Nursing Theories

Nursing Theories
Faye Glenn Abdellah's Contribution to Nursing Theory: Twenty-One Nursing Problems

According to Abdellah's Twenty-One Nursing Problems theory of nursing, "Nursing is
based on an art and science that moulds 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." The patient-centered approach to nursing was
developed from Abdellah's practice, and the theory is considered a human needs theory.
It was created to help with nursing education, so it most applicable in that area. The
nursing model is intended to guide care in hospitals, but can be applied to community
nursing, as well. The model has interrelated concepts of health and nursing problems, as
well as problem-solving, which is an activity inherently logical in nature. Abdellah's
theory identifies ten steps to identify the patient's problem and 11 nursing skills used to
develop a treatment typology. The ten steps are:
1. Learn to know the patient.
2. Sort out relevant and significant data.
3. Make generalizations about available data in relation to similar nursing problems
presented by other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and make additional generalizations.
6. Validate the patient's conclusions about his nursing problems.
7. Continue to observe and evaluate the patient over a period of time to identify any
attitudes and clues affecting his or her behavior.
8. Explore the patient and his or her family's reactions to the therapeutic plan and
involve them in the plan.
9. Identify how the nurses feel about the patient's nursing problems.
10. Discuss and develop a comprehensive nursing care plan.
The 11 nursing skills are:
1. observation of health status
2. skills of communication
3. application of knowledge
4. teaching of patients and families
5. planning and organization of work
6. use of resource materials
7. use of personnel resources
8. problem-solving
9. direction of work of others
10. therapeutic uses of the self
11. nursing procedure
The model identifies nursing as a helping profession. Nursing care is doing something to
or for a patient, or providing information to the patient with the intention of meeting
needs, increasing self-ability, or alleviating impairment. In other words, helping patients
become more healthy.
Abdellah describes health as a state mutually exclusive of illness. There is no definition of
health given by her in the theory, but she speaks to "total health needs" and "a healthy
state of mind and body" in her description of nursing as a comprehensive service.
The nursing process in Abdellah's Twenty-One Nursing Problems theory is: assessment,
nursing diagnosis, planning, implementation, and evaluation.

In the assessment phase, nursing problems provide guidelines for the collection of data.
A principle underlying the problem-solving approach is that for each identified problem,
pertinent data is collected. The overt or covert nature of problems necessitates a direct
or indirect approach, respectively.
The results of the collection of data in the assessment phase determine the patient's
specific problems, which can be grouped under one or more of the broader nursing
problems. This creates the nursing diagnosis.
The statement of nursing problems most closely resembles goal statements. Using the
goals in the framework, a nursing care plan is developed and appropriate nursing
interventions are determined. Putting those interventions in action is the implementation
phase of the nursing process.
After the interventions have been carried out, the evaluation takes place. The most
appropriate evaluation would be the nurses progress or lack of progress toward the
achievement of the goals established in the planning phase.

Phil Barker's Contribution to Nursing Theory: Tidal Model

The Tidal Model of nursing, created by Phil Barker, Poppy Buchanan-Barker and their
colleagues, is widely used in mental health nursing. It views health and illness as fluid,
and life as a journey undertaken on an ocean of experience. However, it states that
patients can become physically, emotionally, or spiritually shipwrecked. This metaphor of
water throughout the theory should be appreciated by nurses to help them gain a better
understanding of the patient's current situation, as well as the inevitability of change.
Barker's model includes six philosophical assumptions: a belief in the virtue of curiosity;
recognition of the power of resourcefulness; respect for the patient's wishes; acceptance
of the paradox of crisis as opportunity; acknowledging that all goals must belong to the
patient; and the virtue of pursuing elegance, which means the simplest possible means
should be sought.

In order for the nurse to start the engagement process with the patient, six things must
be accepted: recovery is possible; change is inevitable; ultimately, people know what's
best for them; the patient has all the resources he or she needs to start the recovery
journey; the patient is the teacher and the helpers are the students; and the helper
needs to be creatively curious, to learn what needs to be done to help the patient
recover.
The engagement process takes place in three domains: self, world, and others. The self
domain is where people feel their experiences, and it includes an emphasis on making
patients more secure through the development of a Security Plan to reduce threats to the
patient and others around him or her. The world domain is where people hold their
stories. The Tidal Model nurse uses a specific way of questioning to explore the patient's
story, reveal its hidden meanings, the patient's resources, and find out what needs to be
done to help with his or her recovery. The others domain represents the relationships of
the patient, past, present, and future. This includes the patient's care team.

The values of the Tidal Model are revealed in the Ten Commitments:
1. Value the voice. That is, the patient's story is paramount.
2. Respect the language, which means to let the patient use his or her own
language.
3. Develop genuine curiosity, or show interest in the patient's story.
4. Become the apprentice to learn from the person being helped.
5. Reveal personal wisdom. Patients are experts in their own stories.
6. Be transparent. Nurses should model confidence by being transparent and helping
make sure the patient always knows exactly what's being done.
7. Use the available toolkit; the patient's story contains valuable information as to
what works and what doesn't.
8. Craft the step beyond. That is, the patient and nurse work together to construct
an appreciation of what needs to be done in that moment.
9. Give the gift of time to foster change.
10. Know that change is constant.
Each of the Ten Commitments has two Competencies associated with it. These were
introduced to help with generating practice-based evidence for the Tidal Model.

Patricia Benner's Contribution to Nursing Theory: From Novice to Expert
Concept

Patricia Benner developed a concept known as "From Novice to Expert." This concept
explains that nurses develop skills and an understanding of patient care over time from a
combination of a strong educational foundation and personal experiences.
Benner proposed that a nurse could gain knowledge and skills without actually learning a
theory. She describes this as a nurse "knowing how" without "knowing that." She further
explains that the development of knowledge in fields such as nursing is made up of the
extension of knowledge through research and understanding through clinical experience.
The theory identifies five levels of nursing experience: novice, advanced beginner,
competent, proficient, and expert.
A novice is a beginner with no experience. They are taught general rules to help perform
tasks, and their rule-governed behavior is limited and inflexible. In other words, they are
told what to do and simply follow instruction.
The advanced beginner shows acceptable performance, and has gained prior experience
in actual nursing situations. This helps the nurse recognize recurring meaningful
components so that principles, based on those experiences, begin to formulate in order
to guide actions.
A competent nurse generally has two or three years' experience on the job in the same
field. For example, two or three years in intensive care. The experience may also be
similar day-to-day situations. These nurses are more aware of long-term goals, and they
gain perspective from planning their own actions, which helps them achieve greater
efficiency and organization.

A proficient nurse perceives and understands situations as whole parts. He or she has a
more holistic understanding of nursing, which improves decision-making. These nurses
learn from experiences what to expect in certain situations, as well as how to modify
plans as needed.
Expert nurses no longer rely on principles, rules, or guidelines to connect situations and
determine actions. They have a deeper background of experience and an intuitive grasp
of clinical situations. Their performances are fluid, flexible, and highly-proficient. Benner's
writings explain that nursing skills through experience are a prerequisite for becoming an
expert nurse.
These different levels of skills show changes in the three aspects of skilled performance:
movement from relying on abstract principles to using past experiences to guide actions;
change in the learner's perception of situations as whole parts rather than separate
pieces; and passage from a detached observer to an involved performer, engaged in the
situation rather than simply outside of it.
The levels reflect movement from reliance on past principles to the use of past
experience and change in the perception of the situation as a complete whole with
certain relevant parts. Each step builds on the previous step as principles are refined and
expanded by experience and clinical expertise.
Benner's theory of From Novice to Expert changed the understanding of what it means to
be an expert in the nursing field. This moves the label from a nurse with the highest pay
or the most prestigious title to the nurse who provided the best care to his or her
patients.

Helen C. Erickson's Contribution to Nursing Theory: Modeling and Role
Modeling Theory

The Modeling and Role Modeling Theory of nursing was created by Helen C. Erickson,
along with Evelyn M. Tomlin and Mary Ann P. Swain. It was first published in their book,
Modeling and Role Modeling: A Theory and Paradigm for Nursing, which was published in
1983.
The Modeling and Role Modeling Theory draws on concepts from Piaget's Theory of
Cognitive Development, Maslow's Theory of Hierarchy of Needs, Erikson's Theory of
Psychosocial Stages, and Selye and Lazarus's General Adaptation Syndrome. Erickson's
theory helps nurses care for their patients by recognizing each individuals uniqueness,
and focusing on the individual patient's needs. It is also a self-care method of nursing,
which means it is based on the patient's perceptions of the environment, and adapts
based on individual stressors for that patient.
According to the theory, modeling recognizes that each patient has a unique perspective
of his or her world. Modeling is a process that enables a nurse to understand that unique
perspective and learn to appreciate its importance to the patient. The nurse uses the
process of modeling to understand the world from the patient's perspective. The
Modeling and Role Modeling Theory of nursing helps the nurse to do this by explaining
some of the similarities and differences among patients.

Role modeling accepts each patient regardless of his or her perspective on the world, and
cares for the patient in order to work toward health. According to the nursing theory, the
patient is the expert in his or her own care, and knows best in how he or she should be
cared for to get back to health.
In the Modeling and Role Modeling Theory, the roles of nursing are facilitation,
nurturance, and unconditional acceptance. In addition, Erickson's model says that the
five goals of nursing intervention are: to build trust, to promote the patient's positive
orientation, to promote the patient's control, to affirm and promote the patient's
strengths, and to set mutual, health-directed goals.

Katie Eriksson's Contribution to Nursing Theory: Theory of Caritative Caring

The Theory of Caritative Caring was developed by Katie Eriksson. This model of nursing
distinguishes between caring ethics, the practical relationship between the patient and
the nurse, and nursing ethics. Nursing ethics are the ethical principles that guide a
nurse's decision-making abilities. Caritative caring consists of love and charity, which is
also known as caritas, and respect and reverence for human holiness and dignity.
According to the theory, suffering that occurs as a result of a lack of caritative care is a
violation of human dignity.

Lydia E. Hall's Contribution to Nursing Theory: Care, Cure, Core Theory of
Nursing

Lydia E. Hall developed the Care, Cure, Core Theory of Nursing in the late 1960s as a
result of her work in psychiatry, as well as her experiences at the Loeb Center. In her
career, she promoted involvement of community members in health-care issues, as well.

Also known as "the Three Cs of Lydia Hall," Hall's theory contains three independent but
interconnected circles. The three circles are: the core, the care, and the cure.
The core is the patient to whom nursing care is directed. The core has set goals by him or
herself rather than by a healthcare provider or family and friends. The core makes
decisions and behaves according to his or her feelings and values.
The cure is the attention given to the patient by the nurse and other medical
professionals. In this model, the focus of care is not only on the nurse, but on all
healthcare professionals involved in the care of the patient. The cure includes
interventions or actions geared toward treating the patient of whatever illness, disease,
or disability he or she may be suffering from.
The care circle is Hall's explanation of the role of nurses in her model. According to the
theory, nurses are focused on performing the noble task of nurturing patients. This
specifically speaks to the "motherly" nature of nursing, which may include a nurse

addressing a patient's comfort issues. The role of nursing also includes educating
patients, and helping a patient meet any needs he or she is unable to meet alone.
The theory puts emphasis on the importance of the total patient rather than looking at
one part or aspect. There is also emphasis put on all three aspects of the theory (care,
cure, and core circles) functioning together.

Virginia Henderson's Contribution to Nursing Theory: Nursing Need Theory

Henderson's Need Theory emphasizes the importance of patient independence so that
the patient will continue to progress after being released from the hospital. Henderson
described the role of the nurse as one of the following: substitutive, which is doing
something for the patient; supplementary, which is helping the patient do something; or
complementary, which is working with the patient to do something. All of these roles are
to help the patient become as independent as possible.
She categorized nursing activities into fourteen components based on human needs. The
fourteen components of Henderson's concept are as follows:
1.
2.
3.
4.
5.
6.

Breathe normally. Eat and drink adequately.
Eliminate body wastes.
Move and maintain desirable postures.
Sleep and rest.
Select suitable clothes-dress and undress.
Maintain body temperature within normal range by adjusting clothing and
modifying environment.
7. Keep the body clean and well groomed and protect the integument.
8. Avoid dangers in the environment and avoid injuring others.
9. Communicate with others in expressing emotions, needs, fears, or opinions.
10. Worship according to one's faith.
11. Work in such a way that there is a sense of accomplishment.
12. Play or participate in various forms of recreation.
13. Learn, discover, or satisfy the curiosity that leads to normal development and
health and use the available health facilities.
While a nurse's job is to care for patients, it is also to help patients be able to care for
themselves when they leave the healthcare facility. This will help ensure that the patient
has fewer setbacks during recovery from the illness or injury, and will help the transition
into self-care be smoother since a nurse will be helping and supervising along the way
until the patient goes home. For those nurses who work in rehabilitation, Henderson's
theory is one that can be easily used every day, and it will be the patients who benefit
from it

Dorothy Johnson's Contribution to Nursing: Behavior System Model

Johnson is known for her Behavior System Model of Nursing, which was first proposed in
1968. The model advocates the fostering of efficient and effective behavioral functioning
in the patient to prevent illness. The patient is defined as a behavioral system composed

of seven behavioral subsystems. Each subsystem is comprised of four structural
characteristics. An imbalance in each system results in disequilibrium. The nurse's role is
to help the patient maintain his or her equilibrium.
Johnson's theory of nursing defines nursing as "an external regulatory force which acts to
preserve the organization and integration of the patients behaviors at an optimum level
under those conditions in which the behavior constitutes a threat to the physical or social
health, or in which illness is found."
The goals of nursing are fourfold, according to the Behavior System Model:
1. To assist the patient whose behavior is proportional to social demands.
2. To assist the patient who is able to modify his behavior in ways that it supports
biological imperatives.
3. To assist the patient who is able to benefit to the fullest extent during illness from
the physician's knowledge and skill.
4. To assist the patient whose behavior does not give evidence of unnecessary
trauma as a consequence of illness.
The assumptions made by Johnson's theory are in three categories: assumptions about
system, assumptions about structure, and assumptions about functions.

There are four assumptions about system in the model:
1. There is "organization, interaction, interdependency and integration of the parts
and elements of behaviors that go to make up the system."
2. A system "tends to achieve a balance among the various forces operating within
and upon it, and that man strive continually to maintain a behavioral system
balance and steady state by more or less automatic adjustments and adaptations
to the natural forces occurring on him."
3. A behavioral system, which requires and results in some degree of regularity and
constancy in behavior, is essential to man. It is functionally significant because it
serves a useful purpose in social life as well as for the individual.
4. "System balance reflects adjustments and adaptations that are successful in some
way and to some degree."
The four assumptions about structure and function are that:
1. "from the form the behavior takes and the consequences it achieves can be
inferred what 'drive' has been stimulated or what 'goal' is being sought."
2. Each individual person has a "predisposition to act with reference to the goal, in
certain ways rather than the other ways." This predisposition is called a "set."
3. Each subsystem has a repertoire of choices called a "scope of action."
4. The individual patient's behavior produces an outcome that can be observed.
There are three functional requirements for the subsystems.
The system must be protected from toxic influences with which the system cannot cope.
Each system has to be nurtured through the input of appropriate supplies from the
environment.
The system must be stimulated for use to enhance growth and prevent stagnation.

These behaviors are "orderly, purposeful and predictable and sufficiently stable and
recurrent to be amenable to description and explanation."
Johnson's theory defines health as a purposeful adaptive response to internal and
external stimuli in order to maintain stability and comfort. The main goal of nursing is to
foster equilibrium within the individual patient. The practice of nursing is concerned with
the organized and integrated whole, but maintaining a balance in the behavior system
when illness occurs is the major focus of the career.
The nursing process of the Behavior System Model of Nursing begins with an assessment
and diagnosis of the patient. Once a diagnosis is made, the nurse and other healthcare
professionals develop a nursing care plan of interventions and setting them in motion.
The process ends with an evaluation, which is based on the balance of the subsystems.

Imogene King's Contribution to Nursing Theory: Theory of Goal Attainment

Imogene King's Theory of Goal Attainment was first introduced in the 1960s. The basic
concept of the theory is that the nurse and patient communicate information, set goals
together, and then take actions to achieve those goals. It describes an interpersonal
relationship that allows a person to grow and develop in order to attain certain life goals.
The factors that affect the attainment of goals are roles, stress, space, and time.
According to King, the patient is a social being who has three fundamental needs: the
need for health information, the need for care that seeks to prevent illness, and the need
for care when the patient is unable to help him or herself. She explains health as
involving life experiences of the patient, which includes adjusting to stressors in the
internal and external environment by using resources available. The environment is the
background for human interaction. It involves the internal environment, which transforms
energy to enable people to adjust to external environmental changes, and it involves the
external environment, which is formal and informal organizations. A nurse is considered
part of the patient's environment.
The three interacting systems in her Theory of Goal Attainment are the personal system,
the interpersonal system, and the social system. Each system is given different concepts.
The concepts for the personal system are: perception, self, growth and development,
body image, space, and time. The concepts for the interpersonal system are: interaction,
communication, transaction, role, and stress. The concepts for the social system are:
organization, authority, power, status, and decision making.
King's Theory of Goal Attainment defines nursing as "process of action, reaction and
interaction by which nurse and patient share information about their perception in
nursing situation." According to King, nursing's focus is on the care of the patient, and its
goal is the health care of patients and groups of patients.
According to King, the goal of the nurse is to help patients maintain health so they can
function in their individual roles. The nurse's function is to interpret information in the
nursing process, to plan, implement, and evaluate nursing care.
In the nurse-patient relationship, the nurse first uses his or her knowledge base to assess
the patient and make a diagnosis. After the diagnosis, the nurse creates a plan for
interventions to solve problems that were identified in the assessment and diagnosis.

Once a care plan is created, actions are implemented to achieve the patient's health
goals. Finally, the nurse evaluates the patient to determine whether or not the goals were
achieved.
In the healthcare field, the ultimate goal in the nurse-patient relationship is to help the
patient achieve his or her goals for getting healthy. By using the nursing process
described in Imogene King's Theory of Goal Attainment, a nurse can be more effective in
working with a patient to achieve those goals, and can truly help patients.

Katharine Kolcaba's Contribution to Nursing Theory: Comfort Theory

Kolcaba developed her nursing theory in the 1990s. It is a middle range nursing theory
designed for nursing practice, research, and education. According to her theory, patient
comfort exists in three forms: relief, ease, and transcendence. These comforts can occur
in four contexts: physical, psychospiritual, environmental, and sociocultural.
Relief comfort usually comes in the form of pain management through medications.
When medications are administered, the patient has a sense of relief from the pain. Ease
comfort is focused more on the environment and psychological state of the patient. For
example, after issues of anxiety are addressed and dealt with, a patient feels at ease.
Finally, transcendence comfort comes when a patient is able to rise above challenges
that occur in care and recovery.
In this theory, the role of a nurse is to assess a patient's comfort needs and create a
nursing care plan to meet those needs. As a patient's comfort needs change, the nurse's
interventions change, as well. Through this method, nurses are able to ensure their
patients are properly cared for, and that they are comfortable. If a patient is comfortable,
he or she will feel emotionally and mentally better, which will aid in recovery.

Madeleine Leininger's Contribution to Nursing Theory: Transcultural Nursing

Madeleine Leininger's theory of Transcultural Nursing, also known as Culture Care Theory,
falls under both the category of a specialty, as well as a general practice area. The theory
has now developed into a discipline in nursing.
The Transcultural Nursing theory first appeared in Leininger's Culture Care Diversity and
Universality, published in 1991, but it was developed in the 1950s. The theory was
further developed in her book Transcultural Nursing, which was published in 1995. In the
third edition of Transcultural Nursing, published in 2002, the theory-based research and
the application of the Transcultural theory are explained.
Transcultural nursing is a study of cultures to understand both similarities and differences
in patient groups. Culture is a set of beliefs held by a certain group of people, handed
down from generation to generation.
In transcultural nursing, nurses practice according to the patient's cultural
considerations. It begins with a culturalogical assessment, which takes the patient's

cultural background into consideration in assessing the patient and his or her health.
Once the assessment is complete, the nurse should use the culturalogical assessment to
create a nursing care plan that also takes the patient's cultural background into
consideration.
There are many reasons it's beneficial for nurses to use cultural knowledge of patients to
treat them. First of all, it helps nurses to be aware of ways in which the patient's culture
and faith system provide resources for their experiences with illness, suffering, and even
death. It helps nurses to be understanding and respectful of the diversity that is often
very present in a nurse's patient load. It also helps strengthen a nurse's commitment to
nursing based on nurse-patient relationships and emphasizing the whole person rather
than viewing the patient as simply a set of symptoms or an illness. Finally, using cultural
knowledge to treat a patient also helps a nurse to be open minded to treatments that can
be considered non-traditional, such as spiritually based therapies like meditation and
anointing.
In the Transcultural Nursing theory, nurses have a responsibility to understand the role of
culture in the health of the patient. Not only can a cultural background influence a
patient's health, but the patient may be taking home remedies that can affect his or her
health, as well.
Leininger identified three nursing decisions and actions that achieve culturally friendly
care for the patient. They are: cultural preservation or maintenance, cultural care
accomodation or negotiation, and cultural care repatterning or restructuring.
The nurse's assessment of the patient should include a self-assessment that addresses
how the nurse is affected by his or her own cultural background, especially in regards to
working with patients from culturally diverse backgrounds. The nurse's diagnosis of the
patient should include any problems that may come up that involve the healthcare
environment and the patient's cultural background. In addition, the nurse's care plan
should involve aspects of the patient's cultural background when needed. Finally, the
nurse's evaluation should include a self-evaluation of attitudes toward caring for patients
from differing cultural backgrounds.
In today's healthcare field, it is required for nurses to be sensitive to their patients'
cultural backgrounds when creating a nursing plan. This is especially important since so
many people's culture is so integral in who they are as individuals, and it is that culture
that can greatly affect their health, as well as their reactions to treatments and care.
Thanks to Madeleine Leininger's Transcultural Nursing theory, nurses can look at how a
patient's cultural background is involved in his or her health, and use that knowledge to
create a nursing plan that will help the patient get healthy quickly while still being
sensitive to his or her cultural background.

Myra Estrine Levine's Contribution to Nursing Theory: Four Conservation
Principles

Levine developed the Four Conservation Principles. In this model, the goal of nursing is to
promote adaptation and maintain wholeness using the principles of conservation. The
model guides nurses to focus on the influences and responses at the level of the

organism. Nurses accomplish the theory's goal through the conservation of energy,
structure, and personal and social integrity.
According to Levine, every individual has a unique range of adaptive responses. They
vary by heredity, age, gender or the challenges that come with experiencing an illness.
The responses are the same, but the timing and manifestation of the responses are
unique to each individual pulse rate. Adaptation is an ongoing process of change in which
the patient is able to maintain his or her integrity while staying within the realities of the
environment. This is achieved through the "frugal, economic, contained and controlled
use of environmental resources by the individual in his or her best interest."
Wholeness exists when the patient's interaction with the environment allows integrity to
be assured. Wholeness is promoted by the use of the conservation principle.

Conservation is the product of adaptation. It is the achievement of a balance of energy
supply and demand that is within the unique biological realities of the individual patient.
The conservation principle has four aspects: conservation of energy, conservation of
structural integrity, conservation of personal integrity, and conservation of social
integrity.
Conservation of energy refers to balancing how energy goes in and out of the body to
avoid fatigue. It includes adequate rest, nutrition, and exercise. Conservation of
structural integrity refers to maintaining or restoring the physical body and promoting
physical healing. The conservation of personal integrity recognizes the patient's need for
recognition, respect, self-awareness, and self-determination. In this area, for example, a
nurse will honor a patient's need for personal space. The conservation of social integrity
addresses the patient's interactions and relationships with other people, such as in a
family, community, or religious group.
In this theory, nursing is a profession and an academic discipline, and should be studied
and practiced in harmony with all disciplines that make up the health sciences. Nursing
involves engaging in human interactions. Levine states that the goal of nursing is to
promote wholeness, while realizing that every individual requires a unique cluster of
activities to achieve wholeness. The patient's individual integrity is his or her concern,
and it is the nurse's responsibility to assist him or her to defend and seek the realization
of that individual integrity.
Levine offers nine models of guided assessment in the Four Conservation Principles
theory of nursing. They are:
1.
2.
3.
4.
5.
6.
7.
8.
9.

vital signs
body movement and positioning
meeting personal hygiene needs
pressure gradient system in nursing interventions
nursing determination in provision of nutritional needs
pressure gradient system in nursing
local application of hot and cold
administration of medicine
establishing an aseptic environment

The nursing process used in this model is:
1. Assessment
2. Trophicognosis

3. Hypothesis
4. Interventions
5. Evaluation

Kurt Lewin's Contribution to Nursing Theory: Change Theory

Considered the father of social psychology, Kurt Lewin developed the nursing model
known as Change Theory. He theorized a three-stage model of change that is known as
the "unfreezing-change-refreeze model" that requires prior learning to be rejected and
replaced. It states behavior as "a dynamic balance of forces working in opposing
directions."
The three concepts identified in Lewin's Change Theory are driving forces, restraining
forces, and equilibrium.
Driving forces are forces that push in a direction that causes change to occur. They
facilitate change because they push the person in the desired direction. They cause a
shift in the equilibrium towards change. Restraining forces are those forces that counter
driving forces. They hinder change because they push the person in the opposite
direction. They cause a shift in the equilibrium which opposes change. Equilibrium is a
state of being where driving forces equal restraining forces and no change occurs.
Equilibrium can be raised or lowered by changes that occur between the driving and
restraining forces.
This model of nursing consists of three distinct stages which are vital to the theory. They
are unfreezing, moving to a new level or changing (or movement), and refreezing.
Unfreezing is the process which involves finding a method of making it possible for
people to let go of an old pattern that was, in some way, counterproductive. It is
necessary to overcome the strains of individual resistance and group conformity. It can
be achieved by the use of three methods. First, increase the driving forces that direct
behavior away from the existing situation or status quo. Second, decrease the restraining
forces that affect movement negatively. Third, find some combination of the first two
methods.
The second stage involves a process of change in feeling, behavior, thought, or all three,
that is more productive in some way. The refreezing stage involves establishing the
change as a habit so it becomes the standard. Without the refreezing stage, the old ways
can easily return.

Ramona Mercer's Contribution to Nursing Theory: Maternal Role Attainment
Theory

The Maternal Role Attainment Theory, a mid-range theory, was developed to serve as a
framework for nurses to provide appropriate health care interventions for nontraditional
mothers in order for them to successfully adopt a strong maternal identity. Though this
theory can be used throughout pregnancy and after childbirth to help mothers connect
with their babies, it can also be beneficial for adoptive mothers, foster mothers, or others
who have had nontraditional motherhood unexpectedly, such as taking care of a relative
or friend's child as the result of a death. The process helps the mother form an
attachment to the infant, which in turn helps the infant form an attachment with the
mother. This helps in the building of the mother-child relationship as the infant grows.
The primary concept of this theory is the developmental and interactional process, which
occurs over a period of time. In the process, the mother bonds with the infant, acquires
competence in general caretaking tasks, and comes to express joy and pleasure in the
maternal role.
The nursing process follows four stages of acquisition in the Maternal Role Attainment
Theory. First is the anticipatory stage, which addresses the social and psychological
adaptation to the maternal role, and learning expectations. Second is the formal stage,
which is the assumption of the role at birth, and addresses behaviors guided by others in
the mother's social system and network. For example, "My mother always said..." Third is
the informal stage, in which the mother develops her own ways of mothering not
conveyed by her social system. Finally, the fourth stage is the personal stage, in which
the mother experiences harmony, confidence, and competence in her maternal role.

Betty Neuman's Contribution to Nursing Theory: Neuman Systems Model

In 1970 she began developing her Systems Model as a way to teach introductory nursing
to students by giving them a holistic view of patients that included the physiological,
psychological, sociological, and developmental aspects. It was first developed as a
graduate course guide, and in 1972, the May/June edition of Nursing Research published
"A model for teaching total person approach to patient problems." In 1974, Neuman's
model was refined and published in Conceptual Models for Nursing Practice. It was
classified as a systems model, and was titled "The Betty Neuman Health-Care Systems
Model: A Total Person Approach to Patient Problems." In this publication, the term
"patient" was replaced with the term "client."
The Neuman Systems Model is based on the patient's relationship to stress, reaction to it,
and reconstitution factors that are dynamic. The Neuman Systems Model is universal in
nature, which allows it to be adapted to a variety of situations, and to be interpreted in
many different ways.
The central philosophy of Neuman's nursing theory consists of energy resources that are
surrounded by three things: several lines of resistence, which represent the internal
factors helping the patient fight against a stressor; the normal line of defense, which
represents the patient's equilibrium; and the flexible line of defense, which represents
the dynamic nature that can rapidly change over a short time.
In the Neuman Systems Model, the nurse's role is to keep the system's stability by using
three levels of prevention. The first is primary prevention, which protects the normal line
and strengthens the flexible line of defense. The secondary prevention is used to

strengthen the internal lines of resistence, which reduces the reaction and increases
resistence factors. Finally, tertiary prevention readapts, stabilizes, and protects the
patient's return to wellness after treatment.
Margaret A. Newman's Contribution to Nursing Theory: Health as Expanding
Consciousness

The initial idea for Newman's Health as Expanding Consciousness Theory came together
as a result of an invitation to speak at a conference on nursing in 1978. It stems from
Rogers' Theory of Unitary Human Beings. It was stimulated by concern for those for
whom the absence of disease or disability is not possible. Newman was also influenced
by Bentov's concept of the evolution of consciousness, Young's Theory of Process, and
Bohm's Theory of Implicate.
This grand theory of nursing claims that every person in every situation, regardless of
how disordered and hopeless it may seem, is part of the universal process of expanding
consciousness, which is a process of becoming more of oneself, finding greater meaning
in life, and of reaching new dimensions of connectedness with other people and the
world.
Newman's theory makes six assumptions. They are:
1. Health encompasses conditions heretofore described as illness, or, in medical
terms, pathology.
2. These pathological conditions can be considered a manifestation of the total
pattern of the individual patient.
3. The pattern of the individual patient that eventually manifests itself as pathology
is primary, and exists prior to structural or functional changes.
4. Removal of the pathology in itself will not change the pattern of the individual
patient.
5. If becoming ill is the only way an individual patient's pattern can manifest itself,
then that is health for that individual patient.
6. Health is an expansion of the consciousness.
According to Newman, "The theory of health as expanding consciousness (HEC) was
stimulated by concern for those for whom health as the absence of disease or disability is
not possible. Nurses often relate to such people: people facing the uncertainty,
debilitation, loss and eventual death associated with chronic illness. The theory has
progressed to include the health of all persons regardless of the presence or absence of
disease. The theory asserts that every person in every situation, no matter how
disordered and hopeless it may seem, is part of the universal process of expanding
consciousness - a process of becoming more of oneself, of finding greater meaning in life,
and of reaching new dimensions of connectedness with other people and the world."
Humans are open to the whole energy system of the universe and constantly interacting
with the energy. With the process of interaction, humans are evolving their individual
patterns of whole. According to Newman, the pattern of the individual patient is
essential. The expanding consciousness is pattern recognition.
How a disease manifests in an individual patient depends on the pattern of that patient,
so the pathology of the disease exists before the symptoms appear. By this logic, the
removal of the symptoms of the disease will not change the patient's individual structure
or pattern.

The model also addresses the interrelatedness of time, space, and movement. Time and
space are the temporal pattern of the patient, and have a complementary relationship.
People are constantly changing through time and space, which is movement, which
shows a unique pattern of reality.
According to Newman, nursing is the process of recognizing the patient in relation to the
environment, and it is the process of the understanding of consciousness. The nurse
helps patients understand how to use the power they have within in order to develop a
higher level of consciousness. Therefore, it helps to realize the process of disease, its
recovery, and its prevention. Nursing is seen as a partnership between the nurse and
patient, and both grow in the sense of higher levels of consciousness.

Florence Nightingale's Contribution to Nursing Theory: Environmental Theory

Florence Nightingale is attributed with establishing the modern practice of nursing. She
also contributed to the field with nursing theories still used today. One of her nursing
theories is the Environmental Theory, which incorporates the patients' surrounding
environment in his or her nursing care plan.
In this theory, the role of the nurse is to use the patient's environment to help him or her
recover and get back to the usual environment. The reason the patient's environment is
important is because it can affect his or her health in a positive or negative way. Some
environmental factors affecting health according to Nightingale's theory are fresh air,
pure water, sufficient food and appropriate nutrition, efficient drainage, cleanliness, and
light or direct sunlight. If any of these factors is lacking, it can delay the patient's
recovery. Nightingale also emphasized providing a quiet, warm environment for patients
to recover in. The theory also calls for nurses to assess a patient's dietary needs,
document food intake times, and evaluate how the patient's diet affects his or her health
and recovery.
Determining a patient's environment for recovery based on his or her condition or
disease is still practiced today, such as in patients suffering from tetanus, who need
minimal noise to keep them calm and prevent seizures.

Ida Jean Orlando's Contribution to Nursing Theory: Deliberative Nursing
Process

Ida Jean Orlando's Deliberative Nursing Process is set in motion by the behavior of the
patient. According to the theory, all patient behavior can be a cry for help, both verbal
and non-verbal, and it is up to the nurse to interpret the behavior and determine the
needs of the patient. The Deliberative Nursing Process has five stages: assessment,
diagnosis, planning, implementation, and evaluation.

In the assessment stage, the nurse completes a holistic assessment of the patient's
needs. This is done without taking the reason for the encounter into consideration. The
nurse uses a nursing framework to collect both subjective and objective data about the
patient.
The diagnosis stage uses the nurse's clinical judgment about health problems. The
diagnosis can then be confirmed using links to defining characteristics, related factors,
and risk factors found in the patient's assessment. The planning stage addresses each of
the problems identified in the diagnosis. Each problem is given a specific goal or
outcome, and each goal or outcome is given nursing interventions to help achieve the
goal. By the end of this stage, the nurse will have a nursing care plan.
In the implementation stage, the nurse begins using the nursing care plan. Finally, in the
evaluation stage, the nurse looks at the progress of the patient toward the goals set in
the nursing care plan. Changes can be made to the nursing care plan based on how well
(or poorly) the patient is progressing toward the goals. If any new problems are identified
in the evaluation stage, they can be addressed, and the process starts over again for
those specific problems.
The goal of this model is for a nurse to act deliberately rather than automatically. This
way, a nurse will have a meaning behind the action which means the patient gets care
geared specifically toward his or her needs at that time. This nursing process is also one
that can easily be adapted to different patients with different problems, and can be
stopped at anytime, depending on the patient's progress or health. This makes Orlando's
theory universal for the nursing field.
Nursing care has to be flexible. Not only does a nursing care plan depend on the needs of
the patient at the time of admittance, but it also needs to be able to change when and if
any complications come up during the treatment and recovery process. Ida Jean
Orlando's Deliberative Nursing Process directly addresses this need for flexibility, and
helps nurses focus on the patient rather than simply sticking to a nursing care plan no
matter what.

Dorothea E. Orem's Contribution to Nursing Theory: Self-Care Deficit Nursing
Theory (SCDNT)

The Self-Care Deficit Nursing Theory, also known as the Orem Model of Nursing, was
developed by Dorothea Orem between 1959 and 2001. It is considered a grand nursing
theory, which means the theory covers a broad scope with general concepts that can be
applied to all instances of nursing.
The central philosophy of the Self-Care Deficit Nursing Theory is that all patients want to
care for themselves, and they are able to recover more quickly and holistically by
performing their own self-care as much as they're able. This theory is particularly used in
rehabilitation and primary care or other settings in which patients are encouraged to be
independent.
The self-care requisites identified by Dorothea Orem fall into one of three categories. The
first is universal self-care requisites, which are needs that all people have. These include
things like air, water, food, activity and rest, and hazard prevention. The second is

developmental self-care requisites, which has two sub-categories: maturational, which
progress the patient to a higher level of maturation, or situational, which prevent against
harmful effects in development. The third category is health deviation requisites, which
are needs that come up based on the patient's condition. If a patient is unable to meet
their self-care requisites, a "self-care deficit" occurs. In this case, the patient's nurse
steps in with a support modality which can be total compensation, partial compensation,
or education and support.
One of the benefits of Dorothea Orem's Self-Care Deficit Nursing Theory is that it can
easily be applied to a variety of nursing situations and patients. The generality of its
principles and concepts make it easily adaptable to different settings, and nurses and
patients can work together to ensure that the patients receive the best care possible, but
are also able to care for themselves. Thanks to Dorothea Orem's dedication to nursing, as
well as her hard work in the field, nurses can use her theory today to care for patients
and make their transition from the hospital or full-time care facility to their own home
much smoother.

Rosemarie Rizzo Parse's Contribution to Nursing Theory: Human Becoming
Theory

Rosemarie Rizzo Parse created the Human Becoming Theory of Nursing, which guides
nurses to focus on quality of life from each person's own perspective as the goal of
nursing. It presents an alternative to most of the other theories of nursing, which take a
bio-medical or bio-psycho-social-spiritual approach.
It was first published in 1981 as the "Man-living-health" theory, and in 1992 the name
was changed to "the Human Becoming Theory." It was developed as a human science
nursing theory, and the assumptions underpinning the theory come from the works of
Heidegger, Sartre, and Merleau-Ponty, as well as Martha Rogers, who was a pioneer
American nursing theorist.
The Human Becoming Theory is a combination of biological, psychological, sociological,
and spiritual factors, and states that a person is a unitary being in continuous interaction
with his or her environment. It is centered around three themes: meaning, rhythmicity,
and transcendence.
The theme of meaning says that Human Becoming is choosing personal meaning in
situations, and that a person's reality is given meaning through experiences he or she
lives in the environment. Rhythmicity explains that Human Becoming is cocreating
rhythmical patterns of relating with the universe, and that a person and the environment
cocreate in rhythmical patterns. Transcendence says that Human Becoming refers to
reaching beyond the limits a person sets, and that a person is constantly transforming
him or herself.

In terms of nursing, the Human Becoming Theory explains that a person is more than the
sum of the parts, the environment and the person are inseparable, and that nursing is a
human science and art that uses an abstract body of knowledge to help people. The
theory allows nurses to create a stronger nurse-patient relationship because the nurse is
not focused on "fixing" problems, but is viewing the patient as a whole person living
experiences through his or her environment.

The Human Becoming Theory of Nursing is a model that focuses on the quality of life of
the patient and sees the patient not as different aspects of a whole, but as a person. This
is different than many other nursing theories, and allows nurses to do what so many of
them go into the nursing field to help people.

Nola Pender's Contribution to Nursing Theory: Health Promotion Model

Nola Pender developed her Health Promotion model, often abbreviated HPM, after seeing
professionals intervening only after patients developed acute or chronic health problems.
She became convinced that patients' quality of life could be improved by the prevention
of problems before this occurred, and health care dollars could be saved by the
promotion of healthy lifestyles. After researching current models and discovering that
most focused on negative motivation, she developed a model that focused on positive
motivation. The first version of the model appeared in literature in 1982. It was revised in
1996 based on changing theoretical perspectives and empirical findings.
The purpose of the model is to assist nurses in understanding the major determinants of
health behaviors as a basis for behavioral counseling to promote healthy lifestyles.
Pender's theory encourages scholars to look at variables that have been shown to impact
health behavior. It uses research findings from nursing, psychology, and public health
into a model of health behavior. The model can be used as a foundation to structure
nursing protocols and interventions. In practices, nurses should focus on understanding
and addressing the variables most predictive of given health behaviors.
There are five key concepts in the Health Promotion Model: person, environment,
nursing, health, and illness.
The person is a biophysical organism shaped by the environment, but also seeks to
create an environment in which human potential can be fully expressed. Because of this,
the relationship between person and environment is reciprocal. Individual characteristics
and life experiences shape behaviors. The environment is described as the social,
cultural, and physical context in which life unfolds. It can be manipulated by the
individual to create a positive context of cues and facilitators for health-enhancing
behaviors. The role of nursing is a collaboration among patients, families, and
communities to create the best conditions for the expression of optimal health and highlevel well-being. Health is defined as the actualization of human potential through goaldirected behavior, self-care, and relationships with others with necessary adjustments
made to maintain relevant environments. Illnesses are discrete events in the life that can
hinder or facilitate the patient's continuing quest for health.
The model is based on the following assumptions:

1. People try to create conditions of living through which they can express their
unique human potential.
2. People have the capacity for reflective self-awareness, including assessment of
their own competencies.
3. People value positive growth, and strive to find a balance between stability and
change.
4. People seek to actively regulate their own behavior.
5. People interact with their environment, transforming it and themselves over time.
6. Nurses and other health professionals make up a part of the interpersonal
environment, which exerts influence on people throughout their lifespan.
7. Self-initiated reconfiguration of the interactive patterns between people and their
environments is necessary for a change in behavior.
8. The model is based on the following theoretical propositions:
9. Behavior and characteristics influence beliefs, affect, and enactment of healthpromoting behavior.
10. People commit to engaging in behaviors from which they anticipate deriving
personally valued benefits.
11. Barriers can constrain commitment to action.
12. Competence to execute a given behavior increases the likelihood of commitment
to action and actual performance of the behavior.
13. Greater perceived self-efficacy results in fewer barriers to a specific health
behavior.
14. Positive affect toward a behavior results in greater perceived self-efficacy.
15. When positive emotions are associated with a behavior, the probability of
commitment and action is increased.
16. People are more likely to commit to health-promoting behaviors when others
model the behavior, expect it to occur, and provide support to enable it.
17. Families, peers, and health care providers are important sources of interpersonal
influence that can increase or decrease commitment to health-promoting
behavior.
18. Situational influences in the external environment can increase or decrease
commitment to or participation in health-promoting behavior.
19. The greater the commitment to a specific plan of action, the more likely healthpromoting behaviors are to be maintained over time.
20. Commitment to a plan of action is less likely to result in the desired behavior
when competing demands over which persons have little control require
immediate attention.
21. Commitment to a plan of action is less likely to result in the desired behavior
when other actions are more attractive and thus preferred over the target
behavior.
22. People can modify cognitions, affect, interpersonal influences, and situational
influences to create incentives for health-promoting behavior.

Hildegard Peplau's Contribution to Nursing Theory: The Theory of Interpersonal
Relations

Peplau's model for nursing, which helped later nursing theorists and clinicians develop
more therapeutic interventions, includes seven nursing roles, which show the dynamic
character roles typical in clinical nursing.
The Seven Nursing Roles are: the stranger role, in which the nurse receives the patient
the way a stranger is met in other situations, and provides an atmosphere to build trust;

the resource role, in which the nurse answers questions, interprets data, and gives
information; the teaching role, in which the nurse gives instructions and provides
training; the counseling role, in which the nurse helps the patient understand the
meaning of current circumstances, as well as provides guidance and encouragement in
order for change to occur; the surrogate role, in which the nurse acts as an advocate on
behalf of the patient; the active leadership role, in which the nurse helps the patient take
responsibility for meeting treatment goals; and the technical expert role, in which the
nurse provides physical care for the patient and operates equipment.
For those who become nurses to work with people, studying Hildegard Peplau's model of
nursing can be very useful. By better understanding the seven roles of nursing, they can
apply different roles in different situations, which will ensure that their patients receive
the best care possible, and will ultimately speed along treatment and recovery.

Isabel Hampton Robb's Contribution to Nursing Theory: Nursing Education

Robb's most notable contribution to nursing was in the field of education. The reforms
she put into place set standards for nursing education, and most of them are still
followed today. Specifically, she developed and implemented a grading policy for nursing
students that required nurses to prove their abilities in order to be awarded
qualifications. She was an advocate for reducing the long hours involved in training
nurses, as well as improving education in nursing schools.
It is thanks to Isabel Hampton Robb that nursing education is what it is today. Because of
the work Robb did in improving nursing education, patients are able to get better care,
and nurses are more prepared to enter their careers after earning their degrees. Her
passion for nursing education changed standards, and her ideas and contributions have
withstood the test of time, despite the rapid advancements that occur in the healthcare
field.

Martha E. Rogers' Contribution to Nursing Theory: Science of Unitary Human
Beings

Patients are considered "unitary human beings," who cannot be divided into parts, but
have to be looked at as a whole. According to Rogers's model, patients have the capacity
to participate knowingly in the process of change. The environment is also irreducible,
and coexists with unitary human beings. In this model, humans are viewed as integral
with the universe. That is, the patient and his or her environment are one.

Rogers defined health as an expression of the life process. To that end, illness and health
are part of the same continuum, and the events occurring throughout the patient's life
show how the patient is achieving his or her health potential.
The basic characteristics that describe the life process of the patient are: energy field,
openness, pattern, and pan dimensionality. The energy field is the fundamental unit of
all, both the living and unliving. It provides a way to view the patient and his or her
environment as wholes, and it continuously changes in intensity, density, and extent.
Openness refers to the fact that the human and environmental fields are constantly
exchanging their energies. That is, there are no boundaries that block the flow of energy
between fields. Pattern is the distinguishing characteristic of an energy field that is seen
as a single wave. It's an abstraction, and simply serves to give identiy to the field. Pan
dimensionality is a domain that has no spatial or temporal attributes.
Nursing in 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 life of the patient.
In this model, the role of the nurse is to serve people. Rogers also proposes noninvasive
modalities for nursing, such as therapeutic touch, humor, music, meditation and guided
imagery, and even the use of color. The interventions of nurses are meant to coordinate
the rhythm between the human and environmental fields, help the patient in the process
of change, and to help patients move toward better health. The practice of nursing,
according to Rogers, should be focused on pain management, and supportive
psychotherapy for rehabilitation.
It is often important to look at both the patient as a whole person, and the patient's
environment when treating the patient for an injury or illness. Martha E. Rogers's Science
of Unitary Human Beings addresses the importance of the environment as an integral
part of the patient, and uses that knowledge to help nurses blend the science and art of
nursing to ensure patients have a smooth recovery and can get back to the best health
possible.

Sister Callista Roy's Contribution to Nursing Theory: Adaptation Model of
Nursing

Developed by Roy in 1976, the Adaptation Model of Nursing asks three central questions:
Who is the focus of nursing care? What is the target of nursing care? and When is nursing
care indicated? This model looks at the patient from a holistic perspective.
The three concepts of her model are the human being, adaptation, and nursing. Under
the concept of adaptation are four modes: physiological, self concept, role function, and
interdependence.
The physiological mode deals with the maintenance of the physical body. This includes
basic human needs such as air, water, food, and temperature regulation. The function of
the mode of self-concept is the need for the maintenance of the mind. The person's
perceptions of his or her physical and personal self are included in this mode. Social
integrity is emphasized in the role function mode. This addresses people's adaptations to

different role changes that occur throughout a lifetime. The interdependence mode also
addresses social integrity. This mode deals with the balance between independence and
interdependence in a person's relationships with other people.
According to Roy's model, the goal of nursing is to promote adaptation of the patient
during illness and health in all four of the modes. The nurse's actions begin with
assessment on two levels. First, the nurse makes a judgment as to the presence or
absence of maladaptation. Second, the nurse focuses on the stimuli influencing the
patient's maladaptive behavior. The nurse then takes actions to promote adaptation by
manipulating the environment, elements of the patient system, or both as part of their
nursing care plan.
Nursing is not rigid. And by applying Roy's Adaptive Model of Nursing to your nursing
practice, you can be sure that the care you give your patients will be the highest quality
you can provide for that individual patient in his or her individual situation.