COURSE: CONCEPTS AND THEORIES IN NURSING

COURSE OBJECTIVES:

By the end of this course, the student is expected to;

- Define basic terms or concepts related to the course.

- Identify and describe the different concepts and conceptual models in nursing

- Able to state and explain the link between concepts and conceptual models in nursing practice.

- Demonstrate how these concepts can be applied in nursing care.

INTRODUCTION TO CONCEPTS AND THEORIES IN NURSING SCIENCE

1.1 Definition of nursing

 Virginia Henderson states that “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 had the
necessary strength, will or knowledge. To do so as to regain independence as rapid
as possible”.
 Florence Nightingale defines nursing as 'the act of utilizing the environment of the
patient to assist him in his recovery'.
 The international council of nurses says: “Nursing encompasses autonomous and
collaborative care of individuals of all ages, families, groups and communities, sick
or well and in all settings”. Nursing includes the promotion of health, prevention of
illness, and the care of ill, disabled and dying people.

1.2 Nursing as a profession

There has been considerable discussion about whether nursing is a profession or an
occupation. This is important for nurses to consider for several reasons. An occupation is a
job or a career, whereas a profession is a learned vocation or occupation that has a status of
superiority and precedence within a division of work.
 In general terms, professions require widely varying levels of training or education, varying
levels of skill, and widely variable defined knowledge bases. In short, all professions are
occupations, but not all occupations are professions.
1.2.1 Differences between occupation and profession

Profession Occupation
Education takes place in college and Training may occur on job.
university.
Education is definite and prolonged. Length of training varies
Values, beliefs and ethics are not
prominent part of preparation.
Commitments and personal identification Commitment and personal identifications
varies are strong
Works are supervised Works are autonomous
People often change jobs People unlikely to change jobs
Accountability rest with employees Accountability rest with individuals

1.2.2 Nursing as an art:

The art of nursing refers to the highly valued qualities of care, compassion, and
communication three core principles guiding nursing practice. These principles
encompass all aspects of patient care, including bio psychosocial needs, cultural
preferences, and spiritual needs.
1.2.3 Nursing as a science:
Although all nurses should exhibit the qualities that are essential to the art of nursing,
nursing interventions should be practical decisions based on evidence based research and
rigorous scientific inquiry. To maintain clinical competency, nurses must commit to
continuous learning. Nurses need to develop and use critical thinking and clinical
decision-making skills to incorporate new academic and scientific knowledge into
everyday practice.
1.3 BASIC TERMS AND CONCEPTS RELATED TO NURSING SCIENCE
2. Concept: a concept is a building block of a theory. Concepts are also known as complex
mental formulations about an object or a situation. A concept is simply a general idea
about a theory of something a concept may be abstract or concrete. Abstract concepts are
mentally constructed independent of specific time or place. For example, the stretcher
and a wheel chair are concrete concepts of the abstract concept transport.
3. Conceptual framework: is a structure that links global concepts together and represent a
unified whole of a larger reality. A conceptual framework is a written or visual
representation of an expected relationship between variables. Variables are simply the
characteristics or properties that you want to study. Example age, educational level and
number of siblings.
4. A phenomenon: it is an observable fact that can be perceived through sciences and
explained.
5. Conceptual model: this term is often used interchangeably with conceptual framework.
It guides or predicts nursing actions.
6. Theory: a theory is a set of concepts and propositions that provide an orderly way to
view a phenomenon.
7. Paradigm: it is a pattern of shared understanding and assumption about reality in the
world: World viewed or widely accepted valued system. It entails philosophical ideas
about human universal health problems. The nursing paradigms represent global ideas
about individuals, groups, situations and phenomena of interest to this discipline.
8. Meta paradigm: it is a set of theories or ideas that provide structure for how a discipline
should function. It is the most global perspective of a discipline and act as an
encapsulating unit or framework within which other more restricted aspects or
phenomena concepts are developed. The paradigms that shape education, research and
practice steps of a discipline are defined as Meta paradigms.
For example, the Meta paradigm for nursing involves four concepts because these four
concepts can be superimposed on almost any work in nursing. They are sometimes
collectively referred to as Meta paradigm for nursing or key concepts of all theories they
include person, environment, health and nurse.
  The person or the patient: That is the recipient of nursing care. This includes the
individual, families, groups and community.
 The environment: It is the internal and external surrounding that affects the
patient positively or negatively. This involves people in the physical environment
such as healthcare personnel’s, families, friends and significant others.
 The nurse or nursing: Nursing that is attributes characteristics and actions of the
nurse providing care on behalf of or in conjunction with the patient.
 Health: Health is the degree of wellness or wellbeing that a person experience.
According to WHO, health is a state of complete physical mental and social
wellbeing and not merely the absence of diseases or infirmities.

1.4 Components of Nursing Theories

For a theory to be a theory, it has to contain concepts, definitions, relational statements, and
assumptions that explain a phenomenon. It should also explain how these components relate to
each other.

a. Phenomenon: A term given to describe an idea or response about an event, a situation, a

process, a group of events, or a group of situations which can be observed. Phenomena
may be temporary or permanent. Nursing theories focus on the phenomena of nursing.
b. Concepts: Interrelated concepts define a theory. Concepts are used to help describe or
label a phenomenon. They are words or phrases that identify, define, and establish
structure and boundaries for ideas generated about a particular phenomenon. Concepts
may be abstract or concrete.
 Abstract Concepts: Defined as mentally constructed independently of a
specific time or place.
 Concrete Concepts: Are directly experienced and related to a particular time
or place.
c. Definitions: Definitions are used to convey the general meaning of the concepts of the
theory. Definitions can be theoretical or operational.
 Theoretical Definitions: Define a particular concept based on the theorist’s
perspective.
 Operational Definitions: States how concepts are measured.
 d. Relational Statements: Relational statements define the relationships between two or
more concepts. They are the chains that link concepts to one another.
e. Assumptions: Assumptions are accepted as truths and are based on values and beliefs.
These statements explain the nature of concepts, definitions, purpose, relationships, and
structure of a theory. Why are Nursing Theories Important? Nursing theories are the basis
of nursing practice today. In many cases, nursing theory guides knowledge development
and directs education,

1.5 IMPORTANCE OF NURSING THEORY

 Nursing theories are the bases of nursing practice today.

 In many cases, nursing theories guide knowledge development and direct education,
research and practice.
 Historically, nursing was not recognized as an academic discipline or as a profession that
is viewed today. Before nursing theories were developed, nursing was considered to be a
task oriented occupation. The training and function off a nurse were under the control and
direction of the medical profession. Thanks to the concepts, theories and knowledge
development in nursing they have been a shift in this paradigm.

1.6 IMPORTANCE OF NURSING THEORIES AND CONCEPTS

1. IN ACADEMIC DISCIPLINE: it is important in building a nursing curriculum for the

training of nurses.
2. IN RESEARCH: The development of theory is fundamental in research process where it
is necessary to use theories as a framework to provide a perspective and guidance to the
research study.
3. IN PROFESSION: the clinical practice generates research questions and knowledge for
theory. This theory provides a framework that encourages nurses to reflect on questions
and think about what they do to provide for an individual.
1.7 SOME FUNDAMENTAL CONCEPTS IN NURSING

1. LIFE: Life is defined differently by different people according to different schools of

thought. However, the biological definition is based on the phenomenon of life, the
appearance and considered as the molecular structure and function of a cell. According to
the biological definition, life is the property or quality that distinguishes living organisms
from non-living organisms or inanimate matter, manifested in function such as
reproduction, excretion, growth, respiration, movement originating within the organism.
2. DEATH: death is defined differently according to different people in different
conditions and at different times. However according to the biological definitions;
 Death according to higher brain standard is the irreversible cessation of all functions of
the entire brain including the brain stem.
 According to the organismic definition, death is the irreversible loss of function of the
organism as a whole
 According to cardio pulmonary standard; death is the irreversible cessation of
cardiopulmonary function. For death to occur, there are stages of grieving an individual
goes through. They include:
a) Denial and Isolation
When we lose someone or something important to us, it is natural to reject the idea that it
could be true. In turn, we may isolate ourselves to avoid reminders of the truth. Others
who wish to comfort us may only make us hurt more while we are still coming to terms
with the loss.
b) Anger
When it is no longer possible to live in denial, it is common to become frustrated and
angry. We might feel like something extremely unfair has happened to us and wonder
what we did to deserve it.
c) Bargaining
In this stage, we might somehow seek to change the circumstances of the situation
causing their grief. For example, a religious person whose loved one is dying might seek
to negotiate with God to keep the person alive. Bargaining may help the grieving person
cope by allowing them a sense of control in the face of helplessness.
d) Depression
In this stage, we feel the full weight of our sadness over the loss. Feeling extremely down
in the wake of a loss is normal; however, it is important to be aware that clinical
depression is different from grief, and they are treated differently by mental health
professionals.
e) Acceptance
Eventually, the grieving person may come to terms with their loss. Accepting a loss does
not necessarily mean the person is no longer grieving. In fact, many grief experts say that
grief can continue for a lifetime after a major loss, and coping with the loss only becomes
easier over time. Waves of grief can be triggered by reminders of the loss long after it has
happened and long after the person has “accepted” it. These waves may also trigger a
crossover into any of the other four stages of grief.
In sum, grief is a personal, nuanced, and complicated process; it will not look the same
for any two people who are grieving. However, those who are grieving may experience
similar emotions along the way.
3. HEALTH: Health as defined by WHO is referred to as a state of complete physical,
mental and social wellbeing and not merely the absence of diseases or infirmities. Such a
definition of health does not allow for any variations in degree of wellness or illness, it is
much more static. On the other hand, the concept of health-illness continuum allows for a
greater range in describing a person’s health status.
THE HEALTH-ILLNESS CONTINUUM
By viewing health and illness on a continuum, it is possible to consider a person having
neither complete health or complete illness. Instead, a person’s state of health is ever
changing and has the potential to range from high level wellness to extremely poor health
and illness. The model of health illness continuum makes it possible to view a person as
simultaneously possessing degree of both health and illness.
 T
he Health Illness Continuum
4. ILLNESS: It is a feeling and experience of ill health which is entirely personal, interior
to the person and subjective to his/her understanding. Such as tiredness, malaise,
discomfort. Often, it accompanies disease but a disease may be undeclared as in the early
stages of cancer, TB or DM. sometimes illness exist where no disease can be found.
5. SICKNESS: sickness is the external and public mode of ill health. It has social and
cultural conceptions. Sickness is objective. The sick role is a functional role adopted by
those who are sick, and for which their peers and society accept their sanction deviance
from their usual healthy role. The sociologist TALCOTT PARSONS saw those in a sick
mode as having two rights;
 They are exempted from the usual social role
 They are not responsible for their sickness
According to Talcott Parsons, those considered sick have two obligations
 They should try to get better and if unable;
 They should seek medical care and follow the doctor’s advice
6. THE SIGN: a sign is the effect of a health problem that can be observed or described by
someone else. It is objective and measurable when possible e.g skin rash, lump.
Download
7. THE SYMPTOM: it is an effect of a health problem noticed and experienced by the
person who has the condition. They are subjective to the individual e.g fatigue, back pain,
headache. NB: the key difference between sign and symptom is who observe the
effect. For example, a rash could be a sign, symptom or both. If a doctor or a nurse
notices the rash, then it is a sign. If both the patient and the nurse or doctor notices
the rash, it can be classified as both a sign and a symptom.
8. 8. DISEASE: an abnormal vital function involving any structure, part or system of an
organism. It is specific, characterized by a recognizable set of manifestation, attributable
to hereditary, infection and diet or environment.
9. THE NEEDS: A need is something that is necessary for an organism to live a healthy
life. Needs are distinguished from wants. In the case of a need, a deficiency causes a clear
adverse outcome: a dysfunction or death. In other words, a need is something required for
a safe, stable and healthy life (e.g. air, water, food, land, shelter).
THE MASLOW’S HIERACHY OF NEEDS (1943)
Maslow’s hierarchy of needs is a theory of psychology explaining human motivation
based on the pursuit of different levels of needs. The theory states that humans are
motivated to fulfil their needs in a hierarchical order. This order begins with the most
basic needs before moving on to more advanced needs. The ultimate goal, according to
this theory, is to reach the fifth level of the hierarchy: self-actualization.
1. Physiological needs: The first of the id-driven lower needs on Maslow's hierarchy
are physiological needs. These most basic human survivals need include food and
water, sufficient rest, clothing and shelter, overall health, and reproduction. Maslow
states that these basic physiological needs must be addressed before humans move on
to the next level of fulfilment.
2. Safety needs: Next among the lower-level needs is safety. Safety needs include
protection from violence and theft, emotional stability and wellbeing, health security,
and financial security.
3. Love and belonging needs: The social needs on the third level of Maslow’s
hierarchy relate to human interaction and are the last of the so called lower needs.
Among these needs are friendships and family bonds— both with biological family
(parents, siblings, and children) and chosen family (spouses and partners). Physical
and emotional intimacy ranging from sexual relationships to intimate emotional
bonds are important to achieving a feeling of elevated kinship. Additionally,
membership in social groups contributes to meeting this need, from belonging to a
team of co-workers to forging an identity in a union, club, or group of hobbyists.
4. Esteem needs: The higher needs, beginning with esteem, are ego-driven needs. The
primary elements of esteem are self-respect (the belief that you are valuable and
 deserving of dignity) and self-esteem (confidence in your potential for personal
growth and accomplishments). Maslow specifically notes that self-esteem can be
broken into two types: esteem which is based on respect and acknowledgment from
others, and esteem which is based on your own self-assessment. Self-confidence and
independence stem from this latter type of self-esteem.
5. Self-actualization needs: Self-actualization describes the fulfilment of your full
potential as a person. Sometimes called self-fulfilment needs, self-actualization needs
occupy the highest spot on Maslow's pyramid. Self-actualization needs include
education, skill development the refining of talents in areas such as music, athletics,
design, cooking, and gardening caring for others, and broader goals like learning a
new language, traveling to new places, and winning awards. Needs lower down in the
hierarchy must be satisfied before individuals can attend to needs higher up.

Maslow’s Hierarchy of needs

Maslow's theory presents his hierarchy of needs in a pyramid shape, with basic needs
at the bottom of the pyramid and more high-level, intangible needs at the top. A
person can only move on to addressing the higher-level needs when their basic needs
are adequately fulfilled.
 CHAPTER TWO

THE THEORIES IN NURSING SCIENCE

1. State and Explain the different types of Classification of Nursing theories

2. List the various types of theorists and their theories

2.0 INTRODUCTION:

Nursing theories are very vital in nursing practice in that the make-up the basic framework for
nursing practices. Nursing theories are organized bodies of knowledge to define what nursing is,
what nurses do, and why they do it. Nursing theories provide a way to define nursing as a unique
discipline that is separate from other disciplines (e.g., medicine). It is a framework of concepts
and purposes intended to guide nursing practice at a more concrete and specific level.

2.1 Classification of Nursing Theories

There are different ways to categorize nursing theories. They are classified depending on their
function, levels of abstraction, or goal orientation.

A. By Abstraction

There are three major categories when classifying nursing theories based on their level of
abstraction: grand theory, middle-range theory, and practice-level theory.

1. Grand Nursing Theories

 Grand theories are abstract, broad in scope, and complex, therefore requiring further research
for clarification.

 Grand nursing theories do not guide specific nursing interventions but rather provide a general
framework and nursing ideas.

 Grand nursing theorists develop their works based on their own experiences and their time,
explaining why there is so much variation among theories.

 Address the nursing metaparadigm components of person, nursing, health, and environment.
2. Middle-Range Nursing Theories

 More limited in scope (compared to grand theories) and present concepts and propositions at a
lower level of abstraction. They address a specific phenomenon in nursing.

 Due to the difficulty of testing grand theories, nursing scholars proposed using this level of
theory.

 Most middle-range theories are based on a grand theorist’s works, but they can be conceived
from research, nursing practice, or the theories of other disciplines.

3. Practice-Level Nursing Theories

 Practice nursing theories are situation-specific theories that are narrow in scope and focuses on
a specific patient population at a specific time.

 Practice-level nursing theories provide frameworks for nursing interventions and suggest
outcomes or the effect of nursing practice.

 Theories developed at this level have a more direct effect on nursing practice than more
abstract theories.

 These theories are interrelated with concepts from middle-range theories or grand theories. By
Goal Orientation Theories can also be classified based on their goals. They can be descriptive or
prescriptive.

B. Descriptive Theories

 Descriptive theories are the first level of theory development. They describe the phenomena
and identify its properties and components in which it occurs.

 Descriptive theories are not action-oriented or attempt to produce or change a situation.

 There are two types of descriptive theories: factor isolating theory and explanatory theory.

1. Factor-Isolating Theory
 Also known as category-formulating or labelling theory.

 Theories under this category describe the properties and dimensions of phenomena.

2. Explanatory Theory

 Explanatory theories describe and explain the nature of relationships of certain phenomena to
other phenomena.

C Prescriptive Theories

 Address the nursing interventions for a phenomenon, guide practice change, and predict
consequences.

 Includes propositions that call for change.

 In nursing, prescriptive theories are used to anticipate the outcomes of nursing interventions.
Other Ways of Classifying Nursing Theories

D. Classification According to Meleis

Afaf Ibrahim Meleis (2011), in her book Theoretical Nursing: Development and Progress,
organizes the major nurse theories and models using the following headings: needs theories,
interaction theories, and outcome theories. These categories indicate the basic philosophical
underpinnings of the theories.

1.Needs-Based Theories.

The needs theorists were the first group of nurses who thought of giving nursing care a
conceptual order. Theories under this group are based on helping individuals to fulfil their
physical and mental needs. Theories of Orem, Henderson, and Abdella are categorized under this
group. Need theories are criticized for relying too much on the medical model of health and
placing the patient in an overtly dependent position.

2. Interaction Theories

These theories emphasized nursing on the establishment and maintenance of relationships. They
highlighted the impact of nursing on patients and how they interact with the environment,
people, and situations. Theories of Imogene King, Orlando, and Travelbee are grouped under this
category.

3. Outcome Theories

These theories describe the nurse as controlling and directing patient care using their knowledge
of the human physiological and behavioural systems. The nursing theories of Johnson, Levine,
Rogers, and Roy belong to this group.

E. According to Alligood in her book, Nursing Theorists and Their Work, Raile Alligood
(2017) categorized nursing theories into four headings: nursing philosophy, nursing conceptual
models, nursing theories and grand theories, and middle-range nursing theories.

1. Nursing Philosophy

It is the most abstract type and sets forth the meaning of nursing phenomena through analysis,
reasoning, and logical presentation. Works of Nightingale, Watson, Ray, and Benner are
categorized under this group.

2. Nursing Conceptual Models

These are comprehensive nursing theories that are regarded by some as pioneers in nursing.
These theories address the nursing metaparadigm and explain the relationship between them.
Conceptual models of Levine, Rogers, Roy, King, and Orem are under this group.

3. Grand Nursing Theories

Are works derived from nursing philosophies, conceptual models, and other grand theories that
are generally not as specific as middle-range theories. Works of Levine, Rogers, Orem, and King
are some of the theories under this category.

4 Middle-Range Theories

Are precise and answer specific nursing practice questions. They address the specifics of
nursing situations within the model’s perspective or theory from which they are derived.
Examples of Middle-Range theories are that of Mercer, Reed, Mishel, and Barker.

2.2 TYPES OF NURSING THEORIES

Nursing theories define nursing as something specialized compared to other medical disciplines.
They provide frameworks for nursing best practices at all levels of comprehension. Some of the
nursing theories include:

 Environmental theory

 Theory of interpersonal relations

 Nursing need theory

 Care, cure, core theory

 Nursing process theory

 Theory of human caring

 Self-care theory

2.3 MAIN CONCEPTS FOR EACH TYPE OF NURSING THEORY

Each nursing theory includes distinct concepts and may focus on different areas of care. Here
are the main concepts and purposes of each theory:

1. ENVIRONMENTAL THEORY

Florence Nightingale developed this theory. It focuses on the importance of positive patient
environments for recovery, curing illnesses or meeting health goals. The environmental theory
also details concepts like how to manage ventilation, light, noise, cleanliness of the facility,
bedding practices, personal hygiene, food safety and patient support strategies. The primary
message of this theory is that nurses can rearrange patient spaces to assist them with their
recovery progress.

2. THEORY OF INTERPERSONAL RELATIONS

This theory, developed by Hildegard Peplau, focuses on the benefits of strong nurse and
patient relationships. It suggests that interpersonal relations comprise four elements, including:

 Person

 Environment
 Health

 Nursing The primary takeaway of this theory is that nurses' interactions and communication
habits can influence a patient's well-being and overall healthcare experience.

3. NURSING NEED THEORY

The nursing need theory comes from Virginia Henderson. It focuses on rebuilding patient
independence to help boost the rate of their recovery. It also focuses on how nurses can address
patient needs directly and help them learn how to meet their needs independently. The principal
concepts of this theory are that a nurse's duty is to care for patients throughout all stages of their
healing process and that a nurse's goal can be to help guide patients back to independent living.

4. Care, cure, core theory

Lydia Hall developed the care, cure, core theory. This theory concentrates on elements of
nursing that it proposes are essential. These elements are care, cure and core. Care refers to the
typical role of nurses providing care to patients. Cure refers to the attention and
treatments patients receive from medical professionals. Core refers to the care a patient
receives from nurses or cures they may experience due to effective treatment plans. The
main concept of this theory is that patients are the focus of nursing care and each patient might
have different needs.

5. Nursing process theory

The nursing process theory, introduced by Ida Jean Orlando, explores the importance of
relationships between nurses and patients. The theory explains that while the actions of nurses
can affect patients, patients' actions can also influence nurses. It also outlines five stages of
patient care, including:

 Assessment of the patient

 Diagnosis and treatment plan

 Implementation of the treatment plan

 Evaluation of the patient's progress

The primary concept of this theory is to produce positive outcomes for patients through
professionalism.

6. Theory of human caring

This theory from Jean Watson focuses on how nurses and the treatment plans they implement
can promote health and prevent sicknesses. It also emphasizes that all patients are unique, so
nurses can offer treatment based on the progress that's possible for a particular patient, rather
than providing treatment based on a general assessment. The primary concept of this theory is
that customized care can help patients grow and that caring environments can be inclusive.

7. Self-care theory

Dorothea Orem developed the self-care theory in nursing, which addresses an individual's
ability to care for themselves. This might include maintaining a healthy lifestyle or managing
overall well-being. Using this theory to assess patients might help you determine if they have
fully recovered or if they may still need care. The central concept of this theory is that patients
who need help caring for themselves often require continued nursing care, while patients who
can care for themselves may no longer need a nurse's assistance.

8. Transcultural nursing theory

Transcultural nursing theory, originally introduced by Madeleine Leininger, focuses on the

importance of nurses understanding the diverse cultural backgrounds of their patients to
ensure they are providing care that is in line with each patient's personal and cultural values.
Understanding transcultural nursing theory can allow nurses to provide personalized care for the
patients they serve.

9. 21 nursing problems theory

Faye Abdellah created the 21 nursing problems theory, which focuses on human needs.
Typically, nursing students review and reference this theory when preparing to begin practicing
because it outlines best practices for providing comprehensive care to patients. Comprehensive
care may involve nurses, patients, treatment plans and societal factors. The fundamental concept
of this theory is that nursing is an art form of care that requires nurses to have positive attitudes,
medical knowledge and specialized skill sets.
2.4 USERS OF NURSING THEORIES

A variety of nursing professionals use nursing theories, including nursing students, nursing
professors, clinical researchers and practicing nurses. Here is an in-depth examination of the
types of professionals who use nursing theories: Academic professionals and nursing students
Both professors and students may use nursing theories in academic settings. Professors might
use them when teaching nursing students about best practices in the field. They might also
reference nursing theories when teaching students how to care for different types of patients.
Nursing theories may help students with a reference as they prepare for their future careers by
working with real or model patients in clinical settings. Professors and students also use nursing
theories to conduct their own research in nursing.

2.5 History of Nursing Theories

The first nursing theories appeared in the late 1800s when a strong emphasis was placed on
nursing education.

 In 1860, Florence Nightingale defined nursing in her “Environmental Theory” as “the act of
utilizing the patient’s environment to assist him in his recovery.”

 In the 1950s, there is a consensus among nursing scholars that nursing needed to validate
itself through the production of its own scientifically tested body of knowledge.

 In 1952, Hildegard Peplau introduced her Theory of Interpersonal Relations that

emphasizes the nurse-client relationship as the foundation of nursing practice.

 In 1955, Virginia Henderson conceptualized the nurse’s role as assisting sick or healthy
individuals to gain independence in meeting 14 fundamental needs. Thus her Nursing Need
Theory was developed.

 In 1960, Faye Abdellah published her work “Typology of 21 Nursing Problems,” which
shifted the focus of nursing from a disease-cantered approach to a patient-cantered approach.
 In 1962, Ida Jean Orlando emphasized the reciprocal relationship between patient and
nurse and viewed nursing’s professional function as finding out and meeting the patient’s
immediate need for help.

 In 1968, Dorothy Johnson pioneered the Behavioural System Model and upheld the
fostering of efficient and effective behavioural functioning in the patient to prevent illness.

 In 1970, Martha Rogers viewed nursing as both a science and an art as it provides a way to
view the unitary human being, who is integral with the universe.

 In 1971, Dorothea Orem stated in her theory that nursing care is required if the client is
unable to fulfil biological, psychological, developmental, or social needs.

 In 1971, Imogene King ‘s Theory of Goal attainment stated that the nurse is considered part
of the patient’s environment and the nurse-patient relationship is for meeting goals towards good
health.

 In 1972, Betty Neuman, in her theory, states that many needs exist, and each may disrupt
client balance or stability. Stress reduction is the goal of the system model of nursing practice.

 In 1979, Sr. Callista Roy viewed the individual as a set of interrelated systems that
maintain the balance between these various stimuli.

 In 1979, Jean Watson developed the philosophy of caring, highlighted humanistic aspects of
nursing as they intertwine with scientific knowledge and nursing practice.
 CHAPTER THREE

THE THOUGHTS OF AUTHORS IN NURSING (CONCCEPTUAL MODELS AND

THEIR APPLICATION IN NURSING)

1. VIRGINIA HENDERSON’S FOURTHEEN FUNDAMENTAL NEEDS (1966 AND

REVISED IN 1972)

The Nursing Need Theory was developed by Virginia Henderson and was derived from her
practice and education. Henderson’s goal was not to develop a theory of nursing, but rather
to define the unique focus of nursing practice. The theory emphasizes the importance of
increasing the patient’s independence so that progress after hospitalization would not be
delayed. Her emphasis on basic human needs as the central focus of nursing practice has led
to further theory development regarding the needs of the patient and how nurses can assist in
meeting those needs.

ASSUMPTIONS

Henderson identifies three major assumptions in her model of nursing. The first is that

 “nurses care for a patient until a patient can care for him or herself,” though it is not stated
explicitly. The second assumption states that

 Nurses are willing to serve and that “nurses will devote themselves to the patient day and
night.”

 That nurses should be educated at the college level in both sciences and arts. The four
major concepts addressed in the theory are the individual, the environment, health, and
nursing. This theory seeks to explain that:

 Nurses temporarily assist an individual who lacks the necessary strength, will, and
knowledge to satisfy one or more of the 14 basic needs.
 She states: “The nurse is temporarily the consciousness of the unconscious, the love life
for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion
for the infant, knowledge, and confidence of the young mother, the mouthpiece for those too
weak or withdrawn to speak.”

Additionally, she stated that “…the nurse does for others what they would do for themselves
if they had the strength, the will, and the knowledge. But I go on to say that the nurse makes
the patient independent of him or her as soon as possible.”

Her definition of nursing distinguished a nurse’s role in health care: The nurse is expected to
carry out a physician’s therapeutic plan, but individualized care results from the nurse’s
creativity in planning for care.

The nurse should be an independent practitioner able to make an independent judgment. In

her work Nature of Nursing, she states the nurse’s role is “to get inside the patient’s skin and
supplement his strength, will or knowledge according to his needs.” The nurse has the
responsibility to assess the patient’s needs, help him or her meet health needs, and provide an
environment in which the patient can perform activity unaided.

14 Components of the Need Theory

The 14 components of Virginia Henderson’s Need Theory show a holistic nursing approach
covering the physiological, psychological, spiritual, and social needs.

Physiological Components

 1. Breathe normally

 2. Eat and drink adequately

 3. Eliminate body wastes

 4. Move and maintain desirable postures

 5. Sleep and rest

 6. Select suitable clothes – dress and undress

 7. Maintain body temperature within normal range by adjusting clothing and modifying
environment

 8. Keep the body clean and well-groomed and protect the integument

 9. Avoid dangers in the environment and avoid injuring others

Psychological Aspects of Communicating and Learning

 10. Communicate with others in expressing emotions, needs, fears, or opinions.

 14. Learn, discover, or satisfy the curiosity that leads to normal development and health
and use the available health facilities.

Spiritual and Moral

 11. Worship according to one’s faith Sociologically Oriented to Occupation and

Recreation  12. Work in such a way that there is a sense of accomplishment

 13. Play or participate in various forms of recreation

Since there is much similarity, Henderson’s 14 components can be applied or compared to
Abraham Maslow ‘s Hierarchy of Needs. Components 1 to 9 are under Maslow’s Physiological
Needs, whereas the 9th component is under the Safety Needs. The 10th and 11th components are
under the Love and Belongingness category, and the 12th, 13th, and 14th components are under
the Self-Esteem Needs.

ANALYSIS OF THE NEED THEORY

One cannot say that every individual who has similar needs indicated in the 14 activities by
Virginia Henderson are the only things that human beings need in attaining health and for
survival. With today’s time, there may be added needs that humans are entitled to be provided
with by nurses. The prioritization of the 14 Activities was not clearly explained whether the first
one is a prerequisite to the other. But still, it is remarkable that Henderson was able to specify
and characterize some of the needs of individuals based on Abraham Maslow’s hierarchy of
needs.

Strengths

Virginia Henderson’s concept of nursing is widely accepted in nursing practice today. Her theory
and 14 components are relatively simple, logical, and applied to individuals of all ages.
Weaknesses

There is an absence of a conceptual diagram that interconnects the 14 concepts and sub concepts
of Henderson’s theory. On assisting the individual in the dying process, there is a little
explanation of what the nurse does to provide “peaceful death.” Application of the Need Theory
Henderson’s Needs Theory can be applied to nursing practice as a way for nurses to set goals
based on Henderson’s 14 components. Meeting the goal of achieving the 14 needs of the client
can be a great basis to improve one’s performance towards nursing care further. In nursing
research, each of her 14 fundamental concepts can serve as a basis for research, although the
statements were not written in testable terms

2. ENVIRONMENTAL THEORY BY FLORENCE NIGHTINGALE.

As the founder of modern nursing, Florence Nightingale’s Environment Theory changed
the face of nursing practice. She served as a nurse during the Crimean War, at which time she
observed a correlation between the patients who died and their environmental conditions. As
a result of her observations, the Environment Theory of nursing was born. Nightingale
explained this theory in her book, notes on Nursing: What it is and what it is not. The model
of nursing that developed from Nightingale, who is considered the first nursing theorist,
contains elements that have not changed since the establishment of the modern nursing
profession. Though this theory was pioneering at the time it was created, the principles it
applies are timeless. There are seven assumptions made in the Environment Theory, which
focuses on taking care of the patient’s environment in order to reach health goals and cure
illness. These assumptions are:

1. natural laws

2. mankind can achieve perfection

3. nursing is a calling

4. nursing is an art and a science

5. nursing is achieved through environmental alteration

6. nursing requires a specific educational base

7. nursing is distinct and separate from medicine

The focus of nursing in this model is to alter the patient’s environment in order to affect
change in his or her health. The environmental factors that affect health, as identified in the
theory, are: fresh air, pure water, sufficient food supplies, and efficient drainage, cleanliness
of the patient and environment, and light (particularly direct sunlight). If any of these areas is
lacking, the patient may experience diminished health. A nurse’s role in a patient’s recovery
is to alter the environment in order to gradually create the optimal conditions for the patient’s
body to heal itself. In some cases, this would mean minimal noise and in other cases could
mean a specific diet. All of these areas can be manipulated to help the patient meet his or her
health goals and get healthy. The Environment Theory of nursing is a patient-care theory.
That is, it focuses on the care of the patient rather than the nursing process, the relationship
between patient and nurse, or the individual nurse. In this way, the model must be adapted to
fit the needs of individual patients. The environmental factors affect different patients unique
to their situations and illnesses, and the nurse must address these factors on a case-by-case
basis in order to make sure the factors are altered in a way that best cares for an individual
patient and his or her needs.

The ten major concepts of the Environment Theory, also identified as Nightingale’s
Canons, are:

1. Ventilation and warming

2. Light and noise

3. Cleanliness of the area

4. Health of houses

5. Bed and bedding

6. Personal cleanliness

7. Variety

8. Offering hope and advice

9. Food

10. Observation

According to Nightingale, nursing is separate from medicine. The goal of nursing is to put
the patient in the best possible condition in order for nature to act. Nursing is “the activities
that promote health which occur in any caregiving situation.” Health is “not only to be well,
but to be able to use well every power we have.” Nightingale’s theory addresses disease on a
literal level, explaining it as the absence of comfort. The environment paradigm in
Nightingale’s model is understandably the most important aspect. Her observations taught
her that unsanitary environments contribute greatly to ill health, and that the environment can
be altered in order to improve conditions for a patient and allow healing to occur.

Nightingale’s Modern Nursing Theory also impacted nursing education. She was the first
to suggest that nurses be specifically educated and trained for their positions in healthcare.
This allowed there to be standards of care in the field of nursing, which helped improve
overall care of patients.

3. HILDEGARD PEPLAU’S THEORY OF INTERPERSONAL RELATIONSHIP

MAJOR CONCEPTS

 The theory explains the purpose of nursing is to help others identify their felt difficulties.

 Nurses should apply principles of human relations to the problems that arise at all levels of
experience.

 Peplau's theory explains the phases of interpersonal process, roles in nursing situations and
methods for studying nursing as an interpersonal process.

 Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in

need of health care.

 Nursing is an interpersonal process because it involves interaction between two or more

individuals with a common goal.

 The attainment of goal is achieved through the use of a series of steps following a series of
pattern.

 The nurse and patient work together so both become mature and knowledgeable in the
process.

PHASES OF INTERPERSONAL RELATIONSHIP

Identified four sequential phases in the interpersonal relationship:

1. Orientation

2. Identification

3. Exploitation

4. Resolution

ORIENTATION PHASE

 Problem defining phase

 Starts when client meets nurse as stranger

 Defining problem and deciding type of service needed

 Client seeks assistance conveys needs, asks questions, shares preconceptions and
expectations of past experiences

 Nurse responds, explains roles to client, helps to identify problems and to use available
resources and services

FACTORS INFLUENCING ORIENTATION PHASE

IDENTIFICATION PHASE

 Selection of appropriate professional assistance

 Patient begins to have a feeling of belonging and a capability of dealing with the problem
which decreases the feeling of helplessness and hopelessness

EXPLOITATION PHASE

 Use of professional assistance for problem solving alternatives

 Advantages of services are used is based on the needs and interests of the patients

 Individual feels as an integral part of the helping environment

 They may make minor requests or attention getting techniques

 The principles of interview techniques must be used in order to explore, understand and
adequately deal with the underlying problem

 Patient may fluctuate on independence

 Nurse must be aware about the various phases of communication

 Nurse aids the patient in exploiting all avenues of help and progress is made towards the
final step

RESOLUTION PHASE

 Termination of professional relationship

 The patients’ needs have already been met by the collaborative effect of patient and nurse

 Now they need to terminate their therapeutic relationship and dissolve the links between
them.

 Sometimes may be difficult for both as psychological dependence persists

 Patient drifts away and breaks bond with nurse and healthier emotional balance is
demonstrated and both becomes mature individuals

How to Use Peplau's Theory in Practice

1. Identify what the client is asking for help with. This means actively listening to their
concerns and exploring their experience and behaviours.
2. Be aware of your own behaviours. It will be essential to act professionally, ethically,
emotionally intelligently and without judgment. Trust and respect need to be built.

3. Educate the client about the issues that are concerning and affecting them. Ensure you
utilise evidence-based education approaches. Be person-centred in your teaching approach
and ask the client how they learn best.

4. Behaviour modification may involve applying evidence-based coaching and behaviourist

education styles. You may want to consider investigating what the client’s triggers are for
their behaviours of concern (e.g. ask ‘Can you list the events that led to this behaviour?’).
You may also wish to consider client goal-setting and positive reinforcement (e.g. positive
verbal praise such as ‘Good work meeting the goal that you set in a healthy manner’).

5. In the termination phase, you may need to ensure that the client has the skills and
knowledge for self-management. For example, you may wish to observe the client’s
demonstration of the desirable behaviour. Or, as a different example, this may mean having
the client describe or paraphrase their plans for self-management. It is important, as with any
nursing discharge process, that there is a realistic contingency plan in place. Where will the
client seek help and support from once discharged? When will their progress be reviewed
next? When is the follow-up meeting going to take place?

6. Ensure that thorough documentation occurs throughout the entire relationship/process.

4. MARTHA ROGERS’ THEORY OF UNITARY HUMAN BEINGS

The belief of the coexistence of the human and the environment has greatly influenced the
process of change toward better health. In short, a patient can’t be separated from his or her
environment when addressing health and treatment. This view leads and opened Martha E.
Rogers’ theory, known as the “Science of Unitary Human Beings,” which allowed nursing
to be considered one of the scientific disciplines.

Rogers’ theory defined Nursing as “an art and science that is humanistic and humanitarian. It
is directed toward the unitary human and is concerned with the nature and direction of human
development. The goal of nurses is to participate in the process of change.”

According to Rogers, the Science of Unitary Human Beings contains two dimensions: the
science of nursing, which is the knowledge specific to the field of nursing that, comes from
scientific research; and the art of nursing, which involves using the science of nursing
creatively to help better the lives of the patient.

Assumptions

Rogers’ Theory of Unitary Human Beings’ assumptions are as follows:

 Man is a unified whole possessing his own integrity and manifesting characteristics that
are more than and different from the sum of his parts.
 Man and the environment are continuously exchanging matter and energy with one
another.
 The life process evolves irreversibly and unidirectional along the space-time continuum.
 Pattern and organization identify the man and reflect his innovative wholeness. And
lastly,
 Man is characterized by the capacity for abstraction and imagery, language and thought
sensation, and emotion.
Major Concepts
The following are the major concepts and meta paradigm of Martha Rogers’ nursing
theory:
Human-unitary human beings
A person is defined as an indivisible, pan-dimensional energy field identified by a pattern
and manifesting characteristics specific to the whole. That can’t be predicted from
knowledge of the parts. A person is also a unified whole, having its own distinct
characteristics that can’t be viewed by looking at, describing, or summarizing the parts.
Health
Rogers defines health as an expression of the life process. The characteristics and
behaviour coming from the mutual, simultaneous interaction of the human and
environmental fields and health and illness are part of the same continuum. The multiple
events occurring during the life process show how a person is achieving his or her
maximum health potential. The events vary in their expressions from greatest health to
those incompatible with the maintaining life process.
Nursing It is the study of unitary, irreducible, indivisible human and environmental
fields: people and their world. Rogers claims that nursing exists to serve people, and the
safe practice of nursing depends on the nature and amount of scientific nursing
knowledge the nurse brings to his or her practice.
Scope of Nursing
Nursing aims to assist people in achieving their maximum health potential. Maintenance
and promotion of health, prevention of disease, nursing diagnosis, intervention, and
rehabilitation encompass the scope of nursing’s goals. Nursing is concerned with people-
all people-well and sick, rich and poor, young and old. The arenas of nursing’s services
extend into all areas where there are people: at home, at school, at work, at play, in
hospital, nursing home, and clinic; on this planet and now moving into outer space.
 Environmental Field
“An irreducible, indivisible, pan-dimensional energy field identified by pattern and
integral with the human field.”
Energy Field
The energy field is the fundamental unit of both the living and the non-living. It provides
a way to view people and the environment as irreducible wholes. The energy fields
continuously vary in intensity, density, and extent.
Strengths
Martha Rogers’ concepts provide a worldview from which nurses may derive theories
and hypotheses and propose relationships specific to different situations.
Rogers’ theory is not directly testable due to a lack of concrete hypotheses, but it is
testable in principle.
Weaknesses
 Rogers’ model does not define particular hypotheses or theories, for it is an abstract,
unified, and highly derived framework.
 Testing the concepts’ validity is questionable because its concepts are not directly
measurable.
 The theory was believed to be profound and was too ambitious because the concepts are
extremely abstract.
 Rogers claimed that nursing exists to serve people. However, nurses’ roles were not
clearly defined.
 The purpose of nurses is to promote health and well-being for all persons wherever they
are. However, Rogers’ model has no concrete definition of a health state.
Conclusion
The Science of Unitary Human Beings is highly generalizable as the concepts and ideas
are not confined to a specific nursing approach, unlike the usual way of other nurse
theorists defining the major concepts of a theory.
Rogers gave much emphasis on how a nurse should view the patient. She developed
principles that emphasize that a nurse should view the client as a whole.
Her statements, in general, made us believe that a person and his or her environment are
integral to each other. A patient can’t be separated from his or her environment when
 addressing health and treatment. Her conceptual framework has greatly influenced
nursing by offering an alternative to traditional nursing approaches.

5. MADELIENE M LEININGER’S TRANSCULTURAL MODEL

Leininger’s model has developed into a movement in nursing care called transcultural
nursing. In 1995, Leininger defined transcultural nursing as “a substantive area of study and
practice focused on comparative cultural care (caring) values, beliefs, and practices of
individuals or groups of similar or different cultures with the goal of providing culture-
specific and universal nursing care practices in promoting health or well-being or to help
people to face unfavorable human conditions, illness, or death in culturally meaningful
ways.”

Leininger proposes that there are three modes for guiding nurse’s judgments, decisions, or
actions in order to provide appropriate, beneficial, and meaningful care: preservation and/or
maintenance; accommodation and/or negotiation; and re-patterning and/or restructuring. The
modes have greatly influenced the nurse’s ability to provide culturally congruent nursing
care, as well as fostering culturally-competent nurses.

Leininger’s model makes the following assumptions:

1. Care is the essence of nursing and a distinct, dominant, and unifying focus.

2. Caring is essential for well-being, health, healing, growth, and to face death.

3. Culture care is the broadest holistic means by which a nurse can know, explain, interpret,
and predict nursing care phenomena to guide nursing care practices.
4. Nursing is a transcultural, humanistic, and scientific care discipline and profession with the
central purpose to serve human beings worldwide.

5. Caring is essential to curing and healing. There can be no curing without caring.

6. Culture care concepts, meanings, expressions, patterns, processes, and structural forms of
care are different and similar among all cultures of the world.

7. Every human culture has lay care knowledge and practices and usually some professional
care knowledge and practices which vary transculturally.

8. Culture care values, beliefs, and practices are influenced in the context of a particular
culture. They tend to be embedded in such things as worldview, language, spirituality,
kinship, politics and economics, education, technology, and environment.

9. Beneficial, healthy, and satisfying culturally-based nursing care contributes to the

wellbeing of individuals, families, and communities within their environmental context.

10. Culturally congruent nursing care can only happen when the patient, family, or
community values, expressions, or patterns are known and used appropriately, and in
meaningful ways by the nurse with the people.

11. Culture care differences and similarities between the nurse and patient exist in any human
culture worldwide.

12. Clients who experience nursing care that fails to be reasonably congruent with their
beliefs, values, and caring life ways will show signs of cultural conflicts, noncompliance,
stresses and ethical or moral concerns.

13. The qualitative paradigm provides new ways of knowing and different ways to discover
the epistemic and ontological dimensions of human care. The Culture Care Theory defines
nursing as a learned scientific and humanistic profession that focuses on human care
phenomena and caring activities in order to help, support, facilitate, or enable patients to
maintain or regain health in culturally meaningful ways, or to help them face handicaps or
death.
6. DOROTHEA OREM’S SELF-CARE DEFICIT THEORY
Description
Dorothea Orem’s Self-Care Deficit Theory defined Nursing as “The act of assisting
others in the provision and management of self-care to maintain or improve human
functioning at the home level of effectiveness.” It focuses on each individual’s ability to
perform self-care, defined as “the practice of activities that individuals initiate and
perform on their own behalf in maintaining life, health, and well-being.”
There are instances wherein patients are encouraged to bring out the best in them despite
being ill for a period of time. This is very particular in rehabilitation settings, in which
patients are entitled to be more independent after being cared for by physicians and
nurses. Between 1959 and 2001, Dorothea Orem developed the Self-Care Nursing
Theory or the Orem Model of Nursing. It is considered a grand nursing theory, which
means the theory covers a broad scope with general concepts applicable to all instances
of nursing.
Major Concepts of the Self-Care Deficit Theory
In this section are the definitions of the major concepts of Dorothea Orem’s Self-Care
Deficit Theory:
Nursing
Nursing is an art through which the practitioner of nursing gives specialized assistance to
persons with disabilities, making more than ordinary assistance necessary to meet self-
care needs. The nurse also intelligently participates in the medical care the individual
receives from the physician.

Humans
Humans are defined as “men, women, and children cared for either singly or as social
units” and are the “material object” of nurses and others who provide direct care.
Environment
The environment has physical, chemical, and biological features. It includes the family,
culture, and community.
Health
Health is “being structurally and functionally whole or sound.” Also, health is a state that
encompasses both the health of individuals and groups, and human health is the ability to
reflect on oneself, symbolize experience, and communicate with others.
Self-Care
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.
From this perspective, caring is an innate human trait, the “human mode of being,” a part
of human nature, and essential to human existence.
 Although all humans have the potential to care, this ability is not uniform.
 Roach suggests that one’s own experience in being cared for and expressing caring
influences one’s ability to care.
 The nurse’s educational experience professionalizes this caring through the acquisition
of knowledge and skills.
 Despite this assertion that one’s ability to care is influenced by life experiences in being
cared for and in expressing caring, research that verifies this by examining the early
experiences of nurses has yet to test this relationship.
 Alternatively, Leininger states that diverse expressions, meanings, patterns, and
modalities of caring are culturally derived. Attributes of professional caring, such as
Roach’s dimensions of compassion, competence, confidence, conscience, and
commitment, or Leininger’s 55 carative constructs, are derived from or have their focus
in caring. According to these definitions, the human trait of caring is the motivator of
nursing actions.
 Benner and Wrubel concur that caring is the “basic way of being in the world” from
which all nursing practice evolves. They agree that one’s ability to care is enhanced by
learning and that differences in nursing practice reflect different levels of expertise in
understanding the meaning of the patients’ experiences of health and illness.
 Similarly, Griffin views caring (and Orem considers self-care) as a human trait
underlying nursing practice.
 However, Orem believes that caring consists of actions by others, which become
necessary when self-care requirements cannot be met.
 The universal concept of care is extended by Ray, who examines the human aspects of
caring in the context of bureaucratic hospital organizations. Because all cultures have
developed social organizations to some degree, this description of caring is universally
apropos. Ray’s description of care encompasses a synthesis among political, economic,
legal, and technological aspects as well as humanistic dimensions of caring. As such, this
theory of “bureaucratic caring” has implications that extend beyond the nursing
profession.

CARING AS A MORAL IMPERATIVE OR IDEAL

 Authors in this category describe caring as a “fundamental value” or moral ideal in
nursing. For example, Gordon and Watson suggest that the substantive base of nursing is
preserving the dignity of patients. From this perspective, caring is not manifest as “a set
of identifiable behaviours,” images, or traits evident in the caring nurse (e.g., sympathy,
tenderness, or support) nor does it encompass all that nurses do. Rather, caring is the
adherence to the commitment of maintaining the individual’s dignity or integrity.
 In contrast to Gordon realistic and attainable view for praxis, Watson suggests that
caring actions revealed in the nurse–patient encounter is merely “approximations of
caring” and not a “pure form of caring.”
 According to Watson, caring remains an unattainable ideal.
 Nevertheless, in agreement with the theorists who adhere to the human-trait
perspective, theorists who describe caring as a moral imperative concur that caring
provides the basis for all nursing actions. Thus, the environment in which nurse’s work
must facilitate and support caring.
 Paradoxically, nurses are caught in a dilemma created by a mandate to care in a society
that does not value caring.
 Nurses are expected to care for others as a duty (i.e., to be altruistic), yet they are
unable to exercise their right to control their own practice (i.e., without professional
autonomy).
 Fry notes that if, as a profession, nursing holds caring as a moral ideal and present
working conditions increasingly limit the opportunity to care (e.g., unsafe staffing
conditions persist), then the survival of the nursing profession remains in question.

CARING AS AN AFFECT
 The authors who define caring as an affect emphasize that the nature of caring extends
from emotional involvement with or an empathetic feeling for the patient experience. For
example, McFarlane states that caring “signifies a feeling of concern, of interest, of
oversight with a view to protection.”
 Bevis considers caring to be a feeling of dedication, a feeling that motivates nursing
actions. It is a response that is primarily focused on increasing intimacy between the
nurse and the patient, which in turn enhances mutual self-actualization and consists of the
following four developmental stages: attachment, assiduity, intimacy, and confirmation,
each with its own tasks to be accomplished. Without successful progression through each
stage, caring does not take place; instead, it becomes “warped, non-functional or
stagnant” and it becomes distorted, changed, and “no longer caring.”.
 From the perspective of caring as an affect (reflecting nursing as a female profession
with historical roots in religion), the nurse is moved to act selflessly without immediate
gratification or expectation of material reward.
  The personal vulnerability of the nurse who becomes involved with a patient or
patient’s family as a result of an empathetic identification with the patient’s experience
can be potentially damaging to the nurse, but support
and recognition from colleagues may alleviate personal frustrations and maintain the
nurse’s ability to care.
 Unfortunately, the effectual nature of caring may be jeopardized or devalued in some
situations. For example, constraints on nursing time (e.g., the increased demand for
technical skills), technological demands (e.g., the distraction of monitors), and
unattractive patient characteristics (e.g., rejecting or unresponsive behaviours) may
inhibit the development of a caring feeling toward the patient.
 Furthermore, institutional incentive for the nurse to care is lacking and professional
socialization to remain objective, such as warnings not to get “too involved” with
patients, continues to contribute to the devaluation of the importance of caring as an
affect in nursing.

CARING AS THE NURSE–PATIENT INTERPERSONAL RELATIONSHIP

 In contrast to those who view the caring relationship between the nurse and the patient
as the foundation of human caring or the medium through which it is expressed, authors
who believe caring is an interpersonal relationship suggested that the nurse–patient
relationship is the essence of caring.
 Those with this perspective believe the interaction between the nurse and the patient
both expresses and defines caring. Caring encompasses both the feeling and the
behaviours occurring within the relationship.39 For example, the relationship (i.e.,
feeling) and content (i.e., behaviour) of caring include aspects such as “showing concern”
and “health teaching.” Alternatively, these may be manifested in the supportive
relationships that nurses have with their patients.
CARING AS A THERAPEUTIC INTERVENTION
 By defining specific nursing interventions or therapeutics as caring or by describing
conditions as necessary for caring actions, these theorists have linked caring more
directly than others to the work of nurses.
  Caring actions may be specific, such as attentive listening, patient teaching, patient
advocacy, touch, “being there,” and technical competence, or caring may include all
nursing actions (i.e., all nursing procedures or interventions) that enable or assist patients.
 Emphasis is placed on the necessity for adequate knowledge and skill as a basis for
these caring actions as well as on the congruence between nursing actions and the
patient’s perception of need.
 Several researchers obtained patients’ perceptions of the importance of preselected
nursing behaviours and interventions in relation to being cared for, implying that these
nursing behaviours and interventions are caring. Two investigations included an open-
ended question asking patients to describe situations in which they felt cared for. These
data were used to verify the “caringness” of interventions included in the questionnaire
rather than to define caring person.
OUTCOMES OF CARE AND CARING
Rather than studying the concept of care and caring, some researchers have examined the
concept of care by exploring patient physiologic or psychologic outcomes. This
perspective is primarily used by those researchers who focus on quality assurance and use
physiologic outcomes as indicators of care (e.g., injuries from patient falls). For example,
these outcomes may be the level of care, determined using selected statistical indices,
such as morbidity and mortality statistics, length of stay (hospitalization), or the number
of patient-incident reports, thus removing the indicators of care to the group level.
Alternatively, researchers and auditors may use a physical examination to observe for the
absence of indicators of poor care, such as skin conditions (decubitus and abrasions),
poor muscle tone, or even the patient’s state of hygiene to ensure that an individual
patient has been cared for. Attempts are now being made to include patients’ subjective
responses to care as part of quality assurance programs.
THEORIES OF CARE AND CARING FOR NURSING
Thus far, three major theories of caring have been developed for nursing.
 The first is Orem’s Self-Care Deficit Theory of Nursing. It includes three interrelated
theories of self-care deficit, self-care, and nursing systems. Assuming that human beings
need “continuous self-maintenance and self-regulation” through actions referred to as
“self-care” and that their ability to meet this need can vary, caregivers may be required to
 perform specific actions to assist patients in meeting their self-care requisites when they
are unable to do so themselves. The main caring functions identified by Orem are part of
a “helping system” and include doing for or acting for another, guiding another,
supporting another (physically and psychologically), providing environmental conditions
that support personal development, and teaching.6 However, the values inherent in this
self-care theory reflect those of western society and may not be appropriate in other
societies, including multicultural ones.
 The second caring theory, the Theory of Human Caring, developed by Watson
explicates the kind of relationships and transactions that are necessary between the
caregiver and care receiver to promote and to protect
the patient’s humanity, thereby influencing the patient’s healing potential. In describing
the processes involved in caring as well as the outcomes of care, Watson, emphasizes the
psychological, emotional, and spiritual dimensions of care almost to the exclusion of
other characteristics of everyday tasks inherent in nursing care, such as bathing or
procedures involving technical expertise. Combinations of interventions related to the
process of human care are presented as carative factors (e.g., a “humanistic altruistic
system of values” and “installation of faith-hope”) that are enacted in the context of the
caring relationship.
Several questions arise regarding Watson’s theory. First, there is a broad gap between the
nurse caring process and the clinical reality, and some authors have suggested that this
gap reduces clinical relevance. Second, the depth of the nurse– patient relationship
required in Watson’s theory may be impossible to attain in many nursing situations in
which the length of hospitalization is short, the nurse– patient contact is brief (as with
minor surgical admissions), or the patients are unable to interact with the nurses (as in the
case of unconscious or cognitively impaired patients). Third, if this theory accurately
describes caring in nursing, and one of nursing’s major responsibilities is to care, then
one may question whether nurses are really nursing in situations when the caring
relationship has not developed. Finally, it is difficult to discern a unique caring role for
nurses on the basis of this theory. As Ryan points out, “not all human caring is nursing.”
Thus, the theory may also be useful to other professionals involved in caring, such as
psychologists, theologians, and social workers.
 The third theory, Leininger’s Theory of Transcultural Care Diversity and
Universality, has matured from a static taxonomy of caring constructs to a theory that
predicts culturally specific “nursing care actions” that are beneficial to and congruent
with the client’s expectations and beliefs.
Although some of the care “patterns, processes and acts” may be universal, cultural
diversity, human variation, and ecologic variation result in some “care diversities.” Three
nursing care actions—maintenance, negotiation, and restructuring assist the client to
change health, life patterns, or “life ways.” Leininger’s Sunrise Model is intended as a
“holistic conceptualization to help the researcher systematically study the theory’s
diverse components.” As yet, the theory is described in general abstract terms (e.g.,
“cultural care preservation/maintenance” or “assistive, supportive or enabling
professional actions and decisions” that encompass a broad range of undesignated
nursing activities. Leininger calls for further research to identify these nursing actions
and decisions and to explore their conditions and consequences. Nevertheless,
Leininger’s Theory of Transcultural Care Diversity and Universality has alerted nurses to
the need to consider cultural values and practices that influence patterns and meanings of
care, and this contribution is significant.

PROCESS OF CARING
Although the authors have been classified, into the above categories on the basis of the
primary emphasis they have given to caring, many have also drawn links to other
categories. Other authors have described caring as a process that moves from one of the
categories in to another and not as a process that changes within an identified category.
For example, Leininger, who views caring as a human trait that motivates caring actions,
links her ideas concerning caring to the categories of therapeutic interventions and the
patient’s subjective experience? On the other hand, on the basis of an ethical foundation,
Gadow draws implications for caring in nurse–patient interactions using the nursing
actions of truth telling and touch and links the moral imperative to therapeutic
intervention. In other words, the subjective (rather than the objective) interaction between
the nurse and the patient results in a change in the patient’s subjective experience.
Watson’s theory fits into the moral imperative category, and as she sees the nurse–patient
relationship and how this affects health and healing, her theory is also linked to the
interpersonal relationship category. Again this extends to the patient’s subjective
experience, “restoring inner harmony and potential healing” of the patient. Many of these
linkages are ill-defined or implicit rather than clearly described. these inferences, the
outcome of caring in nursing is a change in the patient’s physical and psychological
experience through nursing actions and work. However, these linkages are often tenuous
and need further development.

THE FOCUS OF CARE

It is the authors’ opinion, albeit often implicit, that the ultimate outcome of caring is to
alter patient responses. Those theorists who have explicitly extended this caring to the
patient largely focus on the patient’s subjective experience and, with the exception of
Orem6 and Stevenson, do not include the patient’s physical responses (Figure 1.1).
Others who consider outcomes have used global indices, such as health61 and well-being.
Yet, if the goal is changing patient outcomes, then why is the theoretic link from nurse
caring to the patient outcome inexplicit and often tenuous? In particular, among those
theorists who perceive caring to be an effect, little attention is given to the patient;
research efforts focus on the nurse. For example, research may be conducted from this
perspective to develop scales to measure nurses’ propensity to care or to predetermine
nurse caring behaviours.

Such approaches may have only limited usefulness in nursing, especially given the
evidence for the patient’s low valuing of the nurses’ affect. It is apparent that the concept
of caring has not yet matured beyond the stage of adolescence; it is imperative that
researchers mature and move forward to focus on the patient. Many questions are yet to
be answered about the therapeutic nature of caring. Can caring be nontherapeutic? Can a
nurse care too much? There is evidence that a nurse may become overinvolved with a
patient so that the nurse’s commitment to the patient as a person takes precedence over
the nurse’s commitment to the patient’s treatment goals. Consequently, the nurse may
serve to assist the patient to bend or to break institutional rules or to avoid therapy,
which, from a curative perspective, is not in the patient’s best interests. Alternatively, the
nurse may relish a caring relationship and foster patient dependency to meet his or her
own needs for caring, thus interfering with treatment goals that work toward patient
autonomy and health. These unseemly aspects of the caring relationship have yet to be
addressed by contemporary nurse theorists.
THE CONSEQUENCES OF CARING It is unquestionable that caring has limited
utility for meeting all patients’ needs. Gadow writes, “it is not that caring will achieve a
cure … it will not arrest pathology”; and Leininger notes that caring is a necessary but
insufficient condition for cure. Yet, conversely, can a cure be realized without caring?
Reflections on the efficacy of caring, on the health outcomes of caring actions, and, to
take this one step further, on quantifying caring and communicating caring
epidemiologically with morbidity and mortality, have not been attempted. A related
question is whether a nurse can provide safe practice without caring. Gadow notes that
sometimes it may be necessary to practice without care. It is paradoxical that for a nurse
to care, he or she must be embodied and totally immersed in the patient’s experience. Yet
to inflict pain an often necessary part of
any procedure the nurse must be disembodied from the pain experience. Paradoxically,
while the nurse is in this state of disembodiment, the suffering patient is immersed in the
experience, in a state of total embodiment. This introduces an important question as
follows: If nurses must become detached from caring to perform pain-inducing nursing
procedures, in other words, to nurse, how can caring retain its seminal, theoretic position
as the essence of nursing? Analysis of the concept of caring and the identification of the
five conceptualizations of care are important. The breadth of these conceptualizations,
whether caring is “only” an affect or whether caring may also encompass technical tasks
(as in nursing care), is significant for the critics who have difficulty seeing the clinical
relevance of caring as a concept and who for that reason have rejected the concept of
caring. Clearly, further conceptual development and refinement of caring are important.
The first desperately needed step is to develop a clear conceptualization of caring that
encompasses all aspects of nursing. Until this is accomplished, progress will be restricted.
The beginning moves away from the exclusive development of nurse-focused theories of
care to include patient-centered theory is significant. Until this move is developed until
patient outcomes of caring are considered caring will remain an inadequate and only
partially useful concept for nursing. Although caring has been called the glue that holds
nursing together, at this time it does not appear to have the pragmatic implications
necessary for the practice of nursing per se. In addition, none of the authors suggested or
developed a model that includes caring as a minor component. It was always suggested
that other constructs (e.g., Leininger’s care constructs and Watson’s carative factors)
might be a part of caring, not the reverse. Caring as a component of a more encompassing
construct, such as comfort, may be a perspective worthy of consideration.
In a closely related step, the focus of theory and research must shift to incorporate a focus
on the patient, asking, “What difference does caring make to the patient?” If caring
changes, the course of illness for the patient, then the concept may be useful enough to
retain its lofty position as the “essence of nursing.” If the question cannot be answered or
if a negative answer is forthcoming (i.e., a careless nurse can still provide satisfactory
care even in some conditions), then the concept of care is inappropriate or inadequate to
stand alone as the central or encompassing theory for nursing. As distressing as removing
caring as the central paradigm may seem, caring may not be totally discarded. Even if
caring is the main ingredient that makes nursing humanistic, what else is essential to
nursing? Clues are emerging as qualitative research increases and as patients’ “stories” or
case studies, such as those now published in the American Journal of Nursing, become
increasingly available. Thus far, this material has not contributed to the theory
development beyond Benner’s69 concept of the expert nurse, and inductive theory
development from these case histories is sorely needed. This approach can complement
the ongoing philosophic inquiry. Of special concern, discrepancies remain among the
various conceptualizations of care, especially between those who view caring as an
interaction process and those who view care as an intervention. The bedside nurses must
contend with the crosscurrents of these two divergent concepts of care competing for
their allegiance. Thus, the administrator’s goal is to achieve the tasks of nursing as
efficiently (i.e., quickly) and as economically (i.e., with minimal staff) as possible. It is
clear that tension may develop between these administrators and nurses who value caring
as an interpersonal interaction. Administrators seek to control nursing actions, to limit
caring time, and to require concrete, measurable outcomes to justify their actions, while
nurses beg for time for caring tasks (e.g., listening to the patient’s concerns) that do not
 have solid, quantifiable outcomes other than patient satisfaction. Even in their own arena,
the bedside nurses do not have professional control of their own practice; consequently,
they may be forced to resort to deviant and defiant behaviours to maintain minimum
staffing levels and a safe and caring practice. Finally, although the divergent perspectives
of care and caring as described by the nurse theorists provide eclectic and diverse
conceptualizations that strengthen the concept, further development is needed.
Meanwhile, it is imperative that conceptualizations and theories of care and caring must
be debated, queried, and clarified so that the concept, when developed, will be applicable
to the art and science of nursing.
CATEGORIES AND COMPONENTS OF NURSING CARE
Providing the framework for nursing care, the nursing process consists of five
components, each of which follows logically one after the other:
• Assessment
• Nursing diagnosis
• Planning
• Implementation
• Evaluation.
It is important for the nurse to recognise that the process is ongoing and cyclical in that
each step relies on the step preceding and the step following. Shows diagrammatic
representation of the nursing process.
7. MARJORIE GORDON'S 11 FUNCTIONAL HEALTH PATTERNS

Marjorie Gordon proposed functional health patterns as a guide for establishing a

comprehensive nursing data base of pertinent client assessment information (Jones, 2013).
These 11 categories make possible a systematic and standardised approach to data collection,
and enable the nurse to determine the following aspects of health and human function in
order to plan required nursing care for their clients. Consider the questions that you will need
to ask your client to collect relevant and pertinent information for each of the 11 functional
health patterns. Once you have the information, you will need to either type it directly onto
this page, or type it into a separate document and up-load that to this page.
 Health perception and health management: Data collection is focused on the person's
perceived level of health and well-being, and on practices for maintaining health. Habits that
may be detrimental to health are also evaluated, including smoking and alcohol or drug use.
Actual or potential problems related to safety and health management may be identified as
well as needs for modifications in the home or needs for continued care in the home.

Nutrition and metabolism: Assessment is focused on the pattern of food and fluid
consumption relative to metabolic need. The adequacy of local nutrient supplies is evaluated.
Actual or potential problems related to fluid balance, tissue integrity, and host defences may
be identified as well as problems with the gastrointestinal system.

Elimination: Data collection is focused on excretory patterns (bowel, bladder, skin).

Excretory problems such as incontinence, constipation, diarrhoea, and urinary retention may
be identified.

Activity and exercise: Assessment is focused on the activities of daily living requiring energy
expenditure, including self-care activities, exercise, and leisure activities. The status of major
body systems involved with activity and exercise is evaluated, including the respiratory,
cardiovascular, and musculoskeletal systems.

Cognition and Perception: Assessment is focused on the ability to comprehend and use
information and on the sensory functions. Data pertaining to neurological functions are collected
to aid this process. Sensory experiences such as pain and altered sensory input may be identified
and further evaluated.

Sleep and rest: Assessment is focused on the person's sleep, rest, and relaxation
practices. Dysfunctional sleep patterns, fatigue, and responses to sleep deprivation may
be identified. Self-perception and self-concept: Assessment is focused on the person's
attitudes toward self, including identity, body image, and sense of self-worth. The
person's level of self-esteem and response to threats to his or her self-concept may be
identified.
Roles and relationships: Assessment is focused on the person's roles in the world and
relationships with others. Satisfaction with roles, role strain, or dysfunctional
relationships may be further evaluated.
 Sexuality and reproduction: Assessment is focused on the person's satisfaction or
dissatisfaction with sexuality patterns and reproductive functions. Concerns with
sexuality may he identified.
Coping and stress tolerance: Assessment is focused on the person's perception of stress
and on his or her coping strategies Support systems are evaluated, and symptoms of stress
are noted. The effectiveness of a person's coping strategies in terms of stress tolerance
may be further evaluated.
Values and belief: Assessment is focused on the person's values and beliefs (including
spiritual beliefs), or on the goals that guide his or her choices or decisions.
8. FAYE GLENN ABDELLAH 21 NURSING PROBLEMS THEORY

 Developed the 21 Nursing Problems Theory

 “Nursing is based on an art and science that molds the attitudes, intellectual competencies,
and technical skills of the individual nurse into the desire and ability to help people, sick or
well, cope with their health needs.”

 Changed the focus of nursing from disease-centered to patient centered and began to
include families and the elderly in nursing care.

 The nursing model is intended to guide care in hospital institutions but can also be applied
to community health nursing, as well.

9. ERNESTINE WIEDENBACH

 Developed The Helping Art of Clinical Nursing conceptual model.

 Definition of nursing reflects on nurse-midwife experience as “People may differ in their

concept of nursing, but few would disagree that nursing is nurturing or caring for someone in
a motherly fashion.”

 Guides the nurse action in the art of nursing and specified four elements of clinical
nursing: philosophy, purpose, practice, and art.

 Clinical nursing is focused on meeting the patient’s perceived need for help in a vision of
nursing that indicates considerable importance on the art of nursing.
10. Lydia E

 Developed the Care, Cure, Core Theory is also known as the “Three Cs of Lydia Hall“

 Hall defined Nursing as the “participation in care, core and cure aspects of patient care,
where CARE is the sole function of nurses, whereas the CORE and CURE are shared with
other members of the health team.”  The major purpose of care is to achieve an
interpersonal relationship with the individual to facilitate the development of the core.  The
“care” circle defines a professional nurse’s primary role, such as providing bodily care for
the patient. The “core” is the patient receiving nursing care. The “cure” is the aspect of
nursing that involves the administration of medications and treatments.

11. JOYCE TRAVELBEE

 States in her Human-to-Human Relationship Model that the purpose of nursing was to
help and support an individual, family, or community to prevent or cope with the struggles of
illness and suffering and, if necessary, to find significance in these occurrences, with the
ultimate goal being the presence of hope.

 Nursing was accomplished through human-to-human relationships.

 Extended the interpersonal relationship theories of Peplau and Orlando.

12. KATHRYN E. BARNARD

 Developed the Child Health Assessment Model.

 Concerns improving the health of infants and their families.

 Her findings on parent-child interaction as an important predictor of cognitive development

helped shape public policy.

 She is the founder of the Nursing Child Assessment Satellite Training Project
(NCAST), which produces and develops research based products, assessment, and training
programs to teach professionals, parents, and other caregivers the skills to provide nurturing
environments for young children.
 Borrows from psychology and human development and focuses on mother-infant
interaction with the environment.

 Contributed a close link to practice that has modified the way health care providers assess
children in light of the parent-child relationship.

13. Evelyn Adam

 Focuses on the development of models and theories on the concept of nursing.

 Includes the profession’s goal, the beneficiary of the professional service, the role of the
professional, the source of the beneficiary’s difficulty, the intervention of the professional,
and the consequences.

 A good example of using a unique basis of nursing for further expansion.

14. Nancy Roper, Winifred Logan, and Alison J. Tierney

 A Model for Nursing Based on a Model of Living

 Logan produced a simple theory, “which actually helped bedside nurses.”

 The trio collaborated in the fourth edition of The Elements of Nursing: A Model for
Nursing Based on a Model of Living and prepared a monograph entitled The Roper-
Logan-Tierney Model of Nursing: Based on Activities of Daily Living.

 Includes maintaining a safe environment, communicating, breathing, eating and drinking,

eliminating, personal cleansing and dressing, controlling body temperature, mobilizing,
working and playing, expressing sexuality, sleeping, and dying.

15. Ida Jean Orlando

 She developed the Nursing Process Theory.

 “Patients have their own meanings and interpretations of situations, and therefore nurses
must validate their inferences and analyses with patients before drawing conclusions.”

 Allows nurses to formulate an effective nursing care plan that can also be easily adapted
when and if any complexity comes up with the patient.
 According to her, persons become patients requiring nursing care when they have needs for
help that cannot be met independently because of their physical limitations, negative
reactions to an environment, or experience that prevents them from communicating their
needs.

 The role of the nurse is to find out and meet the patient’s immediate needs for help.

16. JEAN WATSON THEORY OF HUMAN CARING

 She pioneered the Philosophy and Theory of Transpersonal Caring.

 “Nursing is concerned with promoting health, preventing illness, caring for the sick, and
restoring health.”

 Mainly concerns with how nurses care for their patients and how that caring progresses into
better plans to promote health and wellness, prevent illness and restore health.

 Focuses on health promotion, as well as the treatment of diseases.

Caring is central to nursing practice and promotes health better than a simple medical cure.

17. Marilyn Anne Ray

 Developed the Theory of Bureaucratic Caring

 “Improved patient safety, infection control, reduction in medication errors, and overall
quality of care in complex bureaucratic health care systems cannot occur without knowledge
and understanding of complex organizations, such as the political and economic systems, and
spiritual-ethical caring, compassion and right action for all patients and professionals.”

 Challenges participants in nursing to think beyond their usual frame of reference and
envision the world holistically while considering the universe as a hologram.

 Presents a different view of how health care organizations and nursing phenomena
interrelate as wholes and parts in the system.

18. Patricia Benner

 Caring, Clinical Wisdom, and Ethics in Nursing Practice

 “The nurse-patient relationship is not a uniform, professionalized blueprint but rather a
kaleidoscope of intimacy and distance in some of the most dramatic, poignant, and mundane
moments of life.”

 Attempts to assert and re-establish nurses’ caring practices when nurses are rewarded more
for efficiency, technical skills, and measurable outcomes.

 States that caring practices are instilled with knowledge and skill regarding everyday
human needs.

19. KARI MARTINSEN

 Philosophy of Caring

 “Nursing is founded on caring for life, on neighbourly love, […]At the same time, the nurse
must be professionally educated.”

 Human beings are created and are beings for whom we may have administrative
responsibility.

 Caring, solidarity, and moral practice are unavoidable realities.

20. Katie Eriksson

 Theory of Carative Caring

 “Caritative nursing means that we take ‘caritas’ into use when caring for the human being
in health and suffering […] Caritative caring is a manifestation of the love that ‘just exists’
[…] Caring communion, true caring, occurs when the one caring in a spirit of caritas
alleviates the suffering of the patient.”

 The ultimate goal of caring is to lighten suffering and serve life and health.

 Inspired many in the Nordic countries and used it as the basis of research, education, and
clinical practice.
21. MYRA ESTRIN LEVINE: CONSERVATION MODEL FOR NURSING

 According to the Conservation Model, “Nursing is human interaction.”

 Provides a framework within which to teach beginning nursing students.

 Logically congruent, externally and internally consistent, has breadth and depth, and is
understood, with few exceptions, by professionals and consumers of health care.

22. MARTHA E. ROGERS: THEORY OF UNITARY HUMAN BEINGS

 In Roger’s Theory of Human Beings, she defined Nursing as “an art and science that is
humanistic and humanitarian.

 The Science of Unitary Human Beings contains two dimensions: the science of nursing,
which is the knowledge specific to the field of nursing that comes from scientific research;
and the art of nursing, which involves using nursing creatively to help better the lives of the
patient.  A patient can’t be separated from his or her environment when addressing health
and treatment.

23. DOROTHEA E. OREM

 In her Self-Care Theory, she defined Nursing as “The act of assisting others in the
provision and management of self-care to maintain or improve human functioning at the
home level of effectiveness.”  Focuses on each individual’s ability to perform self-care. 
Composed of three interrelated theories:

(1) the theory of self-care,

(2) the self-care deficit theory, and

(3) the theory of nursing systems, which is further classified into wholly compensatory,
partially compensatory, and supportive-educative.

24. IMOGENE M. KING

 Conceptual System and Middle-Range Theory of Goal Attainment

  “Nursing is a process of action, reaction and interaction by which nurse and client share
information about their perception in a nursing situation” and “a process of human
interactions between nurse and client whereby each perceives the other and the situation, and
through communication, they set goals, explore means, and agree on means to achieve
goals.”

 Focuses on this process to guide and direct nurses in the nurse-patient relationship, going
hand-in-hand with their patients to meet good health goals.

 Explains that the nurse and patient go hand-in-hand in communicating information, set
goals together, and then take actions to achieve those goals.

25. BETTY NEUMAN

 In Neuman’s System Model, she defined nursing as a “unique profession in that is

concerned with all of the variables affecting an individual’s response to stress.”

 The focus is on the client as a system (which may be an individual, family, group, or
community) and on the client’s responses to stressors.

 The client system includes five variables (physiological, psychological, sociocultural,

developmental, and spiritual). It is conceptualized as an inner core (basic energy
resources) surrounded by concentric circles that include lines of resistance, a normal defense
line, and a flexible line of defense.

26. SISTER CALLISTA ROY

 In Adaptation Model, Roy defined nursing as a “health care profession that focuses on
human life processes and patterns and emphasizes the promotion of health for
individuals, families, groups, and society as a whole.”

 Views the individual as a set of interrelated systems that strives to maintain a balance
between various stimuli.

 Inspired the development of many middle-range nursing theories and adaptation

instruments.
 27. DOROTHY E. JOHNSON

 The Behavioural System Model defined Nursing as “an external regulatory force that
acts to preserve the organization and integrate the patients’ behaviours at an optimum
level under those conditions in which the behaviour constitutes a threat to the physical
or social health or in which illness is found.”

 Advocates to foster efficient and effective behavioural functioning in the patient to prevent
illness and stresses the importance of research-based knowledge about the effect of nursing
care on patients.

 Describes the person as a behavioural system with seven subsystems: the achievement,
attachment-affiliative, aggressive-protective, dependency, ingestive, eliminative, and
sexual subsystems. caring.”  Caring in nursing is “an altruistic, active expression of love,
and is the intentional and embodied recognition of value and connectedness.”

28. AFAF IBRAHIM MELEIS

 Transitions Theory

 It began with observations of experiences faced as people deal with changes related to
health, well-being, and the ability to care for themselves.

 Types of transitions include developmental, health and illness, situational, and

organizational.

 Acknowledges the role of nurses as they help people go through health/illness and life
transitions.

 Focuses on assisting nurses in facilitating patients’, families’, and communities’ healthy

transitions.

29. NOLA J. PENDER

Health Promotion Model

 Describes the interaction between the nurse and the consumer while considering the role of the
health promotion environment.
 It focuses on three areas: individual characteristics and experiences, behaviour-specific
cognitions and affect, and behavioural outcomes.

 Describes the multidimensional nature of persons as they interact within their environment to
pursue health.

30. MADELEINE M. LEININGER: TRANSCULTURAL NURSING THEORY

 Culture Care Theory of Diversity and Universality

 Defined transcultural nursing as “a substantive area of study and practice focused on

comparative cultural care (caring) values, beliefs, and practices of individuals or groups of
similar or different cultures to provide culture-specific and universal nursing care practices in
promoting health or well-being or to help people to face unfavourable human conditions, illness,
or death in culturally meaningful ways.”

 Involves learning and understanding various cultures regarding nursing and health-illness
caring practices, beliefs, and values to implement significant and efficient nursing care services
to people according to their cultural values and health-illness context.

 It focuses on the fact that various cultures have different and unique caring behaviours and
different health and illness values, beliefs, and patterns of behaviours.

31. MARGARET A. NEWMAN

 Health as Expanding Consciousness

 “Nursing is the process of recognizing the patient in relation to the environment, and it is the
process of the understanding of consciousness.”

 “The theory of health as expanding consciousness was stimulated by concern for those for
whom health as the absence of disease or disability is not possible . . . “

 Nursing is regarded as a connection between the nurse and patient, and both grow in the sense
of higher levels of consciousness.

32. ROSEMARIE RIZZO PARSE

 Human Becoming Theory

 “Nursing is a science, and the performing art of nursing is practiced in relationships with
persons (individuals, groups, and communities) in their processes of becoming.”

 Explains that a person is more than the sum of the parts, the environment, and the person is
inseparable and that nursing is a human science and art that uses an abstract body of
knowledge to help people.

 It centered around three themes: meaning, rhythmicity, and transcendence.

33. CAROLYN L. WIENER AND MARYLIN J. DODD

 Theory of Illness Trajectory

 “The uncertainty surrounding a chronic illness like cancer is the uncertainty of life writ
large. By listening to those who are tolerating this exaggerated uncertainty, we can learn
much about the trajectory of living.”

 Provides a framework for nurses to understand how cancer patients stand uncertainty
manifested as a loss of control.

 Provides new knowledge on how patients and families endure uncertainty and work
strategically to reduce uncertainty through a dynamic flow of illness events, treatment
situations, and varied players involved in care organization.

34. Georgene Gaskill Eakes, Mary Lermann Burke, and Margaret A. Hainsworth

 Theory of Chronic Sorrow

 “Chronic sorrow is the presence of pervasive grief-related feelings that have been found to
occur periodically throughout the lives of individuals with chronic health conditions, their
family caregivers and the bereaved.”

 This middle-range theory defines the aspect of chronic sorrow as a normal response to the
ongoing disparity created by the loss.

35. PHIL BARKER

 Barker’s Tidal Model of Mental Health Recovery is widely used in mental health
nursing.
 It focuses on nursing’s fundamental care processes, is universally applicable, and is a
practical guide for psychiatry and mental health nursing.

 Draws on values about relating to people and help others in their moments of distress. The
values of the Tidal Model are revealed in the Ten Commitments: Value the voice, Respect
the language, develop genuine curiosity, Become the apprentice, Use the available toolkit,
Craft the step beyond, Give the gift of time, reveal personal wisdom, know that change is
constant, and Be transparent.

36. CHERYL TATANO BECK

 Postpartum Depression Theory

 “The birth of a baby is an occasion for joy—or so the saying goes […] But for some
women, joy is not an option.”

 Described nursing as a caring profession with caring obligations to persons we care for,
students, and each other.

 Provides evidence to understand and prevent postpartum depression.

37. KRISTEN M. SWANSON

 Theory of Caring

 “Caring is a nurturing way of relating to a valued other toward whom one feels a personal
sense of commitment and responsibility.”

 Defines nursing as informed caring for the well-being of others.

 Offers a structure for improving up-to-date nursing practice, education, and research while
bringing the discipline to its traditional values and caring-healing roots.

38. PAMELA G. REED

 Self-Transcendence Theory

 Self-transcendence refers to the fluctuation of perceived boundaries that extend the person
(or self) beyond the immediate and constricted views of self and the world (Reed, 1997).
 Has three basic concepts: vulnerability, self-transcendence, and well-being.

 Gives insight into the developmental nature of humans associated with health
circumstances connected to nursing care.