Nursing Theories: An Overview

What guides nurses as they make critical decisions about how to care for patients? Whether nurses are treating an emergency room patient or tending to an infant in a neonatal intensive care unit (NICU), many issues factor into the interventions they select. However, nursing theories often serve as a backbone for best practices.

Establishing a professional and communicative relationship with patients infused with empathy and respect for their needs and privacy helps create a productive nurse-patient dynamic. Such a dynamic allows patients to feel more comfortable and nurses to be more effective.

What Are Nursing Theories?

Nursing theories offer frameworks that give shape to the scope of nursing care and practice. These consist of concepts, such as collaboration or respect, descriptions of relationships, and definitions. Nursing theories guide nurses in their practice and give them a foundation to make clinical decisions. They also offer a systematic approach to developing key practices that promote quality patient care.

To get a stronger grasp of what nursing theories are, explore how they:

• Impact a nurse’s daily work
• Set nursing apart from other health care disciplines
• Shape nursing strategies

How Nursing Theories Impact What Nurses Do

Nursing theories impact what nurses do daily. By defining characteristics of the nurse-patient relationship, nursing theories shape how nurses interact with patients. They help nurses:

• Identify who needs nursing care
• Articulate what they do for patients and why they do it
• Determine what information to gather
• Understand and assess health situations
• Explain and anticipate patient responses
• Pinpoint actual and possible issues that need consideration
• Map out objectives and expected outcomes
• Determine which interventions to deliver
• Establish best practices
• Select productive areas for research

Nursing theories help inform every interaction between nurses and their patients. As lenses that color and shape how nurses interpret situations, nursing theories influence the decisions nurses make and the relationships they form with patients.

For example, nurses who root their practice in a theory emphasizing patient autonomy will likely encourage certain types of participation from patients and may pay extra attention to patient education.

How Nursing Theories Separate Nursing from Other Health Care Disciplines

Nursing theories define the unique position of nursing in health care. By exploring the roles of nurses, defining nursing concepts, and building scholarship in the discipline, nursing theories distinguish nursing from other health care disciplines and clarify the distinctive contributions of nursing.

Additionally, nursing theories identify a clear nursing perspective separate from that of physicians and other clinicians. This helps facilitate improved interdisciplinary collaboration.

A Look at the Nursing Metaparadigm

Metaparadigms consist of concepts that address the primary issues in a discipline, mapping out the discipline’s parameters and focus. The nursing metaparadigm contains four essential components on which nursing practice is based. Within these concepts exist all issues central to nursing practice.

These components interact and serve as a foundation for delivering holistic care. They steer nurses toward viewing patients as whole and autonomous persons. They also address a patient’s health and environment, along with a nurse’s responsibilities.

The components are:

• Person
• Nursing
• Environment
• Health

Person, environment, and health relate to the people receiving nursing care, while nursing, obviously, focuses on nurses. Together, these concepts help define the content and context of what it means to be a nurse. Applying the four components to the nursing process allows for a more complete approach to patient care.

Nursing theories must address all four of these concepts and explain their relevance to the theory. The definitions of the metaparadigm differ in each nursing theory according to the theorist’s distinct beliefs, assumptions, and values. Theorists’ worldviews also influence how they conceptualize what nursing is and how it provides for people.

Understanding the nursing metaparadigm calls for a closer look at the four components behind them.

Person

The person component in the nursing metaparadigm focuses on the multiple needs of those receiving nursing care, including individual patients, families, or communities. This area encourages nurses to look at patients as emotional, spiritual, and social beings who also have physical needs.

With this holistic view, nurses can help patients take ownership of various aspects of their health. It may involve emphasizing to patients the importance of:

• Expressing emotions
• Seeking out spiritual support
• Staying connected to family and friends

When nurses see patients as whole individuals rather than medical charts with a list of conditions, it not only benefits patients, but it also enriches the nurse’s experience and brings greater meaning to their work.

Nursing

The nursing component addresses what nurses do and what they know. It consists of nursing actions and interventions, as well as a nurse’s skills, both technical and soft. Successful nursing, after all, requires more than the ability to order the right diagnostic test. It also calls for compassion and teamwork.

Additionally, the nursing component considers a nurse’s:

• Work experience
• Knowledge of theory and best practices
• Application of professional knowledge in hands-on and indirect patient care

Environment

The environment component of the nursing metaparadigm considers a patient’s surroundings, recognizing they can significantly affect well-being. A patient’s surroundings can include physical space, as well as social and emotional environments.

A patient’s interactions with family, friends and health professionals can affect health. For example, negative exchanges with a nurse or relatives can stress a patient, whereas positive exchanges often improve a patient’s state of mind.

The environment component may also include the following:

• Culture
• Economic circumstances
• Technology
• Geographic location

All these aspects of a person’s environment can influence health outcomes.

Health

In the metaparadigm, the health component refers to a patient’s level of wellness when receiving nursing care. However, the component also considers quality of health across the life span, as health fluctuates, and past health issues that can crop up at different stages and present problems.

The health component extends beyond physical wellness. It also includes a person’s emotional, mental, spiritual, and social health, as well as genetic makeup — all factors nurses should consider when selecting treatment plans.

The Work of Famous Nursing Theorists

Examining the work and achievements of famous nursing theorists’ sheds light on the value of nursing theories and how they’ve shaped modern nursing practice.

Florence Nightingale

Florence Nightingale, considered the founder of modern nursing, transformed nursing practice. Her observations while treating patients during the Crimean War led her to conclude that environmental conditions played a significant role in patient mortality. Based on these observations, she developed the Environment Theory.

Some nursing care principles Nightingale established in her theory still hold true today, over 150 years later. Nightingale’s theory highlighted the crucial role of the environment on a patient’s ability to achieve wellness and recover from injury or disease. She noted that lacking a clean environment for the patient, adequate food, and pure water could diminish a patient’s recovery.

Nightingale advocated for nurses to alter patient environments on an individual basis to meet patient needs, which would create ideal conditions for healing. Alterations might include providing specialized diets and ensuring quiet environments. Modern nursing continues to value these principles and recognizes the significance of managing environments in the delivery of quality nursing care.

Faye Abdellah

Faye Abdellah shifted nursing care from a disease-centered approach to a patient-centered approach.

Her theory, 21 Nursing Problems, lays out 10 steps nurses can use to identify a patient’s problems, as well as 11 skills to use when developing nursing care plans.

Several of the steps include instructions geared toward patient-centered nursing. They include the following:

• Paying attention to patients’ reactions to care plans
• Involving patients in therapeutic plans
• Validating patients’ beliefs about their health conditions

Abdellah also developed the Patient Assessment of Care Evaluation (PACE), a system of standards assessing the quality of health care facilities. The standards are used today in the U.S. Additionally, Abdellah’s work made headway for nursing by discussing diagnosis in her model of nursing, since at that time the nurse’s role didn’t extend to diagnosing patients.

Virginia Henderson

Sometimes referred to as the Nightingale of modern nursing, Virginia Henderson helped bring focus to the value of developing a patient’s independence. Her Need Theory, which focuses on people’s basic needs, defines the nursing role in several ways:

• Nurses care for patients as patients would care for themselves if they were healthy and able.
• Nurses help patients by providing supplemental care.
• Nurses work with patients in a complementary way to help them achieve self-care.

In each of these roles, the nurse’s ultimate objective is to help patients build their independence, so they can continue their recovery after a hospital discharge and become more empowered to manage their own health.

Henderson also put together the Nursing Studies Index, the first organized and annotated collection of nursing literature. Additionally, in collaboration with nursing researchers, Henderson synthesized the collection of nursing literature for the sixth edition of her text “Principles and Practice of Nursing.”

Dorothy Johnson

Dorothy Johnson advocated for the use of research-based knowledge to understand how nursing care affects patients. Her Behavior System Model of Nursing proposed nurses should focus on a patient’s behavioral systems. By supporting healthy and efficient behavioral systems in patients and helping patients find and keep their equilibrium, Johnson argued nurses could help prevent illness.

Her theory describes how behavioral systems can get out of balance and ways nurses can help patients restore balance, including the following:

• Helping patients regulate their behaviors and develop new behaviors
• Assisting patients in modifying internal or external environments
• Supporting patients with stimulation, nurture, and protection

Imogene King

Imogene King’s great interest in the nurse-patient relationship allowed her to shed new insights into its role in achieving patient health. Her Theory of Goal Attainment explores how interpersonal relationships facilitate a person’s growth, allowing them to achieve goals. King describes the nurse-patient relationship as one in which nurses and patients share information, set goals and take actions to realize those goals.

Her theory identifies nurses as part of a patient’s environment. It also explains how nurses use their unique knowledge and skills during assessments while patients contribute their self-knowledge and perceptions of their health issues. Communication plays a key role in verifying the accuracy of patients’ perceptions and interpretation of what’s been said.

King’s theory also lays out how communication in the nurse-patient relationship is critical to:

• Accurately diagnose patients
• Develop goals and identify the problems and concerns of patients
• Involve patients in the decision-making process regarding care plans
• Successfully implement interventions and achieve goals

Patricia Benner

Patricia Benner has shaped modern nursing’s concept of what it means to be a nursing expert. Her theory, From Novice to Expert, examines five experience levels of nursing and how nurses build their skills, knowledge, and understanding of patients through education and clinical experience.

Benner defines novice, advanced beginner, competent, proficient, and expert as follows:

• Novices have no experience but use learned rules to perform tasks. With their limited abilities and flexibility, they follow instructions.
• Advanced beginners have some experience and have begun to recognize meaningful patterns in their work. This allows them to start forming principles, which can guide their actions.
• Competent nurses have a few years of experience in a specific nursing field. Their experience has helped them develop perspective on their own actions and allows them to work in a more organized, efficient way.
• Proficient nurses have developed holistic understandings. Their experience-based knowledge allows them to make better decisions, anticipate outcomes in various situations and adjust plans as needed.
• Expert nurses’ extensive experience has given them an intuitive understanding of clinical situations. They can connect situations and work flexibly and fluidly and with a high level of proficiency without needing to depend on guidelines and rules.

Lydia Hall

Lydia Hall directed her attention to bringing a less fragmented and more personalized approach to nursing care. She was also concerned with long-term care and providing a better quality of life to patients with chronic illnesses.

Hall developed a nursing model comprised of three individual, but interconnected, circles:

• The core circle refers to the patients in need of nursing care and the goals they set for themselves.
• The care circle involves providing patients with nurturing and intimate body care. It also involves educating patients, tending to their comfort needs, and assisting them in performing tasks they can’t do on their own.
• The cure circle involves the treatment, intervention, and care given by health care professionals to address patient health conditions.

Hall’s model highlights the importance of treating the whole patient and emphasizes a nurse’s role resides primarily in the care circle. Hall also proposed methods for professionalizing nursing, such as the nursing process.

What Are the Different Types of Nursing Theories?

Nursing theories allow nurses to explain how they care for patients and provide reasons and evidence for their methodologies. Each one of the various types of nursing theories has a separate purpose and typical components.

Grand Nursing Theories

Grand nursing theories offer a broad framework for addressing complex ideas and concepts about nursing. These types of nursing theories set forth abstract and general ideas about the different components of the nursing metaparadigm: person, nursing, environment, and health.

Grand nursing theories can guide research. However, due to their broad scope, they don’t guide particular nursing interventions and aren’t meant for empirical testing. Instead, they provide a wide-ranging perspective on what nursing looks like in different situations and environments.

Typically, grand nursing theories originate from:

• A theorist’s own nursing experience
• Conceptual models
• Nursing philosophies

Middle-Range Nursing Theories

Unlike grand nursing theories and their broad perspectives, middle-range nursing theories focus their lenses more narrowly, making more concrete connections to nursing practice. These nursing theories present precise concepts and propositions addressing specific areas of nursing. They typically aim to:

• Answer specific questions about nursing practice
• Describe and predict nursing practice phenomenon

Due to their more limited scope and less abstract nature, middle-range nursing theories can be tested. Grand nursing theorists typically use grand nursing theories as the basis of their work. However, the ideas in middle-range nursing theories may also come from nursing experience or research.

Ethical Theories

Ethical theories in nursing address the dilemmas that arise in health care and offer guidance about making good judgments. They also explore what integrity looks like and the ethical obligations of those in the nursing profession.

These theories may consider how to address ethical issues in nursing as they relate to:

• Advances in technology
• Changes in society
• Health policy
• Healthy nursing work environments

Ethical theories in nursing may stem from philosophies in other fields and experience in nursing practice.

Change Theories

Change theories in nursing explore ways to make planned shifts in nursing services. Nurse leaders and others use these theories to help them drive changes within nursing practices. These changes can encompass long-term broad initiatives or more simple adjustments to established processes in a nursing environment.

Change theories often consider the forces that drive and resist change and how to handle each. Typically, these theories consist of various stages or steps leading to the successful implementation of change projects.

Why Are Nursing Theories Important?

To answer the question, Why are nursing theories important? it’s useful to explore the vital roles they play in shaping a health care facility’s patient care delivery strategies.

The Relationship Between Nursing Theory and Health Care Facility Policy

Health care facilities regularly turn to nursing theories to shape their policies and guide patient care. The use of nursing theories in forming policies helps health care organizations establish care grounded in principles benefitting patients and improving nurse-patient relationships.

In fact, to earn a magnet designation from the American Nurses Credentialing Center, the highest credential health care organizations can obtain, hospitals must base their practice model on a nursing framework.

Nurse leaders can seek out theories that best suit the settings and communities where they work. For example, health care facilities serving multicultural and multilingual communities may adopt a transcultural nursing practice model.

Correlations Between Nursing Theory and Improved Patient Care

Research has shown a correlation between the use of nursing theories and improved patient care. Using interventions from theoretical frameworks can have a positive impact on:

• Quality of life. When patients receive care tailored to their needs, it can improve how they feel both physically, emotionally, and socially.
• Self-efficacy. Effective nursing strategies can increase a patient’s confidence and motivation, leading to better outcomes and greater patient satisfaction.
• Self-care. Positive interactions between nurses and patients can increase the likelihood patients will listen to health recommendations and follow up with their appointments.
• Stress levels. Nursing care that considers the various needs of a patient can reduce the patient’s stress levels.

The Importance of Nursing Theories to Nurses Throughout Their Careers

Theoretical work in nursing changes regularly. With new questions and developments arising in medicine, technology and so on, nurse theorists continue to adapt, extend, and propose nursing models. This has significance for nurses throughout their careers.

At the beginning of their careers, nurses lack experience. They need a solid framework from which to guide their practice. The concepts and principles of nurse theories can provide invaluable support to nurses as they build knowledge in the field.

As nursing theorists develop new theories, the body of knowledge about nursing issues grows. This means nurses have more and more information to draw from to help them address new and old challenges. As such, nurses can look to nursing theories as a resource to improve their practice throughout their careers.

Additionally, when nurses’ careers advance or the settings where they work change, they often confront situations calling for different strategies and approaches. Again, nurses can seek out nursing theories to help answer and solve problems.

Putting Nursing Theories to Work in Care Delivery

Nursing theories play a vital role in the evolution of nursing as a discipline. They not only establish the critical contributions made by the profession, but also provide nurses with frameworks to guide their practice, grow professionally, and improve the care they deliver to patients.