Running head: TEN NURSING THEORIES 1

Similarities and Differences of Ten Nursing Theories

Leonardo Jr Magtaan Uy

St. Paul University Philippines

Ten Nursing Theories 2

Introduction

Nursing is a Professional discipline focused on the study of human health and healing through

caring. Nursing practice is based on the knowledge of nursing, which consists of its philosophies,

theories, concepts, principles, research findings and practice wisdom. Nursing theories are

patterns that guide the thinking about nursing. All nurses are guided by some implicit or explicit

theory or pattern of thinking as they care for their patients. The major reason for the development

of study of nursing theory is to improve nursing practice and therefore the health and quality of

life of those we serve (Smith, M.C., & Parker M.E., 2015).

The evolution of nursing theories and philosophies has facilitated the progression of nursing as a

vocation to nursing as an academic discipline and profession. Nursing theory promotes

autonomy when used as a guide for critical thinking and decision making. Ultimately nursing

theory and philosophy has increased knowledge development and enriched the quality of nursing

practice (McEwen & Wills, 2011). Nursing philosophy and theory are two interchangeable

terms. The philosophy a nurse has on nursing will determine the theory and model he or she

uses. Nursing philosophy explains what nursing is and gives insight to why nurses practice the

way they do. Nursing theory describes how nurses and patients are able to produce healing and

good health, by using models to explain how beliefs and aspects of health are related. Theory is

used to explain and analyze what nurses do as well as facilitate communication between nurses

and guide research and education. Nursing theory encompasses the foundations of nursing

practice past and present and provides direction for how nursing should develop in the future

(Alligood & Tomey, 2002).

To understand nursing theories, a theory, concept, conceptual frameworks, and conceptual

model must first be defined. A theory is a supposition or system of ideas that is proposed to

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explain a given phenomenon. Concepts are the building blocks of theory, are abstract ideas or

mental images of phenomena. A conceptual framework is a group of related concepts. It provides

an overall view or orientation to focus thoughts. A conceptual model is a graphic illustration or

diagram of a conceptual framework. Nursing has four basic concepts, called metaparadigms.

You can call this conceptual framework of nursing theories in general since a metaparadigm

consists of a group of related concepts. The four metaparadigms of nursing are person or client,

environment, health, and nursing. A person or client is the recipient of nursing care. Environment

is the internal or external surroundings that affect the client. Health is the degree of wellness or

well-being that the client experiences. Nursing are the attributes, characteristics, and actions of

the nurse providing care on behalf of, or in conjunction with, the client (Kozier, Erb, Berman,

and Burke, 2000).

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Similarities and Differences of Ten Nursing Theories

Nurses must know what they are doing, why they are doing, what may be the range of

outcomes of nursing, and indicators for measuring nursing impact (Parker, 2001). The purpose of

this paper is to find similarities and differences of ten nursing models given by ten nursing

theorists who have made major contributions in the field of nursing practice. These models are;

Florence Nightingale-Environmental Theory, Virginia Henderson -The Nature of Nursing, Jean

Watson – Philosophy and Science of Caring, Sister Calista Roy - Adaptation Model, Dorothea

Orem- Self-Care Model, Hildegard Peplau -Interpersonal Relations Model, Madeleine Leininger

- Culture Care Diversity and Universality, Imogene King-Goal Attainment Theory, Fay Abdella-

Topology of 21 Nursing Problems, and Lydia E. Hall - The Core, Care and Cure.

Nightingale’s Environmental Theory

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.

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Virginia Henderson's 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. 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. Breathe normally. Eat and drink adequately.

2. Eliminate body wastes.

3. Move and maintain desirable postures.

4. Sleep and rest.

5. Select suitable clothes-dress and undress.

6. 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.

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Watson’s Human Caring Theory

According to her theory, caring can be demonstrated and practiced by nurses. Caring for

patients promotes growth; a caring environment accepts a person as he or she is, and looks to

what he or she may become. Caring consists of carative factors. Watson's 10 carative factors are:

forming humanistic-altruistic value systems, instilling faith-hope, cultivating a sensitivity to self

and others, developing a helping-trust relationship, promoting an expression of feelings, using

problem-solving for decision-making, promoting teaching-learning, promoting a supportive

environment, assisting with gratification of human needs, and allowing for existential-

phenomenological forces. The first three factors form the "philosophical foundation" for the

science of caring, and the remaining seven come from that foundation. Watson's theory has four

major concepts: human being, health, environment/society, and nursing. The human being is

defined as "...a valued person in and of him or herself to be cared for, respected, nurtured,

understood and assisted; in general, a philosophical view of a person as a fully functional

integrated self. He, human is viewed as greater than and different from, the sum of his or her

parts." A human's health includes a high level of overall physical, mental, and social function; a

general adaptive-maintenance level of daily function; and the absence of illness or the process of

efforts that will lead to an absence of illness.

Roy’s Adaptation Model

Sister Callista Roy developed the Roy Adaptation Model, which is based on the belief

that the human being is an open system. The system responds to environmental stimuli through

the cognator and regulator coping mechanisms for individuals and the stabilizer and innovator

control mechanisms for groups. The responses occur through at least one of four modes—

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physiological-physical, self-concept-group identity, role function, and interdependence. The

responses in these modes are usually visible to others and can be identified as adaptive or

ineffective. Adaptive behaviors that need support and ineffective behaviors are then analyzed to

identify the associated stimuli. The major stimulus leading to one of these behaviors is the focal

stimulus; other stimuli that are verified as being involved are contextual, and stimuli that might

be involved but have not been verified are residual. Nursing care focuses on altering stimuli or

strengthening adaptive processes to result in adaptive behaviors.

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

The central philosophy of the Self-Care Deficit Nursing Theory is that all patients want to

care for themselves, and they can 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.

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Peplau’s Interpersonal Relations Model

Her focus is on the interpersonal process between a nurse and a client and the roles played

by the nurse in this process. The interpersonal process occurs in three phases: orientation, working,

and termination. In the orientation phase, the client seeks help, and the nurse assists the client to

understand the problem and the extent of the need for help. In the identification phase, the client

assumes a posture of dependence, interdependence, or independence in relation to the nurse. In the

exploitation phase, the client derives full value from what the nurse offers through the relationship.

The client uses available services based on self-interest and needs. Power shifts from the nurse to

the client. To utilize this theory in the nursing practice, the nurse recognizes that the client moves

from one phase of dependence to independence during the nurse-patient interaction for the

provision of health care.

Leininger’s Cultural Care Diversity and Universality Theory

Madeleine M. Leininger recognized the importance of an understanding of culture—both

the nurse’s and the client’s—to effective nursing practice. She believes that all cultures have

practices related to caring. Those practices that are common across cultures are culture care

universalities, and those that are specific to a given culture are culture care diversities. Research

findings indicate there is more diversity than universality. Leininger’s Sunrise Model depicts the

dimensions of Culture Care Diversity and Universality. The cultural and social structure

dimensions include technological, religious, philosophic, kinship, social, value and lifeway,

political, legal, economic, and educational factors. These factors influence the patterns and

expressions of caring in relation to the health of individuals, families, groups, and communities.

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The involved health systems include folk systems, nursing, and other professional systems. To

achieve culture congruent care, nursing actions are to be planned in one of three modes: culture

care preservation/maintenance, culture care accommodation/negotiation, or culture care

repatterning/restructuring. This theory can easily be applied in the nursing practice. For example,

the nurse needs to be aware that caring is common to all cultures. However, there are more

differences than similarities in the practice related to caring. Therefore, becoming familiar of

one’s culture is of utmost importance to provide the ultimate nursing care (Kozier, Erb, Berman,

Burke, 2000).

King’s Goal Attainment Theory

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,

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power, status, and decision making. 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 the goals were achieved.

Faye Glenn Abdellah's 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 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 healthier.

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

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.

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Conclusion

In conclusion, nursing is a multi-paradigmatic discipline. The nursing paradigms play an

essential role for understanding multifaceted human beings and related nursing phenomena. The

conceptual models and theories in nursing represent different paradigms and aspects of nursing.

However, the definitive purpose of these paradigms and the models and theories which follow

these paradigms is to improve professional nursing practice through knowledge development.

In nursing, a patient’s autonomy must be cared for just as much as any other part of the patient.

Nurses can be used as tools to support autonomy in most patient situations. Individual patients

and nursing situations are difficult to peg into one specific theory model. I believe that using a

combination of theories, as well as ethical behavior in practice, can help us to cater to each

individual patient’s needs. Nurse-led, self-care equilibrium can be achieved which is the best

support we can offer to any patient.

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References

Smith, M.C., & Parker M.E. (2015) Nursing Theories & Nursing Practice (4th Edition).

Philadelphia, PA: F.A. Davis Company

Essays, UK. (November 2013). Nursing Theory and Philosophy Nursing Essay. Retrieved from

https://www.ukessays.com/essays/nursing/nursing-theory-and-philosophy-nursing-

essay.php?cref=1

Currentnursing.com. (2011). Nursing Theories. Retrieved from

http://currentnursing.com/nursing_theory/nursing_theorists.html

Petiprin A., Nursing-Theory.org (2016) Retrieved from

http://www.nursing-theory.org/nursing-theorists

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