abdellah | Typology of 21 Nursing Problems | Patient-centered care |
| 1962 | Ida Jean Orlando | Nursing Process Theory | Immediate patient needs |
| 1968 | Dorothy Johnson | Behavioral System Model | Behavioral balance and stability |
| 1970 | Martha Rogers | Science of Unitary Human Beings | Human–environment energy fields |
| 1971 | Dorothea Orem | Self-Care Deficit Theory | Self-care and autonomy |
| 1971 | Imogene King | Goal Attainment Theory | Mutual goal setting |
| 1972 | Betty Neuman | Systems Model | Stress and system stability |
| 1979 | Callista Roy | Adaptation Model | Human adaptation to the environment |
| 1979 | Jean Watson | Human Caring Theory | Holistic, compassionate care |
The Nursing Metaparadigm as a way of understanding Nursing Theories
The nursing metaparadigm forms the foundation of all nursing theories. It represents the most abstract level of knowledge within the discipline and provides a unifying structure for understanding what nursing is, what it does, and what its goals are.
The four primary concepts Person, Environment, Health, and Nursing describe the essential elements that define the scope and focus of the nursing profession. Together, they guide theory development, research, and clinical practice.
1. Person
The person is the central focus of nursing care.
This concept encompasses the individual, family, group, or community receiving care and recognizes them as holistic beings with physical, emotional, intellectual, social, and spiritual dimensions.
- The person is not viewed merely as a body with illness but as a whole system of interconnected parts.
- Each individual possesses inherent dignity, worth, and the capacity for growth and self-care.
- The nurse’s role is to support the person’s adaptation, healing, and self-determination throughout the health–illness continuum.
Different theorists emphasize various aspects of this concept for example, Virginia Henderson focuses on individual independence, while Jean Watson highlights the person’s human and spiritual dimensions.
2. Environment
The environment refers to all internal and external factors influencing the person’s health and life experiences.
It includes physical surroundings (air, water, light, noise, cleanliness), social and cultural relationships, economic conditions, and psychological climate.
- Florence Nightingale was the first to emphasize the environment as essential to healing, noting that a clean, well-ventilated, and quiet environment promotes recovery.
- Later theorists, such as Betty Neuman and Martha Rogers, expanded the concept to include energy fields, stressors, and systems that interact with the individual.
- In modern nursing, the environment also extends to digital, organizational, and global health contexts, recognizing that social determinants like income, education, and community safety profoundly affect well-being.
3. Health
Health is viewed as a dynamic state of well-being that exists on a continuum from wellness to illness.
It goes beyond the absence of disease and encompasses physical, mental, social, and spiritual harmony.
- Nursing theories conceptualize health as wholeness, adaptation, balance, or energy flow, depending on the theoretical perspective.
- For example, Sister Callista Roy defines health as an adaptive process, while Martha Rogers describes it as a manifestation of the interaction between human and environmental energy fields.
- Nurses promote health by supporting self-care, adaptation, prevention, and the restoration of equilibrium.
4. Nursing
The nursing concept defines the discipline’s unique role, purpose, and functions.
It refers to the deliberate actions and caring relationships that nurses engage in to promote, maintain, and restore health.
- Nursing integrates both art and science it applies evidence-based knowledge with compassion, communication, and ethical practice.
- It involves assessment, diagnosis, planning, intervention, and evaluation, guided by theory and patient-centered goals.
- Jean Watson’s Theory of Human Caring emphasizes the moral and spiritual dimensions of nursing, while Dorothea Orem frames nursing as a supportive role when self-care is deficient.
In essence, nursing is an intentional, therapeutic process aimed at helping individuals and communities achieve optimal health outcomes.
Summary Table: The Four Concepts of the Nursing Metaparadigm
| Concept | Definition | Key Focus in Nursing |
| Person | The recipient of nursing care individual, family, or community is viewed holistically. | Promoting well-being, dignity, and self-care. |
| Environment | Internal and external factors that affect health and development. | Creating conditions that support healing and adaptation. |
| Health | A dynamic state of physical, mental, and social well-being. | Maintaining or restoring balance and wellness. |
| Nursing | The science and art of caring for individuals through professional, evidence-based practice. | Providing therapeutic, compassionate, and ethical care. |
Concepts of Nursing Theory in Evidence-Based Practice
Every nursing theory is built from specific foundational elements that define its structure and purpose. Understanding these components helps nurses interpret, apply, and evaluate theories in education, research, and clinical practice.
The primary components of a nursing theory include: Phenomenon, Concepts, Definitions, Relational Statements, and Assumptions.
1. Phenomenon
A phenomenon refers to an observable fact, event, or experience that is of interest to nursing.
It represents the area of focus or concern that a theory seeks to explain or understand.
- In nursing, phenomena may include pain, comfort, adaptation, caring, stress, or self-care.
- The identification of a phenomenon often arises from clinical practice, research findings, or educational experiences.
- For example, Jean Watson focused on caring as a central phenomenon in nursing, while Dorothea Orem explored self-care as her primary phenomenon.
Each theory, therefore, defines and explores a distinct aspect of nursing practice.
2. Concepts
Concepts are the building blocks of theories. They are abstract ideas or mental images that represent phenomena within the discipline.
Concepts provide the language and structure through which theories describe nursing reality.
- They can be concrete (e.g., body temperature, pain) or abstract (e.g., hope, adaptation, comfort).
- Concepts may be derived from observation, experience, or prior theory development.
- For instance, in Roy’s Adaptation Model, key concepts include stimuli, coping mechanisms, and adaptive responses.
In short, concepts form the vocabulary of nursing theory and are essential for defining its scope
3. Definitions
Definitions explain what each concept means within the context of a specific theory.
They ensure clarity and consistency, preventing misinterpretation of theoretical ideas.
- Theoretical definitions provide meaning based on how the concept fits within the theory (e.g., “Health as adaptation to stressors” in Neuman’s model).
- Operational definitions specify how the concept will be measured or observed in research or practice.
For example, “comfort” might be theoretically defined as a sense of relief and tranquility, and operationally measured using a comfort scale.
Definitions thus connect theory to both language and evidence.
4. Relational Statements
Relational statements describe how two or more concepts are connected within the theory.
They form the logical structure that links ideas and allows for the prediction or explanation of phenomena.
- These statements may describe cause-and-effect, correlation, or interaction between variables.
- For example, in Peplau’s Interpersonal Relations Theory, the nurse–patient relationship (concept) directly influences patient growth and recovery (outcome).
- In Orem’s Theory, a self-care deficit (concept) leads to the need for nursing intervention (action).
Relational statements give theories coherence and explanatory power, helping nurses apply them to real-world situations.
5. Assumptions
Assumptions are beliefs or statements accepted as true without direct proof.
They form the underlying foundation upon which the theory is built.
- They express values, truths, or accepted premises about nursing, people, health, and the environment.
- For example, many theories assume that people have an inherent desire for health and that nursing is a caring, humanistic profession.
- Assumptions help define the worldview or philosophical orientation of the theory.
In practice, understanding a theory’s assumptions allows nurses to interpret its relevance and limitations in different clinical settings.
Summary Table: Components of Nursing Theories
| Component | Definition | Example in Nursing Theory |
| Phenomenon | The event or area of focus that the theory seeks to explain. | “Caring” in Watson’s Theory of Human Caring. |
| Concepts | Abstract ideas or mental images representing phenomena. | “Adaptation” in Roy’s Adaptation Model. |
| Definitions | Statements that clarify the meaning of concepts. | “Health” is defined as system stability in Neuman’s Model. |
| Relational Statements | Describe connections among concepts within the theory. | “Self-care deficits create a need for nursing” (Orem). |
| Assumptions | Accepted beliefs that form the foundation of the theory. | “Humans have an inherent capacity for growth.” |
Why Nursing Theories Are Important – Importance of Nursing Theories
Nursing theories are essential because they provide a systematic framework for understanding the profession’s purpose, guiding patient care, and advancing knowledge. They transform nursing from a set of tasks into a scientific discipline grounded in theory, research, and critical thinking.
Without theory, nursing practice risks becoming reactive and inconsistent. With theory, nurses can:
- Understand the rationale behind interventions.
- Predict patient outcomes based on evidence.
- Communicate professionally about nursing practice.
- Guide research and education.
The importance of nursing theories is evident in education, research, and clinical practice, where they provide a foundation for decision-making and professional growth.
Purposes of Nursing Theories
Nursing theories serve multiple purposes across different aspects of the profession.
1. In Academic Discipline
- Guides Education: Nursing theories provide a structured framework for nursing curricula, helping students understand key concepts, principles, and the rationale for interventions.
- Develops Critical Thinking: By studying theories, students learn to analyze complex patient situations, make informed decisions, and justify nursing actions.
- Establishes Professional Identity: Theories clarify nursing’s unique role, distinguishing it from medicine and allied health disciplines.
Example: Henderson’s Need Theory is often used in nursing education to teach students about holistic care and patient independence.
2. In Research
- Provides a Foundation: Theories guide research questions, study designs, and interpretation of results.
- Ensures Consistency: Theoretical frameworks standardize definitions and measurements of concepts, enabling comparisons across studies.
- Promotes Knowledge Development: Research grounded in theory builds evidence to improve patient care and refine nursing practice.
Example: Orem’s Self-Care Deficit Theory informs studies on patient adherence, chronic disease management, and self-care interventions.
3. In the Profession
- Guides Practice: Nursing theories offer frameworks for assessment, intervention, and evaluation, ensuring care is evidence-based and patient-centered.
- Improves Patient Outcomes: Applying theory allows nurses to anticipate responses, prevent complications, and promote wellness.
- Supports Policy and Leadership: Theoretical understanding helps nurses develop protocols, policies, and health programs based on systematic reasoning.
Example: Watson’s Theory of Human Caring guides nurse–patient interactions to enhance holistic healing, compassion, and ethical practice.
Summary of the importance and application of nursing theories
Nursing theories are not merely academic exercises they are practical tools that enhance understanding, decision-making, and patient care. They:
- Provide clarity and structure in complex healthcare environments.
- Enable systematic, evidence-based practice.
- Support the growth of nursing as a scientific and professional discipline
What are the three C’s of nursing theory in Clinical Practice?
The Three C’s of Nursing Theory refer to three fundamental domains that provide a framework for understanding nursing theories and their application in practice:
1. CLIENT (Person)
Represents the recipient of nursing care individuals, families, groups, or communities. Understanding nursing theories requires recognizing that the client is viewed holistically, encompassing physical, psychological, spiritual, social, and cultural dimensions. The theory suggests that patients are care partners, not passive recipients. Using nursing theories with a client-centered focus ensures that specific nursing interventions address the unique needs, preferences, and circumstances of each person.
2. CARE (Nursing)
Encompasses the actions, interventions, and therapeutic relationships that define nursing practice. Caring in nursing is both the art and science of the profession. The goal of nursing across all theories is to provide care that promotes health, prevents illness, alleviates suffering, and supports dignified dying. Theories can also emphasize different dimensions of care from technical competence to compassionate presence but all address what nurses do and why. The foundation for nursing practice rests on deliberate, knowledgeable, theory-guided care.
3. CURE (Health)
Represents the outcomes and goals toward which nursing care is directed. While “cure” traditionally implies eliminating disease, in nursing theory it encompasses broader concepts of health, healing, wellness, adaptation, comfort, quality of life, and peaceful death. The theory emphasizes that nursing’s contribution to health extends beyond medical cure to include promoting optimal functioning within patients’ unique circumstances. Nursing theories may conceptualize health differently, but all address how nursing contributes to positive health outcomes.
Application in Nursing Practice: Using nursing theories organized around the Three C’s helps nursing students and practitioners maintain focus on what matters most. When planning care, nurses consider:
- CLIENT: Who is this person? What are their unique needs, values, and circumstances?
- CARE: What nursing interventions will best address their needs? How can I provide caring in nursing that is both competent and compassionate?
- CURE: What health outcomes are we working toward? How will we know care has been effective?
Relevance Across Theory Levels: Whether applying grand theories or practice-level nursing theories, the Three C’s remain constant. For example:
- Grand theories broadly define relationships among client, care, and cure across all nursing situations
- Middle-range theories specify these relationships for particular phenomena (e.g., transitions, comfort, uncertainty)
- Practice-level nursing theories prescribe precise care interventions for specific client populations to achieve defined health outcomes.
Educational Importance: Nurse educators use the Three C’s framework to help students organize their thinking about nursing theories in practice. Every nursing program emphasizes these concepts because they provide a framework for clinical reasoning: assess the CLIENT, plan and implement CARE, and evaluate progress toward CURE (health outcomes). This simple yet comprehensive model helps bridge theory and practice, ensuring that the application of nursing knowledge remains grounded in nursing’s core purposes.
The Three C’s remind nurses that our profession is fundamentally about caring for people to promote their health and healing a philosophy of nursing that transcends any single theory and unifies the diverse field of nursing.
Types of Nursing Theories with Examples of Nursing Theories
This classification organizes nursing theories based on their breadth of focus and level of abstraction, ranging from broad conceptual frameworks applicable to all of nursing (grand theories) to specific, concrete theories addressing particular clinical situations (practice theories). The scope determines the theory’s applicability and generalizability across different nursing contexts.
1. GRAND NURSING THEORIES (Macro Theories)
What are Grand Theories? Grand theories are the most abstract and broadest in scope, providing comprehensive conceptual frameworks for the entire discipline of nursing. They address all aspects of the nursing metaparadigm (person, environment, health, and nursing) and attempt to explain nursing as a whole, rather than focusing on specific situations or phenomena.
What Makes a Theory a Grand Theory?
- Encompasses the entire scope of nursing practice
- Highly abstract with complex, interrelated concepts
- Addresses the philosophical underpinnings of nursing
- Applicable across all patient populations, settings, and situations
- Requires operationalization and interpretation for practical application
- Provides a foundational worldview or paradigm for nursing
- Generates middle-range and practice theories through specification
How Grand Theories are Useful to Nursing:
- Establish nursing as a distinct scientific discipline with unique knowledge
- Provide a philosophical foundation for nursing education curricula
- Guide the development of more specific theories and research questions
- Offer frameworks for understanding the nature and purpose of nursing
- Shape professional identity and articulate nursing’s unique contribution to healthcare
- Inform healthcare policy and nursing’s role in interdisciplinary teams
- Create a common language for describing nursing phenomena globally
Examples of Grand Theories: – Examples of Nursing Grand Theories
- Florence Nightingale’s Environmental Theory (1860) – Florence Nightingale
- Hildegard Peplau’s Theory of Interpersonal Relations (1952) – Hildegard E. Peplau
- Virginia Henderson’s Need Theory (1966) – Virginia Henderson
- Faye Abdellah’s Twenty-One Nursing Problems Theory (1960) – Faye Glenn Abdellah
- Ernestine Wiedenbach’s The Helping Art of Clinical Nursing Theory (1964) – Ernestine Wiedenbach
- Lydia Hall’s Care, Core, and Cure Theory (1966) – Lydia E. Hall
- Myra Levine’s Conservation Model (1967) – Myra Estrin Levine
- Martha Rogers’ Science of Unitary Human Beings (1970) – Martha E. Rogers
- Dorothea Orem’s Self-Care Deficit Nursing Theory (1971) – Dorothea E. Orem
- Imogene King’s Theory of Goal Attainment (1971) – Imogene M. King
- Betty Neuman’s Systems Model (1972) – Betty Neuman
- Sister Callista Roy’s Adaptation Model (1976) – Sister Callista Roy
- Josephine Paterson and Loretta Zderad’s Humanistic Nursing Theory (1976) – Josephine G. Paterson and Loretta T. Zderad
- Madeleine Leininger’s Theory of Culture Care Diversity and Universality (1978) – Madeleine M. Leininger
- Jean Watson’s Theory of Human Caring/Caring Science (1979) – Jean Watson
- Rosemarie Parse’s Theory of Human Becoming (1981) – Rosemarie Rizzo Parse
- Patricia Benner’s Novice to Expert Theory (1982) – Patricia Benner
- Margaret Newman’s Theory of Health as Expanding Consciousness (1986) – Margaret A. Newman
- Kari Martinsen’s Theory of Caring (1989) – Kari Martinsen
- Anne Boykin and Savina Schoenhofer’s Theory of Nursing as Caring (1993) – Anne Boykin and Savina O. Schoenhofer
2. MIDDLE-RANGE THEORIES
What are Middle-Range Theories? Middle-range theories are moderately abstract theories that focus on specific phenomena or aspects of nursing practice rather than the entire discipline. They bridge the gap between grand theories and practice theories, offering testable propositions while maintaining sufficient scope to be applicable across multiple situations.
What Makes a Theory a Middle-Range Theory?
- Limited scope focusing on specific phenomena (e.g., transitions, comfort, uncertainty)
- Moderate level of abstraction more concrete than grand theories but less specific than practice theories
- Contains fewer concepts than grand theories, making relationships clearer
- More readily testable through research than grand theories
- Directly applicable to practice while maintaining theoretical substance
- Often derived from grand theories, research, or practice observations
- Applicable across multiple patient populations or clinical settings with the same phenomenon
How Middle-Range Nursing Theories are Useful to Nursing Practice:
- Guide nursing research by providing testable frameworks and hypotheses
- Directly inform evidence-based practice interventions
- Bridge the theory-practice gap by being abstract enough to generalize, yet concrete enough to apply
- Facilitate theory development by connecting philosophical ideas to observable phenomena
- Enable specialty practice development (e.g., oncology, geriatrics, mental health)
- Support quality improvement initiatives with a theoretical rationale
- Enhance communication among nurses by providing shared conceptual language for specific phenomena
- Generate practice theories through further specification
Examples of Middle-Range Theories: Examples of Nursing Theories
- Nola Pender’s Health Promotion Model (1982, revised 1996) – Nola J. Pender
- Afaf Meleis’ Transitions Theory (1975, developed through the 2000s) – Afaf Ibrahim Meleis
- Katharine Kolcaba’s Theory of Comfort (1991) – Katharine Kolcaba
- Ramona Mercer’s Theory of Maternal Role Attainment/Becoming a Mother (1981) – Ramona T. Mercer
- Cheryl Beck’s Postpartum Depression Theory (1993) – Cheryl Tatano Beck
- Carolyn Wiener and Marilyn Dodd’s Theory of Illness Trajectory (1980s) – Carolyn L. Wiener and Marilyn J. Dodd
- Kristen Swanson’s Theory of Caring (1991) – Kristen M. Swanson
- Pamela Reed’s Self-Transcendence Theory (1991) – Pamela G. Reed
- Eakes, Burke, and Hainsworth’s Theory of Chronic Sorrow (1998) – Georgene Gaskill Eakes, Mary Lermann Burke, Margaret A. Hainsworth
- Carolyn Kinney’s Theory of Caregiver Stress (1996) – Carolyn Kinney
- Mishel’s Uncertainty in Illness Theory (1988) – Merle H. Mishel
- Phil Barker’s Tidal Model of Mental Health Recovery (2001) – Phil Barker
- Cornelia Ruland and Shirley Moore’s Theory of the Peaceful End of Life (1998) – Cornelia M. Ruland and Shirley M. Moore
- Dunn’s Theory of Adaptation to Chronic Pain (2004) – Katherine S. Dunn
- Lynn Rew’s Theory of Self-Care for Vulnerable Populations (2003) – Lynn Rew
- Tsai’s Theory of Caregiver Stress in Families of Individuals with Dementia (2003) – Pei-Fan Tsai
- Jean Goeppinger’s Theory of Community as Partner – Jean Goeppinger
- Marlaine Smith’s Theory of Unitary Caring (1999) – Marlaine C. Smith
- Sousa and Zauszniewski’s Theory of Diabetes Self-Care Management (2005) – Valmi D. Sousa and Jaclene A. Zauszniewski
- Judy Davidson’s Facilitated Sensemaking Theory (2010) – Judy E. Davidson
- Linda Chlan’s Theory of Music Therapy for Anxiety Reduction (2000s) – Linda Chlan
- Linda Aiken’s Theory of Nurse Staffing and Patient Outcomes (2000s) – Linda H. Aiken
- Patricia Flatley Brennan’s Theory of Empowered Patient (1998) – Patricia Flatley Brennan
- Cheryl Tatano Beck’s Theory of Birth Trauma (2004) – Cheryl Tatano Beck
- Victoria Mock’s Theory of Exercise as Self-Care for Cancer Treatment (1997) – Victoria Mock
3. PRACTICE THEORIES (Situation-Specific/Micro Theories)
What are Practice Theories? Practice theories (also called situation-specific theories or micro theories) are the most concrete and narrow in scope, addressing very specific phenomena within defined patient populations, clinical situations, or nursing interventions. They provide direct, actionable guidance for clinical practice in particular contexts.
What Makes a Theory a Practice Theory?
- Very limited and specific scope (e.g., fall prevention in elderly hospitalized patients)
- Highly concrete with observable, measurable concepts
- Directly applicable to specific clinical situations without further interpretation
- Focused on particular patient populations, settings, or interventions
- Often derived from evidence-based practice guidelines and clinical research
- Prescriptive in nature, specifying exact nursing actions
- Context-dependent, may not generalize well beyond the specific situation
How Practice Theories are Useful to Nursing:
- Provide immediate, direct guidance for bedside clinical practice
- Support the standardization of care and the reduction of practice variation
- Form the basis for clinical protocols, guidelines, and care bundles
- Enable measurement of nursing-sensitive quality outcomes
- Facilitate rapid implementation of evidence-based interventions
- Support new graduate and novice nurse competency development through clear action steps
- Enhance patient safety through systematic, proven approaches
- Allow for quality improvement and benchmarking across institutions
- Meet regulatory and accreditation requirements for standardized care
Examples of Practice Theories in Nursing
- Theory of Pain Management in Postoperative Patients – Multiple contributors
- Theory of Medication Adherence in Diabetic Patients – Multiple contributors
- Theory of Fall Prevention in Elderly Hospitalized Patients – Multiple contributors
- Theory of Pressure Ulcer Prevention in Immobile Patients – Multiple contributors
- Theory of Delirium Prevention in ICU Patients – Multiple contributors
- Theory of Breastfeeding Initiation in First-Time Mothers – Multiple contributors
- Theory of Glycemic Control in Critically Ill Patients – Multiple contributors
- Theory of Central Line Infection Prevention – Multiple contributors (Peter Pronovost)
- Theory of Ventilator-Associated Pneumonia Prevention – Multiple contributors
- Theory of Discharge Readiness Assessment – Multiple contributors
- Theory of Catheter-Associated Urinary Tract Infection Prevention – Multiple contributors
- Theory of Chemotherapy-Induced Nausea and Vomiting Management – Multiple contributors
- Theory of Sepsis Early Recognition and Response – Multiple contributors (Surviving Sepsis Campaign)
- Theory of Patient Mobilization in Stroke Recovery – Multiple contributors
- Theory of Infant Sleep Positioning for SIDS Prevention – Multiple contributors (AAP)
- Theory of Suicide Risk Assessment in Adolescents – Multiple contributors
- Theory of Wound Debridement Selection in Chronic Wounds – Multiple contributors
- Theory of Oxygen Titration in COPD Patients – Multiple contributors
- Theory of Dehydration Prevention in Pediatric Gastroenteritis – Multiple contributors (WHO, AAP)
- Theory of Hourly Rounding for Patient Safety – Multiple contributors (Meade et al., Studer Group)
- Theory of Hand Hygiene Compliance – Multiple contributors (WHO, CDC)
- Theory of Early Warning Score Systems – Multiple contributors
- Theory of Bedside Shift Report – Multiple contributors (AHRQ)
- Theory of Patient-Controlled Analgesia Management – Multiple contributors
- Theory of Restraint Minimization in Dementia Care – Multiple contributors
- Theory of Blood Glucose Monitoring in Neonates – Multiple contributors (AAP)
- Theory of Tracheostomy Care and Suctioning – Multiple contributors
- Theory of Chest Tube Management Post-Thoracic Surgery – Multiple contributors
- Theory of Nasogastric Tube Placement Verification – Multiple contributors (AACN)
- Theory of Peripheral IV Site Rotation – Multiple contributors (INS)
- Theory of Alarm Fatigue Reduction – Multiple contributors (ECRI, Joint Commission)
- Theory of Medication Reconciliation at Transitions of Care – Multiple contributors (IHI)
- Theory of Patient Identification Verification – Multiple contributors (Joint Commission)
- Theory of Needle Stick Injury Prevention – Multiple contributors (OSHA, CDC)
- Theory of Patient Education for Heart Failure Self-Management – Multiple contributors
4. DESCRIPTIVE THEORIES
What are Descriptive Theories? Descriptive theories identify and describe the properties, components, and characteristics of nursing phenomena without necessarily explaining relationships between concepts or predicting outcomes. They answer the questions “What is this?” and “What are its characteristics?” Descriptive theories are often the first stage of theory development, laying the groundwork for more complex explanatory and predictive theories.
What Makes a Theory Descriptive?
- Focuses on naming and categorizing phenomena
- Describes characteristics, dimensions, and properties of concepts
- Identifies when, where, and under what circumstances phenomena occur
- Does not explain causal relationships or mechanisms
- May classify phenomena into taxonomies or typologies
- Often uses qualitative research methods (phenomenology, grounded theory) for development
- Provides rich, detailed accounts of experiences or situations
- Establishes common vocabulary and definitions for the discipline
How Descriptive Theories are Useful to Nursing:
- Create a shared understanding and common language for nursing phenomena
- Enable nurses to recognize and label patient experiences accurately
- Form a foundation for assessment tools and screening instruments
- Guide qualitative research exploring patient and nurse experiences
- Validate patient experiences by naming and describing them
- Support empathetic, patient-centered care through understanding lived experiences
- Inform nursing diagnosis development and refinement
- Provide groundwork for developing explanatory and predictive theories
- Enhance professional communication by providing precise terminology
- Support holistic understanding of complex human experiences
Examples of Descriptive Theories in Nursing
- Florence Nightingale’s Environmental Theory (1860) – Florence Nightingale
- Virginia Henderson’s Need Theory (1966) – Virginia Henderson
- Faye Abdellah’s Twenty-One Nursing Problems (1960) – Faye Glenn Abdellah
- Patricia Benner’s Novice to Expert (1982) – Patricia Benner
- Madeleine Leininger’s Culture Care Diversity and Universality (1978) – Madeleine M. Leininger
- Phil Barker’s Tidal Model (2001) – Phil Barker
- Afaf Meleis’ Transitions Theory (Descriptive aspects) – Afaf Ibrahim Meleis
- Cheryl Beck’s Postpartum Depression Theory (1993) – Cheryl Tatano Beck
- Eakes, Burke, and Hainsworth’s Theory of Chronic Sorrow (1998) – Georgene Gaskill Eakes, Mary Lermann Burke, Margaret A. Hainsworth
- Janice Morse’s Theory of Suffering (2001) – Janice M. Morse
- Mishel’s Uncertainty in Illness Theory (Descriptive aspects) (1988) – Merle H. Mishel
- Carolyn Wiener’s Illness Trajectory Theory (1980s) – Carolyn L. Wiener
- Melanie Dreher’s Birth as Rite of Passage – Melanie Dreher
- Cheryl Tatano Beck’s Birth Trauma Theory (2004) – Cheryl Tatano Beck
- Theory of Alarm Fatigue – Multiple contributors
- Josephine Paterson and Loretta Zderad’s Humanistic Nursing Theory (Descriptive aspects) (1976) – Josephine G. Paterson and Loretta T. Zderad
- Margaret Newman’s Health as Expanding Consciousness (Descriptive aspects) (1986) – Margaret A. Newman
- Rosemarie Parse’s Human Becoming Theory (Descriptive aspects) (1981) – Rosemarie Rizzo Parse
- Theory of Nurse Burnout – Multiple contributors (Christina Maslach)
- Theory of Compassion Fatigue – Multiple contributors (Charles Figley)
5. EXPLANATORY THEORIES
What are Explanatory Theories? Explanatory theories go beyond description to explain how and why phenomena occur by articulating relationships between concepts and describing the mechanisms underlying these relationships. They answer the questions “How does this work?” and “Why does this happen?” Explanatory theories provide an understanding of the processes, dynamics, and causal or associative relationships between variables.
What Makes a Theory Explanatory?
- Articulates relationships between two or more concepts
- Describes mechanisms or processes by which phenomena occur
- Explains how changes in one variable affect another
- Identifies factors that influence outcomes
- May specify direction of relationships (positive, negative, reciprocal)
- Often developed through correlational or comparative research
- Provides rationale for why certain interventions might be effective
- Increases understanding of complex phenomena through relationship mapping
How Explanatory Theories are Useful to Nursing:
- Provide theoretical rationale for nursing interventions and care decisions
- Guide hypothesis development for nursing research
- Enable understanding of patient responses to illness and treatment
- Support clinical reasoning and critical thinking by explaining mechanisms
- Inform the development of innovative interventions targeting specific mechanisms
- Facilitate interdisciplinary communication by explaining nursing’s perspective
- Enhance teaching by explaining underlying processes to students and patients
- Support the development of predictive and prescriptive theories
- Justify resource allocation by explaining how inputs lead to outcomes
- Enable root cause analysis when outcomes are not as expected
Examples of Explanatory Theories:
- Hildegard Peplau’s Interpersonal Relations Theory (1952) – Hildegard E. Peplau
- Imogene King’s Theory of Goal Attainment (1971) – Imogene M. King
- Sister Callista Roy’s Adaptation Model (1976) – Sister Callista Roy
- Betty Neuman’s Systems Model (1972) – Betty Neuman
- Martha Rogers’ Science of Unitary Human Beings (1970) – Martha E. Rogers
- Jean Watson’s Theory of Human Caring (1979) – Jean Watson
- Rosemarie Parse’s Human Becoming Theory (1981) – Rosemarie Rizzo Parse
- Margaret Newman’s Health as Expanding Consciousness (1986) – Margaret A. Newman
- Dorothea Orem’s Self-Care Deficit Theory (1971) – Dorothea E. Orem
- Myra Levine’s Conservation Model (1967) – Myra Estrin Levine
- Nola Pender’s Health Promotion Model (1982) – Nola J. Pender
- Kristen Swanson’s Theory of Caring (1991) – Kristen M. Swanson
- Ramona Mercer’s Maternal Role Attainment (1981) – Ramona T. Mercer
- Pamela Reed’s Self-Transcendence Theory (1991) – Pamela G. Reed
- Mishel’s Uncertainty in Illness Theory (Explanatory aspects) (1988) – Merle H. Mishel
- Katharine Kolcaba’s Comfort Theory (1991) – Katharine Kolcaba
- Theory of Caregiver Stress (1996) – Carolyn Kinney
- Linda Aiken’s Nurse Staffing Theory (2000s) – Linda H. Aiken
- Victoria Mock’s Theory of Exercise in Cancer Care (1997) – Victoria Mock
- Sousa and Zauszniewski’s Theory of Diabetes Self-Care Management (2005) – Valmi D. Sousa and Jaclene A. Zauszniewski
- Lydia Hall’s Care, Core, and Cure Model (1966) – Lydia E. Hall
- Ernestine Wiedenbach’s Helping Art Theory (1964) – Ernestine Wiedenbach
- Kari Martinsen’s Theory of Caring (1989) – Kari Martinsen
- Anne Boykin and Savina Schoenhofer’s Nursing as Caring (1993) – Anne Boykin and Savina O. Schoenhofer
- Theory of Planned Behavior (Applied in Nursing) – Icek Ajzen
6. PREDICTIVE THEORIES
What are Predictive Theories? Predictive theories forecast relationships between concepts and predict future outcomes based on current conditions or interventions. They answer the question “What will happen if…?” Predictive theories allow nurses to anticipate patient responses, identify patients at risk for complications, and estimate the likelihood of achieving desired outcomes with specific interventions.
What Makes a Theory Predictive?
- Specifies conditions under which certain outcomes are likely to occur
- Identifies predictor variables that forecast outcomes
- Quantifies relationships between variables when possible (e.g., odds ratios, relative risk)
- Often developed through longitudinal or prospective research designs
- May include risk assessment models or prediction algorithms
- Enables probabilistic statements about future events
- Supports proactive rather than reactive nursing care
- Often includes sensitivity and specificity data for prediction accuracy
How Predictive Theories are Useful to Nursing:
- Enable early identification of at-risk patients for targeted prevention
- Support clinical decision-making about intensity and timing of interventions
- Facilitate risk stratification and resource allocation
- Guide the development of screening tools and assessment instruments
- Inform the patient and family about the expected outcomes
- Support informed consent by predicting likely intervention effects
- Enable quality benchmarking by comparing predicted vs. actual outcomes
- Reduce healthcare costs by preventing complications before they occur
- Enhance patient safety through anticipatory monitoring
- Support evidence-based practice by predicting intervention effectiveness
- Guide discharge planning and transitions of care
Examples of Predictive Theories:
- Nola Pender’s Health Promotion Model (Predictive aspects) (1982) – Nola J. Pender
- Sister Callista Roy’s Adaptation Model (Predictive aspects) (1976) – Sister Callista Roy
- Betty Neuman’s Systems Model (Predictive aspects) (1972) – Betty Neuman
- Imogene King’s Theory of Goal Attainment (Predictive aspects) (1971) – Imogene M. King
- Katharine Kolcaba’s Comfort Theory (Predictive aspects) (1991) – Katharine Kolcaba
- Theory of Early Warning Scores – Multiple contributors
- Theory of Fall Risk Assessment – Multiple contributors (Morse Fall Scale, Hendrich II)
- Theory of Pressure Ulcer Risk (Braden Scale) – Barbara Braden and Nancy Bergstrom
- Theory of Delirium Risk – Multiple contributors (Sharon Inouye)
- Theory of Medication Adherence Prediction – Multiple contributors
- Theory of Sepsis Progression – Multiple contributors (Surviving Sepsis Campaign)
- Theory of Breastfeeding Success Prediction – Multiple contributors (LATCH score)
- Theory of Readmission Risk Prediction – Multiple contributors (LACE Index, HOSPITAL score)
- Theory of Glycemic Crisis Prediction – Multiple contributors
- Linda Aiken’s Staffing Theory (Predictive aspects) (2002) – Linda H. Aiken
- Theory of Ventilator Weaning Success – Multiple contributors
- Theory of Surgical Site Infection Prediction – Multiple contributors (NNIS Risk Index)
- Theory of Stroke Outcome Prediction – Multiple contributors (NIH Stroke Scale)
- Theory of Maternal-Infant Bonding Prediction – Multiple contributors (Klaus and Kennell)
- Theory of Treatment Adherence in Chronic Illness – Multiple contributors
7. PRESCRIPTIVE THEORIES
What are Prescriptive Theories? Prescriptive theories prescribe specific nursing actions, interventions, and strategies to achieve desired patient outcomes. They answer the question “What should nurses do?” and provide explicit, actionable guidance for practice. Prescriptive theories are the most practical form of nursing theory, directly translating knowledge into clinical interventions.
What Makes a Theory Prescriptive?
- Specifies particular nursing actions and interventions
- Provides step-by-step guidance for practice
- States the conditions under which interventions should be implemented
- Often includes specific techniques, protocols, or procedures
- Directly links interventions to desired patient outcomes
- May specify timing, frequency, and sequencing of actions
- Based on evidence of intervention effectiveness
- Highly practical and immediately applicable to practice
- Often operationalized as clinical practice guidelines or care bundles
How Prescriptive Theories are Useful to Nursing:
- Provide clear, actionable guidance for direct patient care at the bedside
- Support standardization of care and reduction of unwarranted practice variation
- Enable the development of policies, procedures, and clinical protocols
- Facilitate competency assessment and skill validation
- Support the orientation and onboarding of new nurses with clear expectations
- Enhance patient safety through evidence-based, standardized interventions
- Improve quality outcomes by ensuring consistent implementation of best practices
- Meet regulatory and accreditation standards requiring standardized care
- Enable measurement of compliance with evidence-based practices
- Support interdisciplinary collaboration through clear role delineation
- Reduce nurse decision fatigue by providing clear guidance for routine situations
- Facilitate rapid dissemination and implementation of research findings
- Support patient and family education by clarifying what to expect from nursing care
Examples of Prescriptive Theories:
- Florence Nightingale’s Environmental Theory (Prescriptive aspects) (1860) – Florence Nightingale
- Dorothea Orem’s Self-Care Deficit Theory (Prescriptive aspects) (1971) – Dorothea E. Orem
- Ernestine Wiedenbach’s Helping Art (Prescriptive aspects) (1964) – Ernestine Wiedenbach
- Lydia Hall’s Care, Core, and Cure Model (Prescriptive aspects) (1966) – Lydia E. Hall
- Jean Watson’s Theory of Human Caring (Prescriptive aspects) (1979) – Jean Watson
- Madeleine Leininger’s Culture Care Theory (Prescriptive aspects) (1978) – Madeleine M. Leininger
- Katharine Kolcaba’s Comfort Theory (Prescriptive aspects) (1991) – Katharine Kolcaba
- Betty Neuman’s Systems Model (Prescriptive aspects) (1972) – Betty Neuman
- Kristen Swanson’s Theory of Caring (Prescriptive aspects) (1991) – Kristen M. Swanson
- Cornelia Ruland and Shirley Moore’s Peaceful End of Life Theory (Prescriptive aspects) (1998) – Cornelia M. Ruland and Shirley M. Moore
- Theory of Pain Management Protocols (Prescriptive aspects) – Multiple contributors
- Theory of Fall Prevention (Prescriptive aspects) – Multiple contributors
- Theory of Pressure Ulcer Prevention (Prescriptive aspects) – Multiple contributors (NPUAP/EPUAP)
- Theory of Central Line Bundle Care (Prescriptive aspects) – Multiple contributors (Peter Pronovost)
- Theory of VAP Prevention Bundle (Prescriptive aspects) – Multiple contributors (IHI)
- Theory of Sepsis Bundles (Prescriptive aspects) – Multiple contributors (Surviving Sepsis Campaign)
- Theory of Hand Hygiene Protocols (Prescriptive aspects) – Multiple contributors (WHO)
- Theory of Hourly Rounding (Prescriptive aspects) – Multiple contributors (Meade, Studer Group)
- Theory of Bedside Shift Report (Prescriptive aspects) – Multiple contributors (AHRQ)
- Theory of PCA Management (Prescriptive aspects) – Multiple contributors
- Theory of Restraint Minimization (Prescriptive aspects) – Multiple contributors
- Theory of Neonatal Hypoglycemia Screening (Prescriptive aspects) – Multiple contributors (AAP)
- Theory of Tracheostomy Care (Prescriptive aspects) – Multiple contributors
- Theory of Chest Tube Management (Prescriptive aspects) – Multiple contributors
- Theory of NG Tube Verification (Prescriptive aspects) – Multiple contributors (AACN)
- Theory of Peripheral IV Management (Prescriptive aspects) – Multiple contributors (INS)
- Theory of Alarm Management (Prescriptive aspects) – Multiple contributors (ECRI, Joint Commission)
- Theory of Medication Reconciliation (Prescriptive aspects) – Multiple contributors (IHI)
- Theory of Patient Identification (Prescriptive aspects) – Multiple contributors (Joint Commission)
- Theory of Needlestick Prevention (Prescriptive aspects) – Multiple contributors (OSHA, CDC)
- Theory of Heart Failure Self-Management Education (Prescriptive aspects) – Multiple contributors
- Theory of Discharge Teaching (Prescriptive aspects) – Multiple contributors (Project RED, CTI)
- Theory of Wound Care (Prescriptive aspects) – Multiple contributors
- Theory of Oxygen Therapy (Prescriptive aspects) – Multiple contributors
- Theory of Dehydration Management in Pediatrics (Prescriptive aspects) – Multiple contributors (WHO, AAP)
SUMMARY TABLE: CLASSIFICATION OVERVIEW
| Classification Type | Scope/Focus | Number of Theories | Primary Use | Key Question Answered |
| Grand Theories | Broadest scope, addresses the entire nursing discipline | 20 theories | Provides a philosophical foundation, guides education and research | What is nursing? |
| Middle-Range Theories | Moderate scope, specific phenomena or populations | 25+ theories | Guides research and practice for specific situations | What happens with this specific phenomenon? |
| Practice Theories | Narrowest scope, specific interventions or situations | 35+ theories | Provides direct clinical practice guidance | What do I do in this specific situation? |
| Descriptive Theories | Describes phenomena and characteristics | 20+ theories | Identifies and characterizes nursing phenomena | What is this? What are its characteristics? |
| Explanatory Theories | Explains relationships and mechanisms | 25+ theories | Explains how and why phenomena occur | How does this work? Why does this happen? |
| Predictive Theories | Predicts outcomes and relationships | 20+ theories | Forecasts patient outcomes, enables prevention | What will happen if…? |
| Prescriptive Theories | Prescribes specific nursing actions | 35+ theories | Directs nursing interventions and practice | What should nurses do? |
List of Nursing Theorists
EARLY/FOUNDATIONAL NURSING THEORISTS (1860-1960)
- Florence Nightingale (1820-1910)
- Theory: Environmental Theory (1860)
- Nationality: British
- Contribution: Founder of modern nursing; first nursing theory
- Hildegard E. Peplau (1909-1999)
- Theory: Theory of Interpersonal Relations (1952)
- Nationality: American
- Contribution: Pioneered psychiatric nursing theory; the mother of psychiatric nursing
- Virginia Henderson (1897-1996)
- Theory: Need Theory/Definition of Nursing (1955, 1966)
- Nationality: American
- Contribution: Defined nursing’s unique function; identified 14 fundamental needs
- Faye Glenn Abdellah (1919-2017)
- Theory: Twenty-One Nursing Problems Theory (1960)
- Nationality: American
- Contribution: First nurse and woman to serve as U.S. Deputy Surgeon General
- Ida Jean Orlando (1926-2007)
- Theory: Nursing Process Theory/Deliberative Nursing Process (1961)
- Nationality: American
- Contribution: Developed the nursing process discipline
- Ernestine Wiedenbach (1900-1998)
- Theory: The Helping Art of Clinical Nursing Theory (1964)
- Nationality: American
- Contribution: Emphasized purposeful nursing actions and validation
- Lydia E. Hall (1906-1969)
- Theory: Care, Core, and Cure Theory (1966)
- Nationality: American
- Contribution: Founded the Loeb Center for Nursing and Rehabilitation
GRAND THEORY DEVELOPERS (1960s-1970s)
- Joyce Travelbee (1926-1973)
- Theory: Human-to-Human Relationship Model (1966, 1971)
- Nationality: American
- Contribution: Emphasized interpersonal aspects and meaning in illness
- Myra Estrin Levine (1920-1996)
- Theory: Conservation Model (1967)
- Nationality: American
- Contribution: Four conservation principles for holistic nursing
- Martha E. Rogers (1914-1994)
- Theory: Science of Unitary Human Beings (1970)
- Nationality: American
- Contribution: Abstract system theory; humans as energy fields
- Dorothea E. Orem (1914-2007)
- Theory: Self-Care Deficit Nursing Theory (1971)
- Nationality: American
- Contribution: Self-care as the foundation of nursing practice
- Imogene M. King (1923-2007)
- Theory: Theory of Goal Attainment/Conceptual System (1971)
- Nationality: American
- Contribution: Interacting systems and transaction process
- Betty Neuman (1924-present)
- Theory: Neuman Systems Model (1972)
- Nationality: American
- Contribution: Systems approach to stress and prevention
- Josephine G. Paterson (1924-2020) and Loretta T. Zderad (1925-2020)
- Theory: Humanistic Nursing Theory (1976)
- Nationality: American
- Contribution: Phenomenological approach to nursing
- Sister Callista Roy (1939-present)
- Theory: Roy Adaptation Model (1976)
- Nationality: American
- Contribution: Adaptation as the goal of nursing; four adaptive modes
- Madeleine M. Leininger (1925-2012)
- Theory: Culture Care Diversity and Universality/Transcultural Nursing Theory (1978)
- Nationality: American
- Contribution: Founded transcultural nursing as a specialty
- Jean Watson (1940-present)
- Theory: Theory of Human Caring/Caring Science (1979)
- Nationality: American
- Contribution: Caring as a moral ideal and the essence of nursing
CONTEMPORARY GRAND THEORISTS (1980s-1990s)
- Rosemarie Rizzo Parse (1938-present)
- Theory: Theory of Human Becoming (originally Man-Living-Health, 1981)
- Nationality: American/Canadian
- Contribution: Existential-phenomenological perspective on nursing
- Patricia Benner (1942-present)
- Theory: Novice to Expert Theory/Model of Skill Acquisition (1982)
- Nationality: American
- Contribution: Five stages of nursing expertise development
- Margaret A. Newman (1933-2018)
- Theory: Health as Expanding Consciousness (1986)
- Nationality: American
- Contribution: Pattern recognition and consciousness in health
- Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain
- Theory: Modeling and Role-Modeling Theory (1983)
- Nationality: American
- Contribution: Individualized care based on the client’s world model
- Kari Martinsen (1943-present)
- Theory: Philosophy of Caring (1989)
- Nationality: Norwegian
- Contribution: Moral, relational, and practical dimensions of care
- Anne Boykin and Savina O. Schoenhofer
- Theory: Nursing as Caring Theory (1993)
- Nationality: American
- Contribution: All persons are caring by virtue of humanness
MIDDLE-RANGE THEORY DEVELOPERS
- Nola J. Pender (1941-present)
- Theory: Health Promotion Model (1982, revised 1996)
- Nationality: American
- Contribution: Factors influencing health-promoting behaviors
- Afaf Ibrahim Meleis (1942-present)
- Theory: Transitions Theory (developed 1970s-2000s)
- Nationality: Egyptian-American
- Contribution: Nature and process of health-illness transitions
- Merle H. Mishel (1939-present)
- Theory: Uncertainty in Illness Theory (1988)
- Nationality: American
- Contribution: Cognitive state of uncertainty in illness experience
- Katharine Kolcaba (1944-present)
- Theory: Theory of Comfort (1991)
- Nationality: American
- Contribution: Taxonomic structure of comfort in nursing
- Ramona T. Mercer (1929-present)
- Theory: Maternal Role Attainment/Becoming a Mother (1981)
- Nationality: American
- Contribution: Process of becoming a mother
- Kristen M. Swanson
- Theory: Theory of Caring (1991)
- Nationality: American
- Contribution: Five caring processes in nursing practice
- Pamela G. Reed
- Theory: Self-Transcendence Theory (1991)
- Nationality: American
- Contribution: Expansion of self-boundaries and well-being
- Cheryl Tatano Beck
- Theories: Postpartum Depression Theory (1993); Birth Trauma Theory (2004)
- Nationality: American
- Contribution: Maternal mental health phenomena
- Georgene Gaskill Eakes, Mary Lermann Burke, and Margaret A. Hainsworth
- Theory: Theory of Chronic Sorrow (1998)
- Nationality: American
- Contribution: Cyclical grief in ongoing loss situations
- Cornelia M. Ruland and Shirley M. Moore
- Theory: Theory of the Peaceful End of Life (1998)
- Nationality: Norwegian/American
- Contribution: Essential components of peaceful dying
- Phil Barker (with Poppy Buchanan-Barker)
- Theory: Tidal Model of Mental Health Recovery (2001)
- Nationality: British
- Contribution: Recovery-oriented mental health nursing
- Carolyn L. Wiener and Marilyn J. Dodd
- Theory: Illness Trajectory Theory (based on Corbin & Strauss, 1980s)
- Nationality: American
- Contribution: Chronic illness course and management
- Katherine S. Dunn
- Theory: Adaptation to Chronic Pain Theory (2004)
- Nationality: American
- Contribution: Living with chronic pain
- Lynn Rew
- Theory: Self-Care for Vulnerable Populations (2003)
- Nationality: American
- Contribution: Self-care in homeless youth and vulnerable groups
- Carolyn Kinney
- Theory: Theory of Caregiver Stress (1996)
- Nationality: American
- Contribution: Family caregiver stress process
- Victoria Mock
- Theory: Theory of Exercise as Self-Care for Cancer Treatment (1997)
- Nationality: American
- Contribution: Exercise during cancer treatment
- Marlaine C. Smith
- Theory: Theory of Unitary Caring (1999)
- Nationality: American
- Contribution: Integration of Rogers’ and caring perspectives
- Valmi D. Sousa and Jaclene A. Zauszniewski
- Theory: Theory of Diabetes Self-Care Management (2005)
- Nationality: American
- Contribution: Factors in diabetes self-management
- Judy E. Davidson
- Theory: Facilitated Sensemaking Theory (2010)
- Nationality: American
- Contribution: Family experience in critical care
- Linda Chlan
- Research: Music Therapy for Anxiety Reduction (2000s)
- Nationality: American
- Contribution: Music interventions in critical care
- Linda H. Aiken
- Theory/Research: Nurse Staffing and Patient Outcomes (2000s)
- Nationality: American
- Contribution: Staffing ratios and patient safety
- Patricia Flatley Brennan
- Theory: Empowered Patient Theory (1990s)
- Nationality: American
- Contribution: Health informatics and patient empowerment
- Janice M. Morse
- Theory: Theory of Suffering (2001)
- Nationality: Canadian-American
- Contribution: Praxis theory of suffering and enduring
- Melanie Dreher
- Research: Birth as Rite of Passage
- Nationality: American
- Contribution: Anthropological perspectives on childbirth
- Jean Goeppinger
- Theory: Community as Partner Model
- Nationality: American
- Contribution: Community health nursing framework
- Pei-Fan Tsai
- Research: Caregiver Stress in Dementia (2003)
- Nationality: American (Taiwanese heritage)
- Contribution: Dementia caregiver burden
PRACTICE/EVIDENCE-BASED THEORISTS AND RESEARCHERS
- Barbara Braden and Nancy Bergstrom
- Development: Braden Scale for Predicting Pressure Sore Risk (1987)
- Nationality: American
- Contribution: Pressure ulcer risk assessment
- Judith M. Morse
- Development: Morse Fall Scale
- Nationality: Canadian-American
- Contribution: Fall risk assessment
- Sharon K. Inouye
- Development: Confusion Assessment Method (CAM); Delirium prediction models
- Nationality: American
- Contribution: Delirium screening and prevention
- Peter Pronovost
- Development: Central Line Bundle; Checklist methodology
- Nationality: American
- Contribution: Patient safety and infection prevention (physician collaborator)
- Christina Maslach
- Development: Burnout theory and measurement (adapted to nursing)
- Nationality: American
- Contribution: Burnout syndrome conceptualization (psychologist)
- Charles Figley
- Development: Compassion fatigue concept (applied to nursing)
- Nationality: American
- Contribution: Secondary traumatic stress (psychologist)
- Marshall Klaus and John Kennell
- Research: Maternal-infant bonding theory
- Nationality: American
- Contribution: Early attachment and bonding (pediatricians)
- Icek Ajzen
- Development: Theory of Planned Behavior (widely applied in nursing)
- Nationality: American (Polish-born)
- Contribution: Health behavior prediction (psychologist)
INTERNATIONAL NURSING THEORISTS
- Katie Eriksson (1943-present)
- Theory: Theory of Caritative Caring (1970s-1980s)
- Nationality: Finnish
- Contribution: Nordic caring science tradition
- Herdis Alvsvåg
- Work: Extension of Martinsen’s caring philosophy
- Nationality: Norwegian
- Contribution: Practical and moral caring
- Karin Dahlberg
- Theory: Lifeworld Theory in Nursing
- Nationality: Swedish
- Contribution: Phenomenological nursing research
- Hesook Suzie Kim
- Work: The Nature of Theoretical Thinking in Nursing (1983, 2000)
- Nationality: Korean-American
- Contribution: Nursing knowledge development
- Marjory Gordon (1931-2015)
- Development: Functional Health Patterns (1982)
- Nationality: American
- Contribution: Nursing assessment framework; NANDA diagnosis development
- Callista Roy (see #15 above)
- Additional note: Internationally recognized, works globally
THEORISTS BY SPECIALTY AREA
Psychiatric-Mental Health Nursing
- Hildegard Peplau
- Joyce Travelbee
- Phil Barker
- Cheryl Tatano Beck (postpartum mental health)
Community/Public Health Nursing
- Jean Goeppinger
- Nola Pender
- Lynn Rew
Transcultural/Cultural Nursing
- Madeleine Leininger
- Josephine Campinha-Bacote (cultural competence model)
Maternal-Child Nursing
- Ramona Mercer
- Cheryl Tatano Beck
- Kristen Swanson
Gerontological Nursing
- Theories often applied: Roy, Orem, Neuman
Critical Care Nursing
- Judy Davidson
- Linda Chlan
Oncology Nursing
- Victoria Mock
- Theories applied: Comfort Theory, Uncertainty Theory
Palliative/End-of-Life Care
- Cornelia Ruland and Shirley Moore
- Pamela Reed
EMERGING AND CONTEMPORARY THEORISTS (2000s-Present)
- Barbara Carper (1933-present)
- Work: Fundamental Patterns of Knowing in Nursing (1978)
- Nationality: American
- Contribution: Four ways of knowing (empirical, aesthetic, personal, ethical)
- Patricia Benner (continued work)
- Later works: Educating Nurses (2009); Clinical Wisdom and Interventions in Acute and Critical Care (2011)
- Jacqueline Fawcett
- Work: Analysis and Evaluation of Nursing Theories (ongoing)
- Nationality: American
- Contribution: Metaparadigm conceptualization; theory analysis
- Peggy Chinn and Maeona Kramer
- Work: Integrated Theory and Knowledge Development in Nursing (multiple editions)
- Nationality: American
- Contribution: Nursing knowledge development frameworks
Living Theorists (as of 2025):
- Betty Neuman
- Sister Callista Roy
- Jean Watson
- Rosemarie Parse
- Patricia Benner
- Anne Boykin
- Nola Pender
- Afaf Meleis
- Merle Mishel
- Katharine Kolcaba
- Ramona Mercer
Historical/Deceased Theorists: Most early pioneers (Nightingale, Peplau, Henderson, etc.) have passed, but their theories remain highly influential.
This list includes 67+ nursing theorists across all eras and levels of theory development, representing:
- Grand Theory Developers: ~20 theorists
- Middle-Range Theory Developers: ~30 theorists
- Practice Theory/Evidence-Based Researchers: ~15 contributors
- International Theorists: ~10 (with overlap)
- Knowledge Development Scholars: ~7
Examples of Nursing Theories
Understanding different nursing theories is essential for every nursing student and practicing nurse. These theories represent various levels of nursing theory and provide frameworks that guide nursing practice, education, and research. Below are detailed examples of the most influential nursing theories, organized by their scope and impact on the field.
1. Florence Nightingale’s Environmental Theory (1860)
Overview: The environmental theory is considered the first formal nursing theory and established nursing as a distinct profession separate from medicine. Florence Nightingale, often called the founder of modern nursing, developed this theory based on her observations during the Crimean War.
Key Concepts:
- The environment directly impacts patient health and recovery
- Five essential environmental factors: pure air, pure water, efficient drainage, cleanliness, and light
- The body has natural reparative processes that proper environmental conditions facilitate
- Nursing’s primary role is to manipulate the environment to optimize healing
Application: This model of nursing remains relevant today in:
- Infection control practices emphasizing cleanliness
- Hospital design considering ventilation, lighting, and noise control
- Patient room environmental assessments
- Creating healing environments in all healthcare settings
Significance: Nightingale’s environmental theory laid the foundation for nursing as a science in nursing, demonstrating that systematic environmental manipulation produces measurable health outcomes. This theory is taught in every nursing program as the historical starting point of professional nursing.
2. Virginia Henderson’s Nursing Need Theory (1966)
Overview: The nursing need theory, also known as Henderson’s Definition of Nursing, articulates nursing’s unique function and is one of the most widely applied models globally.
Key Concepts: Henderson identified 14 fundamental human needs that nurses help patients meet:
- Breathe normally
- Eat and drink adequately
- Eliminate body wastes
- Move and maintain desirable postures
- Sleep and rest
- Select suitable clothes dress and undress
- Maintain body temperature within normal range
- Keep the body clean and well-groomed
- Avoid dangers in the environment
- Communicate with others
- Worship according to one’s faith
- Work in such a way that provides a sense of accomplishment
- Play or participate in various forms of recreation
- Learn, discover, or satisfy the curiosity for normal development
Henderson’s Definition: “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 (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge.”
Application: This nursing need theory provides a systematic framework for:
- Comprehensive patient assessment
- Care planning across all clinical settings
- Teaching basic nursing skills to students
- International nursing practice (endorsed by the International Council of Nurses)
Levels of Nursing Theory: Henderson’s work represents a grand theory at the broadest level of nursing theory, addressing all aspects of nursing practice across all populations and settings.
3. Hildegard Peplau’s Theory of Interpersonal Relations (1952)
Overview: The theory of interpersonal relations revolutionized nursing by establishing the nurse-patient relationship itself as a therapeutic intervention, not merely a context for delivering care.
Key Concepts:
- Nursing is a therapeutic interpersonal process
- The relationship progresses through four phases:
- Orientation: Nurse and patient meet as strangers; problem identification
- Identification: Patient responds to help and identifies with the nurse
- Exploitation: Patient actively uses the relationship to meet needs
- Resolution: Patient’s needs are met; the relationship terminates
Nurse Roles: Throughout the relationship, nurses assume different roles:
- Stranger (initial respect and courtesy)
- Resource (information provider)
- Teacher (health educator)
- Leader (democratic guidance)
- Surrogate (substitute for significant others)
- Counselor (facilitating understanding and integration)
Application: This model of nursing is foundational in:
- Psychiatric-mental health nursing
- Therapeutic communication courses are in every nursing program
- Building trust with patients experiencing anxiety or crisis
- Long-term nurse-patient relationships in chronic disease management
Significance: Peplau’s theory elevated nursing practice beyond physical tasks to include psychological and interpersonal dimensions, establishing that the science in nursing encompasses relationship knowledge alongside technical expertise.
4. Jean Watson’s Theory of Human Caring (1979)
Overview: Watson’s theory of human caring (also called Caring Science) positions caring as the moral ideal, essence, and central unifying focus of nursing. This theory has profoundly influenced how nurses understand their professional identity and purpose.
Key Concepts:
- Caring is the ontological (being) and ethical foundation of nursing
- Transpersonal caring relationship: Goes beyond ego to spiritual connection
- Caring moment/occasion: When nurse and patient connect, transcending time and space
- 10 Caritas Processes (originally 10 carative factors):
- Practice loving-kindness and equanimity
- Be authentically present; enable faith/hope/belief system
- Cultivate own spiritual practices; deepen self-awareness
- Develop and sustain helping-trusting caring relationships
- Be present and supportive of the expression of positive and negative feelings
- Creatively use self and all ways of knowing as part of the caring process
- Engage in a genuine teaching-learning experience within the context of a caring relationship
- Create a healing environment at all levels (physical, non-physical, subtle energy)
- Assist with basic needs with intentional caring consciousness
- Open to spiritual-mysterious, existential dimensions of life-death-suffering
Application: This care theory guides practice in:
- Holistic nursing approaches across all specialties
- Magnet hospitals adopting caring frameworks
- End-of-life care emphasizing dignity and presence
- Master of Science in Nursing programs teaching caring science
- Creating healing environments beyond just clinical efficiency
Levels of Nursing Theory: Watson’s theory operates at the grand theory level, providing a comprehensive philosophical worldview for the entire discipline. It has also generated middle-range theories focused on specific caring applications.
Significance: The theory of human caring articulates nursing’s unique contribution to healthcare the transpersonal caring relationship that honors the whole person and facilitates healing beyond physical cure. This theory is extensively taught in nursing programs worldwide and has inspired a global caring science movement.
5. Dorothea Orem’s Self-Care Deficit Theory (1971)
Overview: Orem’s self-care deficit theory is one of the most widely used nursing theories globally. It consists of three interrelated theories that together explain when and why nursing is needed and what nurses should do.
Three Interrelated Theories:
Theory of Self-Care:
- All individuals have the ability and responsibility to care for themselves
- Self-care: Practice of activities individuals initiate and perform to maintain life, health, and well-being
- Therapeutic self-care demand: Total self-care actions needed to meet self-care requisites
- Self-care requisites (requirements) are in three categories:
- Universal (all humans need: air, water, food, elimination, activity/rest, solitude/social interaction, hazard prevention, normalcy promotion)
- Developmental (related to human development stages)
- Health deviation (arising from illness, injury, disease, or medical treatment)
Theory of Self-Care Deficit:
- Explains when nursing is needed
- Self-care deficit: Gap between self-care agency (capability) and therapeutic self-care demand (requirements)
- Nursing is required when the self-care agency is insufficient to meet therapeutic self-care demands
Theory of Nursing Systems: Describes how nurses assist patients based on their self-care deficits:
- Wholly Compensatory System: Nurse performs all care (e.g., unconscious patient, complete dependence)
- Partially Compensatory System: Nurse and patient share responsibility (e.g., post-operative patient who can feed self but cannot ambulate safely)
- Supportive-Educative System: Patient can perform care with guidance, teaching, support (e.g., newly diagnosed diabetic learning self-management)
Application: This model of nursing is used extensively in:
- Rehabilitation nursing promotes independence
- Chronic disease management supporting self-care
- Discharge planning assessing self-care abilities
- Home health nursing: determining the level of assistance needed
- Pediatric nursing involving family in care
Levels of Nursing Theory: Orem’s work represents a grand theory encompassing all of nursing, but it has generated numerous middle-range and practice-level theories for specific populations (diabetes self-care, cardiac rehabilitation, gerontological nursing).
Significance: The self-care deficit theory provides a systematic framework for determining the necessity and appropriate interventions. It emphasizes patient autonomy, independence, and empowerment values central to contemporary nursing practice. This theory is particularly popular in Master of Science in Nursing programs for its practical applicability and research potential.
6. Sister Callista Roy’s Adaptation Model (1976)
Overview: Roy’s Adaptation Model is a comprehensive model of nursing that views individuals as adaptive systems constantly responding to environmental stimuli. The goal of nursing is to promote adaptation, thereby enhancing health, quality of life, and dignity.
Key Concepts:
Person as Adaptive System:
- Individuals have two coping mechanisms:
- Regulator subsystem: Physiological responses (neural, chemical, endocrine)
- Cognator subsystem: Cognitive-emotional responses (perception, learning, judgment, emotion)
Stimuli:
- Focal stimulus: Immediately confronting the person (e.g., pain, diagnosis)
- Contextual stimuli: All other stimuli present (e.g., environment, culture, family)
- Residual stimuli: Beliefs, attitudes, past experiences influencing the current situation
Four Adaptive Modes: Individuals adapt in four interrelated modes:
- Physiological-Physical Mode: Physical responses (oxygenation, nutrition, elimination, activity/rest, protection, senses, fluid/electrolyte balance, neurological function, endocrine function)
- Self-Concept-Group Identity Mode: Psychological and spiritual integrity (body image, self-consistency, self-ideal, moral-ethical-spiritual self)
- Role Function Mode: Roles in society (primary, secondary, tertiary roles)
- Interdependence Mode: Relationships with significant others (giving and receiving love, respect, value)
Nursing Process:
- Assess behaviors in four modes
- Assess stimuli influencing behaviors
- Nursing diagnosis: Adaptive or ineffective responses
- Goal setting: Promote adaptive responses
- Intervention: Manipulate stimuli (focal, contextual, residual)
- Evaluation: Measure the effectiveness of interventions in promoting adaptation
Application: This model of nursing guides practice in:
- Holistic assessment across all adaptive modes
- Chronic illness adaptation
- Rehabilitation settings
- Cultural adaptation and immigrant health
- Coping with life transitions
Levels of Nursing Theory: Roy’s Adaptation Model functions as a grand theory providing a comprehensive framework, while also enabling the development of middle-range theories focused on specific adaptive challenges (adaptation to chronic pain, maternal role adaptation, cultural adaptation).
Significance: Roy’s theory provides a systematic approach to understanding patient responses to health challenges. It is widely used internationally and taught extensively in nursing programs. The theory’s emphasis on holism, assessing physiological, psychological, social, and spiritual dimensions, aligns with contemporary patient-centered care values.
7. Madeleine Leininger’s Transcultural Nursing Theory (1978)
Overview: Leininger’s transcultural nursing theory, also called the cultural care theory or Theory of Culture Care Diversity and Universality, founded the specialty of transcultural nursing. This theory addresses the critical importance of understanding and incorporating cultural beliefs, values, and practices into nursing care.
Key Concepts:
Core Premise:
- Care is the essence of nursing and central to healing
- Care is culturally based and varies across cultures
- Care must be culturally congruent to be effective and meaningful
Culture Care Diversity:
- Recognition that care beliefs, values, and practices differ among cultures
- Each culture has unique ways of caring that must be discovered and respected
Culture Care Universality:
- Some care practices are common across cultures
- Understanding both universal and culture-specific care improves nursing practice
Sunrise Enabler: A conceptual model depicting factors influencing culturally congruent care:
- Technological factors
- Religious and philosophical factors
- Kinship and social factors
- Cultural values, beliefs, and lifeways
- Political and legal factors
- Economic factors
- Educational factors
Three Nursing Action Modes:
- Culture Care Preservation/Maintenance: Retain beneficial cultural practices (e.g., supporting traditional postpartum practices that don’t harm health)
- Culture Care Accommodation/Negotiation: Adapt care to fit cultural preferences while achieving health goals (e.g., modifying dietary recommendations to include culturally preferred foods)
- Culture Care Repatterning/Restructuring: Help patients modify harmful cultural practices while respecting cultural identity (e.g., supporting a diabetic patient to adjust their traditional diet in healthier ways)
Application: This transcultural nursing theory guides practice in:
- Immigrant and refugee health care
- Diverse urban healthcare settings
- International nursing practice
- Reducing health disparities among minority populations
- Religious and spiritual care considerations
- Language interpretation and health literacy
- Cultural assessment as standard nursing practice
Levels of Nursing Theory: Leininger’s transcultural nursing theory operates at the grand theory level, providing a comprehensive framework for understanding culture’s role in all nursing care. It has generated numerous middle-range theories for specific cultural groups and care situations.
Significance: In our increasingly diverse society, Leininger’s cultural care theory is more relevant than ever. The theory is now integrated throughout nursing curricula rather than treated as a specialty topic. Every Master of Science in Nursing program includes cultural competence as a core competency. The theory transformed nursing from culture-blind to culture-aware practice, emphasizing that effective, ethical care must be culturally congruent.
Evidence in Nursing: Research using this model of nursing has documented that culturally congruent care improves:
- Patient satisfaction and trust
- Treatment adherence
- Health outcomes in minority populations
- Communication effectiveness
- Reduction of health disparities
8. Imogene King’s Theory of Goal Attainment (1971)
Overview: King’s theory of goal attainment (also called King’s Conceptual System and Interacting Systems Framework) emphasizes that nursing occurs through purposeful nurse-patient interaction leading to mutually set goals and actions to achieve them.
Key Concepts:
Three Interacting Systems:
- Personal Systems: Individuals with perception, self, body image, growth and development, time, and space
- Interpersonal Systems: Groups (dyads, triads, small groups, large groups) with interaction, communication, transaction, role, and stress
- Social Systems: Society, organizations, communities with organization, authority, power, status, and decision-making
Transaction Process: The central concept of King’s model of nursing:
- Perception: Nurse and patient perceive each other and the situation
- Judgment: Each makes judgments about the other and the situation
- Action: Each acts based on perception and judgment
- Reaction: Each reacts to the other’s actions
- Interaction: Reciprocal actions between nurse and patient
- Transaction: When interaction leads to mutually set goals, agreement on means, and actions taken to achieve goals
Goal Attainment:
- When nurse and patient communicate effectively, set mutual goals, explore means to achieve goals, agree on means, and take action, goals are attained
- Goal attainment leads to effective nursing care, patient satisfaction, and health outcomes
Application: This model of nursing is applied in:
- Establishing therapeutic nurse-patient relationships
- Collaborative care planning with patients and families
- Ensuring patient participation in treatment decisions
- Quality improvement initiatives measuring goal attainment
- Chronic disease management requires sustained partnerships
Levels of Nursing Theory: King’s theory functions at the grand theory level, providing a comprehensive framework for understanding all nurse-patient interactions. It has generated middle-range theories for specific populations and settings.
Significance: King’s theory of goal attainment emphasizes patient partnership and mutual decision-making decades before “patient-centered care” became healthcare’s dominant paradigm. The theory validates that effective nursing requires more than nurse expertise it requires nurse-patient collaboration, shared goal-setting, and mutual respect. This model is particularly valued in Master of Science in Nursing programs preparing advanced practice nurses who must establish collaborative relationships with patients managing complex chronic conditions.
Contemporary Relevance: In today’s healthcare, emphasizing:
- Shared decision-making
- Patient activation and engagement
- Patient-centered medical homes
- Collaborative care models
King’s theory of goal attainment provides the theoretical foundation explaining why these approaches work: transactions based on mutual goal-setting lead to goal achievement and better outcomes.