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There is a reciprocal relationship between conceptual models of nursing and nursing practice Conceptual models influence clinical nursing

practice by specifying standards for and purposes of practice, identifying relevant clinical problems, settings for practice, legitimate recipients of nursing care, and the content for the nursing process, suggesting methods for delivery of nursing services, and by providing frameworks for clinical information systems, patient classifications systems and quality assurance programmes Nursing practice, in turn, provides data that can be used to determine the credibility of the conceptual models Sources of data from clinical practice for credibility determination include evaluations of nursing interventions, the recipient's perspective of nursing care and quality assurance reviews

A conceptual model of nursing and health policy was proposed by the authors in 2001. Revisions in the model have been made, and the model has been used to guide the evolution of a nursing doctoral program and doctoral dissertation research. The revised model provides a framework for analysis and evaluation of public, organizational, and professional polices influencing the quality, cost, and access to nursing and other health care services, as well as for nursing-discipline specific and health services research at any one of four interacting levels: Level 1efficacy of nursing practice processes; Level 2 effectiveness of nursing practice processes and effectiveness and efficiency of health care delivery subsystems; Level 3equity of access to effective and efficient nursing practice processes and efficient nursing practice delivery systems, and equity in distribution of costs and burdens of care delivery; Level 4 justice and the social changes and market interventions addressing equity.

Introduction to Nursing Theories

This page was last updated on February 21, 2011 INTRODUCTION

Each discipline has a unique focus for knowledge development that directs its inquiry and distinguishes it from other fields of study. (Smith & Liehr, 2008).

Nursing knowledge is the inclusive total of the philosophies, theories, research, and practice wisdom of the discipline.As a professional discipline this knowledge is important for guiding practice.(Smith & Liehr, 2008).

Theory-guided, evidence-based practice is the hallmark of any professional discipline. Nursing is a professional discipline (Donaldson & Crowley, 1978). Nursing theory is the term given to the body of knowledge that is used to support nursing practice Almost 90% of all Nursing theories are generated in the last 20 years. Nursing models are conceptual models, constructed of theories

and concepts METAPARADIGMS IN NURSING 1. Person

Recipient of care, including physical, spiritual, psychological, and sociocultural components. Individual, family, or community

2. Environment

All internal and external conditions, circumstances, and influences affecting the person

3. Health

Degree of wellness or illness experienced by the person

4. Nursing

Actions, characteristics and attributes of person giving care


A theory is a group of related concepts that propose action that guide practice. A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of

describing, explaining, predicting, and /or prescribing.. Based on the knowledge structure levels the theoretical works in nursing can be studied under the following headings:

Metaparadigm (Person, Environment, Health & Nursing) (Most abstract) Nursing philosophies. Conceptual models and Grand theories. Nursing theories and Middle range theories (Least abstract)




a set of related statements that describes or explains phenomena in a systematic way

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a mental idea of a phenomenon Concepts are the building blocksthe primary elements of a theory.


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a phenomena that cannot be observed and must be inferred Constructs are concepts developed or adopted for use in a particular theory. The key concepts of a given theory are its constructs.


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a statement of relationship between concepts made up of concepts and propositions They epresent ways of thinking about a problem or ways of representing how complex things work the way that they do.

Conceptual model-

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Different Frameworks will emphasize different variables and outcomes and their interrelatedness.( Bordage, 2009) Models may draw on a number of theories to help understand a particular problem in a certain setting or context. They are not always as specified as theory.


Variables are the operational forms of constructs. They

define the way a construct is to be measured in a specific situation.

Match variables to constructs when identifying what needs to be assessed during evaluation of a theory-driven program.

NURSING PHILOSOPHIES Theory Florence Nightingales Legacy of caring Key emphasis Focuses on nursing and the patient environment relationship. Helping process meets needs through the art of individualizing care. Nurses should identify patients need-for help by:

Ernestine Wiedenbach: The helping art of clinical nursing

Observation Understanding client behaviour Identifying cause of discomfort

Virginia Hendersons Definition of Nursing

Determining if clients can resolve problems or have a need for help Patients require help towards achieving independence. Derived a definition of nursing Identified 14 basic human needs on which nursing care is based. Patients problems determine nursing care

Faye G.Abedellahs Typology of twenty one Nursing problems Lydia E. Hall :Care, Cure, Core model Jean Watsons Philosophy and Science of caring

Nursing care is person directed towards self love. Caring is moral ideal: mind -body soul engagement with one and other.

Caring is a universal, social phenomenon that is only effective when practiced interpersonally considering humanistic aspects and caring. Patricia Benners Primacy of Caring is central to the essence of nursing. It caring sets up what matters, enabling connection and concern. It creates possibility for mutual helpfulness. Caring creates - possibilities of coping possibilities for connecting with and concern for others, possibilities for giving and receiving help Described systematically five stages of skill acquisition in nursing practice novice, advanced beginner, competent, proficient and expert. CONCEPTUAL MODELS AND GRAND THEORIES Dorothea E. Orems Self Selfcare maintains wholeness.

care deficit theory in nursing Three Theories: Theory of Self-Care Theory of Self-Care Deficit Theory of Nursing Systems Wholly compensatory (doing for the patient) Partly compensatory (helping the patient do for himself or herself) Supportive- educative (Helping patient to learn self care and emphasizing on the importance of nurses role Holism is maintained by conserving integrity Proposed that the nurses use the principles of conservation of:

Myra Estrin Levines: The conservation model

Client Energy Personal integrity Structural integrity Social integrity A conceptual model with three nursing theories Conservation Redundancy

Therapeutic intention Martha E.Rogers: Science Person environment are energy fields that evolve of unitary human beings negentropically
Martha proposed that nursing was a basic scientific discipline Nursing is using knowledge for human betterment. The unique focus of nursing is on the unitary or irreducible human being and the environment (both are energy fields) rather than health and illness Individuals maintain stability and balance through adjustments and adaptation to the forces that impinges them. Individual as a behavioural system is composed of seven subsystems. Attachment, or the affiliative subsystems is the corner stone of social organisations.

Dorothy E.Johnsons Behavioural system model

Behavioural system also includes the subsystems of dependency, achievement, aggressive, ingestive-eliminative and sexual. Disturbances in these causes nursing problems. Stimuli disrupt an adaptive system The individual is a biopsychosocial adaptive system within an environment. The individual and the environment provide three classes of stimuli-the focal, residual and contextual. Through two adaptive mechanisms, regulator and cognator, an individual demonstrates adaptive responses or ineffective responses requiring nursing interventions Reconstitution is a status of adaptation to stressors A conceptual model with two theories Optimal patient stability and prevention as intervention Neumans model includes intrapersonal, interpersonal and extrapersonal stressors. Nursing is concerned with the whole person. Nursing actions (Primary, Secondary, and Tertiary levels of prevention) focuses on the variables affecting the clients response to stressors. Transactions provide a frame of reference toward goal setting. A conceptual model of nursing from which theory of goal attainment is derived. From her major concepts (interaction, perception, communication, transaction, role, stress, growth and development) derived goal attainment theory. Perceptions, Judgments and actions of the patient and the nurse lead to reaction, interaction, and transaction (Process of nursing). Individuality in living. A conceptual model of nursing from which theory of goal attainment is derived. Living is an amalgam of activities of living (ALs). Most individuals experience significant life events which can affect ALs causing actual and potential

Sister Callista: Roys Adaptation model

Betty Neumans : Health care systems model

Imogene Kings Goal attainment theory

Nancy Roper, WW.Logan and A.J.Tierney A model for nursing based on a model of living

problems. This affects dependence independence continuum which is bi-directional. Nursing helps to maintain the individuality of person by preventing potential problems, solving actual problems and helping to cope. Interpersonal process is maturing force for personality. Stressed the importance of nurses ability to understand own behaviour to help others identify perceived difficulties.

Hildegard E. Peplau: Psychodynamic Nursing Theory

The four phases of nurse-patient relationships are: 1. Orientation 2. Identification 3. Exploitations 4. Resolution

The six nursing roles are:

1. Stranger 2. Resource person 3. Teacher 4. Leader 5. Surrogate

6. Counselor Ida Jean Orlandos Nursing Interpersonal process alleviates distress. Process Theory
Nurses must stay connected to patients and assure that patients get what they need, focused on patients verbal and non verbal expressions of need and nurses reactions to patients behaviour to alleviate distress. Elements of nursing situation: 1. Patient 2. Nurse reactions 3. Nursing actions Therapeutic human relationships. Nursing is accomplished through human to human relationships that began with: The original encounter and then progressed through stages of Emerging identities

Joyce Travelbees Human To Human Relationship Model

Developing feelings of empathy and sympathy, until the nurse and patient attained rapport in the final stage. Kathryn E. Barnards Parent Growth and development of children and mother Child Interaction Model infant relationships Individual characteristics of each member influence the parentinfant system and adaptive behaviour modifies those characteristics to meet the needs of the system. Parenting and maternal role attainment in diverse populations

Ramona T.Mercers :Maternal Role Attainment

A complex theory to explain the factors impacting the development of maternal role over time. Katharine Kolcabas Theory Comfort is desirable holistic outcome of care. of comfort Health care needs are needs for comfort, arising from stressful health care situations that cannot be met by recipients traditional support system. These needs include physical, psycho spiritual, social and environmental needs. Comfort measures include those nursing interventions designed to address the specific comfort needs. Caring is universal and varies transculturally. Major concepts include care, caring, culture, cultural values and cultural variations Caring serves to ameliorate or improve human conditions and life base. Care is the essence and the dominant, distinctive and unifying feature of nursing Rosemarie Rizzo Parses Indivisible beings and environment co-create :Theory of human becoming health. A theory of nursing derived from Rogers conceptual model. Clients are open, mutual and in constant interaction with environment. The nurse assists the client in interaction with the environment and co creating health Nola J.Penders :The Health Promoting optimum health supersedes disease promotion; model prevention. Identifies cognitive, perceptual factors in clients which are modified by demographical and biological characteristics, interpersonal influences, situational and behavioural factors that help predict in health promoting behaviour

Madeleine Leiningers Transcultural nursing, culture-care theory

CONCLUSION The conceptual and theoretical nursing models help to provide knowledge to improve practice, guide research and curriculum and identify the goals of nursing practice. The state of art and science of nursing theory is one of continuing growth. Using the internet the nurses of the world can share ideas and knowledge, carrying on the work begun by nursing theorists and continue the growth and development of new nursing knowledge. It is important the nursing knowledge is learnt, used, and applied in the theory based practice for the profession and the continued development of nursing and academic discipline REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26, 113120. Smith, M. J., & Liehr, P. R. (2008). Middle range theory for nursing. New York: Springer Publishing. George B. Julia , Nursing Theories- The base for professional Nursing Practice, 3rd ed. Norwalk, Appleton & Lange. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts Process & Practice 3rd ed. London Mosby Year Book. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002 9. Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby, Philadelphia, 2002.

Nursing Theories and Research

This page was last updated on March 6, 2011 === Introduction

RESEARCH Process of inquiry THEORY Product of knowledge SCIENCE Result of the relationship between research & theory To effectively build knowledge to research process should be developed within some theoretical structure that facilities analysis and interpretation of findings. Relationship between theory and research in nursing is not well understood.

Relationship Between Theory and Research

Research without theory results in discreet information or data which does not add to the accumulated knowledge of the discipline. Theory guides the research process, forms the research questions, aids in design, analysis and interpretation. It enables the scientist to weave the facts together. The relationship is direct and positive The choice of a research design depends on the question asked and the current state of theory development. (Kaiser Permanente, 2009) Theory and its associated research design may be

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Descriptive Correlational Experimental

Theories from Nursing or Other Disciplines?

Nursing science is blend of knowledge that is unique to nursing and knowledge that is borrowed from other disciplines. Debate is whether the use of borrowed theory has hindered the development of the discipline. It has contributed to problems connecting research and theory in nursing.

Historical Overview of Research and Theory in Nursing

Florence Nightingale supported her theoretical propositions through research,

as statistical data and prepared graphs were used to depict the impact of nursing care on the health of British soldiers.

Afterwards, for almost century reports of nursing research were rare. Research and theory developed separately in nursing. Between 1928 and 1959 only 2 out of 152 studies reported a theoretical basis for the research design. In 1970s growing number of nurse theorists were seeking researchers to test their models in research and clinical application Grand nursing theories are still not widely used. In 1990s borrowed theories were used more. Now the focus of research and theory have moved more towards middle range theories

Purpose of Theory in Research

To identify meaningful and relevant areas for study. To propose plausible approaches to health problems. To develop or refine theories Define the concepts and proposed relationships between concepts. To interpret research findings To develop clinical practice protocols. To generate nursing diagnosis.

Bordage (2009) explainsuse of conceptual frameworks in research

Allow researchers to build upon one anothers work; thereby building a body of knowledge Programmatic, conceptually based research helps accumulate deeper understanding over time and this moves a discipline (such as nursing) forward.

Types of theory and corresponding research

Type of theory

Type of research

Descriptive Explanatory Predictive

Descriptive or explanatory Co relational Experimental

How Theory is used in Research

Causal theory of planned behaviour

Theory Generating Research

It is designed to develop and describe relationships between and among phenomena without imposing preconceived notations. It is inductive and includes field observations and phenomenology. During the theory generating process, the researcher moves by logical thought from fact to theory by means of a proposition stated as an empirical generalization.

Grounded Theory Research

Inductive research technique developed by Glazer and Strauss (1967) Grounded theory provides a way to describe what is happening and understanding the process of why it happens. Methodology The researcher observes, collects data, organizes data and forms theory from the data at the same time. Data may be collected by interview, observation, records or a combination of these techniques. Data are coded in preparation for analysis. Category development Categories are identified and named Category saturation Comparison of similar characteristics in each of the


Concept development Defines the categories Search for additional categories Continues to examine the data for additional categories Category reduction Higher order categories are selected Linking of categories The researcher seeks to understand relationships among categories Selective sampling of the literature Emergence of the core variable Central theme are focus of the theory Concept modification and integration Explaining the phenomenal

Theory testing research

In theory testing research, theoretical statements are translated into questions and hypothesis. It requires a deductive reasoning process. The interpretation determines whether the study supports are contradicts the propositional statement. If a conceptual model is used as a theoretical framework for research it is not theory testing. Theory testing requires detailed examination of theoretical relationships.

Theory as a conceptual framework

Problem being investigated is fit into an existing theoretical framework, which guides the study and enriches the value of its findings. The conceptual definitions are drawn from the framework The data collection instrument is congruent with the framework. Findings are interpreted in light of explanations provided by the framework. Implications are based on the explanatory power of a framework.

A Typology of Research

Testing Analyzing Experimentation Deducting Deductive research Quantitative research The scientific method Theory / hypothesis testing Assaying Refining Interpreting

Reflecting Inducing Inductive research Qualitative research Phenomenological research Theory generation Divining; heuristic research

Guidelines for writing about a research studys theoretical framework In the studys problem statement

Introduce the framework Briefly explain why it is a good fit for the research problem area At the end of the literature review Thoroughly describe the framework and explain its application to the present study. Describe how the framework has been used in studies about similar problems In the studys methodology section Explain how the framework is being operationalized in the studys design. Explain how data collection methods (such as questionnaire items) reflect the concepts in the framework. In the studys discussion section Describe how study findings are consistent (or inconsistent) with the framework. Offer suggestions for practice and further research that are congruent with the frameworks concepts and propositions.

Conclusion The relationship between research and theory is undeniable, and it is important to recognize the impact of this relationships on the development of nursing knowledge. So interface theory and research by generating theories, testing the theories and by using it as a conceptual framework that drives the study. References 1. 2. 3. 4. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton and Lange. Polit DF, Hungler BP. Nursing Research: Principles and Methods. Philadelphia: JB Lippincott Company; 1998. Burns N, Grove SK. The practice of Nursing Research. 4th Ed. Philadelphia: WB Saunders Publications; 2001. Treece JW, Treece EW. Elements of Research in Nursing (3rded.). St. Louis:

Mosby; 1982.


Nursing Research Series. Essentials of Science: Methods, Appraisal and Utilization. Kaiser Permanente. Northern and Southern California Nursing Research, 2009. Available at .html

Publications on Nursing Research and Theories

1. 2.

The relationship of nursing theory and research: the state of the art Middle range theory: spinning research and practice to create knowledge for the new millennium

Development of Nursing Theories

This page was last updated on November 4, 2010 ============================================ Introduction

Theories are a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory & predictive in nature.

Theories are composed of concepts, definitions, models, propositions & are based on assumptions. Theory gives planners tools for moving beyond intuition to design and evaluate health behavior and health promotion interventions based on understanding of behavior.[Robert T. Croyle (2005)].

They are derived through two principal methods; deductive reasoning and inductive reasoning. Nursing theorists use both of these methods. Theory is a creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena. A theory makes it possible to organize the relationship among the concepts to describe, explain, predict, and control practice

Definition Concepts are basically vehicles of thought that involve images. Concepts are words that describe objects, properties, or events & are basic components of theory.

Types: 1. 2. 3. Empirical concepts Inferential concepts Abstract concepts


Models are representations of the interaction among and between the concepts showing patterns. Propositions are statements that explain the relationship between the concepts. Process it is a series of actions, changes or functions intended to bring about a desired result. During a process one takes systemic & continuous steps to meet a goal & uses both assessments & feedback to direct actions to the goal.

A particular theory or conceptual frame work directs how these actions are carried out. The delivery of nursing care within the nursing process is directed by the way specific conceptual frameworks & theories define the person (patient), the environment, health & nursing.

The terms model and theory are often wrongly used interchangeably, which further confounds matters. In nursing, models are often designed by theory authors to depict the beliefs in their theory (Lancaster and Lancaster 1981). They provide an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice, for example, through specific methods of assessment.

Models are useful as they allow the concepts in nursing theory to be successfully applied to nursing practice (Lancaster and Lancaster 1981). Their main limitation is that they are only as accurate or useful as the underlying theory.

Importance of nursing theories

Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs1978). It should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964).

Theory is important because it helps us to decide what we know and what we need to know (Parsons1949). It helps to distinguish what should form the basis of practice by explicitly

describing nursing.

The benefits of having a defined body of theory in nursing include better patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education (Nolan 1996).

The main exponent of nursing caring cannot be measured, it is vital to have the theory to analyze and explain what nurses do. As medicine tries to make a move towards adopting a more multidisciplinary approach to health care, nursing continues to strive to establish a unique body of knowledge.

This can be seen as an attempt by the nursing profession to maintain its professional boundaries.

The characteristics of theories Theories are:

interrelating concepts in such a way as to create a different way of looking at a particular phenomenon. logical in nature. generalizable. bases for hypotheses that can be tested. increasing the general body of knowledge within the discipline through the research implemented to validate them. used by the practitioners to guide and improve their practice. consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated.

Basic processes in the development of nursing theories Nursing theories are often based on & influenced by broadly applicable processes & theories. Following theories are basic to many nursing concepts. General System Theory It describes how to break whole things into parts & then to learn how the parts work together in systems. These concepts may be applied to different kinds of systems, e.g. Molecules in chemistry, cultures in sociology, and organs in Anatomy & Health in Nursing. Adaptation Theory It defines adaptation as the adjustment of living matter to other living things & to

environmental conditions. Adaptation is a continuously occurring process that effects change & involves interaction & response. Human adaptation occurs on three levels :

1. The internal (self) 2. The social (others) & 3. the physical (biochemical reactions)

Developmental Theory

It outlines the process of growth & development of humans as orderly & predictable, beginning with conception & ending with death. The progress & behaviors of an individual within each stage are unique. The growth & development of an individual are influenced by heredity, temperament, emotional, & physical environment, life experiences & health status.

Common concepts in nursing theories Four concepts common in nursing theory that influence & determine nursing practice are:

The person (patient). The environment Health Nursing (goals, roles, functions)

Each of these concepts is usually defined & described by a nursing theorist, often uniquely; although these concepts are common to all nursing theories. Of the four concepts, the most important is that of the person. The focus of nursing, regardless of definition or theory, is the person. Historical perspectives and key concepts 1. 2. 3. 4. Nightingale (1860): To facilitate the bodys reparative processes by manipulating clients environment Peplau 1952: Nursing is; therapeutic interpersonal process. Henderson 1955: The needs often called Hendersons 14 basic needs Abdellah 1960: The nursing theory developed by Faye Abdellah et al (1960) emphasizes delivering nursing care for the whole person to meet the

physical, emotional, intellectual, social, and spiritual needs of the client and family. 5. Orlando 1962: To Ida Orlando (1960), the client is an individual; with a need; that, when met, diminishes distress, increases adequacy, or enhances well-being. 6. Johnsons Theory 1968: Dorothy Johnsons theory of nursing 1968 focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. The goal of nursing to reduce stress so that; the client can move more easily through recovery. 7. Rogers 1970: to maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through humanistic science of nursing 8. Orem1971: This is self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs. 9. King 1971: To use communication to help client reestablish positive adaptation to environment. 10. Neuman 1972: Stress reduction is goal of system model of nursing practice. 11. Roy 1979: This adaptation model is based on the physiological, psychological, sociological and dependence-independence adaptive modes. 12. Watsons Theory 1979: Watsons philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the; humanistic aspects of life. Classification of nursing theories A. Depending On Function (Polit et al 2001)

1. 2. 3. 4.

Descriptive-to identify the properties and workings of a discipline Explanatory-to examine how properties relate and thus affect the discipline Predictive-to calculate relationships between properties and how they occur Prescriptive -to identify under which conditions relationships occur

B. Depending on the Generalisability of their principles

1. 2.

Metatheory: the theory of theory. Identifies specific phenomena through abstract concepts. Grand theory: provides a conceptual framework under which the key concepts and

C. Principles of the discipline can be identified.

1. 2.

Middle range theory: is more precise and only analyses a particular situation with a limited number of variables. Practice theory: explores one particular situation found in nursing. It identifies explicit goals and details how these goals will be achieved.

D. Based on the philosophical underpinnings of the theories 1. 2. 3. 4. Needs theories. Interaction theories. Outcome theories. Humanistic theories.

1. Needs theories These theories are based around helping individuals to fulfill their physical and mental needs. Needs theories have been criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position. 2.Interaction theories As described by Peplau (1988), these theories revolve around the relationships nurses form with patients.

Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs.

3. Outcome theories"

Oucome theories portray the nurse as the changing force, who enables individuals to adapt to or cope with ill health.

Outcome theories have been criticized as too abstract and difficult to implement in practice.

4. Humanistic Theories Humanistic theories developed in response to the psychoanalytic thought that a persons destiny was determined early in life.

Humanistic theories emphasize a persons capacity for self-actualization. Humanists believe that the person contains within himself the potential for healthy & creative growth. Carl Rogers developed a person centered model of psychotherapy that

emphasizes the uniqueness of the individual.

The major contribution that Rogers added to nursing practice is the understandings that each client is a unique individual, so, person-centered approach now practice in nursing.

Models of nursing A model, as an abstraction of reality, provides a way to visualize reality to simplify thinking.

A conceptual model shows how various concepts are interrelated and applies theories to predict or evaluate consequences of alternative actions.

According to Fawcett (2000), A conceptual model gives direction to the search for relevant questions about the phenomena of central interest to a discipline and suggests solutions to practical problems Four concepts are generally considered central to the discipline of nursing: the person who receives nursing care (the patient or client); the environment (society); nursing (goals, roles, functions); and health. These four concepts form a metaparadigm of nursing. The term metaparadigm comes from the Greek prefix meta, which means more comprehensive or transcending, and the word Greek word paradigm, which means a philosophical or theoretical framework of a discipline upon which all theories, laws, and generalizations are formulated (Merriam-Websters Collegiate Dictionary, 1994). Categories of Conceptual Models Ten conceptual models of nursing have been classified according to two criteria:

the world view of change reflected by the model (growth or stability); and the major theoretical conceptual classification with which the model seems most consistent (systems, stress/adaptation, caring, or growth/development).

1.Systems Theory as a Framework

Systems theory is concerned with changes caused by interactions among all the factors (variables)

General systems theory states

A system is defined as a whole with interrelated parts, in which the parts have a function and the system as a totality has a function. A general systems approach allows for consideration of the subsystems levels of the human being, as a total human being, and as a social creature who networks himself with others in hierarchically arranged human systems of increasing complexity. Thus the human being, from the level of the individual to the level of society, can be conceptualized as the client and becomes the target system for nursing intervention (Sills & Hall, 1977).

An example of systems interaction

Input (Diet teaching) Throughput (Assimilation of information) Output (Food intake) Feedback (Weight record, Hb estimation etc.)

Two nursing models based on systems theory: 1. 2. Imogene Kings systems interaction model, and Betty Neumans health care systems model.

Major Concepts as Defined in Kings Model

Person (Human Being)

A personal system that interacts with interpersonal and social systems


Health Nursing

A context within which human beings grow, develop, and perform daily activities dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of ones resources to achieve maximum potential for daily living A process of human interaction

Imogene Kings Systems Interaction Model In interaction model, the purpose of nursing is to help people attain, maintain, or restore health. Kings model conceptualizes three levels of dynamic interacting systems. 1. Individuals are called personal systems. 2. Groups (two or more persons) form interpersonal systems. 3. Society is composed of social systems.

As the person interacts with the environment, he or she must continuously adjust to stressors in the internal and external environment (King, 1981). Health assumes achievement of maximum potential for daily living and an ability to function in social roles. It is the dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of ones resources to achieve maximum potential for daily living (King, 1981,).

Illness is a deviation from normal, that is, an imbalance in a persons biological structure or in his psychological makeup, or a conflict in a persons social relationships (King, 1989).

The goal of nursing is to help individuals and groups attain, maintain, and restore health Stress: a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance

Betty Neumans Health Care Systems Model Betty Neuman specifies that the purpose of nursing is to facilitate optimal client system stability.

Normal line of defense: an adaptational level of health considered normal for an individual Lines of resistance: protection factors activated when stressors have penetrated the normal line of defense

Neumans model, organized around stress reduction, is concerned primarily with how stress and the reactions to stress affect the development and maintenance of health. The person is a composite of physiologic, psychological, sociocultural, developmental, and spiritual variables considered simultaneously. Ideally the five variables function harmoniously or are stable in relation to internal and external environmental stressor influences (Neuman, 2002).

A person is constantly affected by stressors from the internal, external, or created environment. Stressors are tension-producing stimuli that have the potential to disturb a persons equilibrium or normal line of defense. This normal line of defense is the persons usual steady state. It is the way in which an individual usually deals with stressors.

Stressors may be of three types: 1. 2. 3. Intrapersonal: forces arising from within the person Interpersonal: forces arising between persons Extrapersonal: forces arising from outside the person

Resistance to stressors is provided by a flexible line of defense, a dynamic protective buffer made up of all variables affecting a person at any given moment the persons resistance to any given stressor or stressors. If the flexible line of defense is no longer able to protect the person against a stressor, the stressor breaks through, disturbs the persons equilibrium, and triggers a reaction. The reaction may lead toward restoration of balance or toward death. Neuman intends for the nurse to assist clients to retain, attain, or maintain optimal system stability (Neuman, 1996). Thus, health (wellness) seems to be related to dynamic equilibrium of the normal line of defense, where stressors are successfully overcome or avoided by the flexible line of defense. Neuman defines illness as a state of insufficiency with disrupting needs unsatisfied (Neuman, 2002). Illness appears to be a separate state when a stressor breaks through the normal line of defense and causes a reaction with the persons lines of resistance. Stress/Adaptation Theory as a Framework In contrast to systems theory, stress and adaptation theories view change caused by personenvironment interaction in terms of cause and effect. The person must adjust to environmental changes to avoid disturbing a balanced existence. Adaptation theory provides a way to understand both how the balance is maintained and the possible effects of disturbed equilibrium. This theory has been widely applied to explain, predict, and control biologic (physiologic and psychological) phenomenon. Criticisms of nursing theories To understand why nursing theory is generally neglected on the wards it is necessary to take a closer look at the main criticisms of nursing theory and the role that nurses

play in contributing to its lack of prevalence in practice. Summarization

Definition Importance of Nursing Theories The characteristics of theories: Basic Processes in the Development Of Nursing Theories: Nursing theories are often based on & influenced ANA definition of Nursing Practice Common concepts in Nursing Theories: Historical Perspectives & Key Concepts Clasification of Nursing Theories Models Of Nursing Growth and Stability Models of Change Betty Neumans Health Care Systems Model Stress/Adaptation Theory as a Framework A unique body of knowledge Criticisms of nursing theories

Conclusion Theory and practice are related. A theory presents a systematic way of understanding events or situations.It is a set of concepts, definitions, and propositions that explain or predict these events or situations by illustrating the relationships between variables.Theories must be applicable to a broad variety of situations. They are, by nature, abstract, and dont have a specified content or topic area. Like empty coffee cups, theories have shapes and boundaries, but nothing inside. They become useful when filled with practical topics, goals, and problems. [Robert T. Croyle (2005)] Reference 1. Robert T. Croyle (2005). Theory at a Glance: Application to Health Promotion and Health Behavior (Second Edition). U.S. Department of Health and Human Services, National Institutes of Health. Available at 2. 3. 4. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott.

5. 6. 7.

Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts Process & Practice 3rd ed. London Mosby Year Book. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15


Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):22

Middle - Range Nursing Theories

Criteria and a number of views on mid-range theory is available on the University of San Diego Hahn School of Nursing And Health Science web site: Click Here! Evelyn Adam - Conceptual Model for Nursing Jeanine Roose Auger - Behavioral systems and nursing. Dr Phil Barker - Tidal Theory Kathryn E. Barnard - Parent-Child Interaction Model. Dr. Mary Bennett - PNI Nursing Theory Carrie Jo Braden - Learned Response to Chronic Illness Theory Jeanine M. Carr - Nursing theory of Vigilance Dr. Marion Conti-O'Hare - Theory of The Nurse As Wounded Healer Cheryl Cox - Interaction Model of Client Health Behavior. Eakes, Burke & Hainsworth - Middle Range Theory: Chronic Sorrow Marion Good & Shirley Moore - Acute Pain Management (Adults) Eugenie Hildebrandt & Cynthia Armstrong Persily - Theory of Community Empowerment M.M. Huth & Shirley Moore - Prescriptive theory ofacute pain management in infants and children Jean Johnson - Sensation Theory Dr. Katharine Kolcaba - The Comfort Theory June H Larrabee - Quality of Nursing Care Madelaine M Leininger - Transcultural Nursing. E. Lenz and L. Pugh - The Theory of Unpleasant Symptoms Ramona T. Mercer - Role Attainment: Chronically ill children: how families adjust. Blanche Mikhail - Utilization of Health Belief Model Merle Mishel - Uncertainty in Illness Theory Kathleen O'Connell - Theory of Self Control Strength. Joanne K. Olson & E Hanchett - Nurse - expressed empathy and patient outcomes. Ida Jean Orlando - The Deliberative Nursing Process. Dr. Nola J. Pender - Health Promotion Model Hildegard E. Peplau - Interpersonal Relations. Susan E. Pollock - Health-related Hardiness Sue Popkess-Vawter - Holistic self-care model for permanent weight control Larry D. Purnell - Purnell's Model for Cultural Competence Pamela Reed - Self Transcendence Barbara Resnick - Middle Range Nursing Theory of Self-efficacy Gayle M. Roux - Theory of Inner Strength in Women Reva Rubin - Theory of Maternal Identity. Cornelia Maria Ruland - End of Life Care Hollie Shaner - Environmentally Responsible Clinical Practice Model. Kristen M. Swanson - Theory of Caring (1991) Ann L. Whall - Disruptive Behavior. Janet B. Younger - A Theory: Mastery of Stress

Patricia Liehr & Mary Jane Smith - Attentively Embracing Story

Geri LoBiondo-Wood - The Theory of Family Stress and Adaptation Rozzano Locsin - Advancing Technology, Caring and Nursing

Nursing Theory
To be a nursing theory, the theory must be about nursing-related concepts. The metaparadigm concepts of person, environment, health, and nursing serve as an umbrella for other concepts that may be present in a nursing theory. Nursing theories vary in their scope and level of abstraction. The following are types of nursing theories. Conceptual Model or Conceptual Framework - A conceptual model is a group of concepts that flow from the same paradigm perspective. It describes a certain approach and view of the discipline. Although it may contain more than one concept, the relationships among concepts are not clearly delineated and not testable. A conceptual model is intended as an organizing framework from which a more concrete theory will be derived. Grand Theory - A grand theory is similar to a conceptual model in that it describes a certain viewpoint that is applicable across many different fields within nursing. A grand theory is broad in scope; it is composed of related concepts but the relationships are not concrete. A grand theory is a highly abstract description of proposed truth. Although grand theory is testable, the concepts and relationships involved make testing difficult. Martha Rogers science of unitary human beings proposes ideas about humans that are highly abstract and difficult to test using accepted research methods. Theory A theory is less abstract than a grand theory and has a narrower scope. A theory applies to a specific aspect or practice area of nursing, but is not as limited as a middle range theory. Middle Range Theory - A middle-range theory is less abstract than a grand theory. It is more concrete, more usable and closer to practice. Often a middle range theory is developed from a grand theory. The concepts and relationship in a middle-range theory are directed more at a specific nursing situation than in the preceding types of theory. Middlerange theories are more amenable to testing through research. Practice Theory - A practice theory describes a theory that is very concrete. It has a low level of abstraction. An example of a very simple practice theory would be something like "turning every 2 hours decreases the risk of pressure sores". You can see how this could be easily tested to see if it is supported.


Describe the process of nursing theory development

A theory is generated from observations made regarding a given phenomena. In everyday life, people often create theories about how and why things happen. To develop formal theory requires structured observations and subsequent testing. Knowledge that is gained through observing multiple instances of the same phenomena is from an inductive approach. Inductive reasoning takes information gathered from specific events and derives a general statement or theory to describe the underlying principle. For example, multiple observations could be made of clients who are experiencing a similar situation; some general statements could be developed that might be expected to apply to other people who also experience that situation. Qualitative research is an inductive process that is valuable to generate theoretical ideas. Once a theory is proposed, it must be tested to see whether the proposed generalities seem to hold true, and under what circumstances. In research, this proposed relationship is called a hypothesis. A hypothesis is an educated hunch about what is thought to be true. Hypothesis testing is a deductive approach that examines how well a general statement applies to a specific case. Deductive reasoning is the type of thought process used in the scientific method. Although traditional experiments are done in a lab, that type of environment does not usually work for the things about which nurses are concerned. When testing a theory, other contextual aspects of the situation must be considered, making nursing research quite complex. It is impossible to actually "prove" something beyond a shadow of a doubt, so nurse researchers attempt to find "support" for a theory.