Understanding Nursing Theories

Nursing theories help guide and define nursing care and provide a foundation for clinical decision-making. Although some nursing theories have been around for hundreds of years in public health, many are still being used in today’s hospitals and healthcare settings.

If you’re thinking about going to school to become a nurse, it’s safe to assume that nursing theory will be a critical part of your curriculum. However, you can get a head start and learn more about nursing theories in this article.

A metaparadigm is a set of ideas that provide structure for how a health care discipline should function. In nursing, this refers to the four main concepts that are tied to nursing theory.

Person

The person component of the metaparadigm focuses on the receiver of care, as well as the people in their life, and takes into consideration the patient’s social, spiritual, and healthcare needs. The theory is that a person can be more empowered to manage their health when they have positive personal connections.

Health

The health concept realizes the multiple factors that go into a patient’s well-being—including physical, emotional, intellectual, spiritual, and social components—and how they can be integrated to achieve maximum health outcomes.

Environment

This concept focuses on the surroundings that affect the patient and how those surroundings can influence their health and wellness. It theorizes that a person can alter their environment to improve their health.

Nursing

This aspect of the metaparadigm recognizes the relationship between a nurse and patient. It focuses on the nurse’s role in providing a safe and caring environment and values the high degree of service necessary to provide the best patient health outcomes.

There are a host of different nursing models and theories, based on nursing research, that drive nursing practice and the nursing profession at large all around the country and the world. These theories each incorporate the concepts of the metaparadigm of nursing, with specific nursing practice being shaped by the ideas of the nursing theorists that created the various models as nursing education and implementation strategies.

All nursing theories are organized into three levels: grand, middle-range, and practice-level. Here’s a look at each:

Grand Nursing Theories

Like the name implies, any theory based on broad, abstract, or more complex concepts will fall under this category. Grand nursing theories typically provide a high-level framework for nursing ideas rather than diving into the details.

Middle-Range Nursing Theories

Middle-range theories get into more specific areas of nursing as opposed to grand theories. They can come from day-to-day nursing practice, research, or from theories of similar disciplines.

Practice-Level Nursing Theories

Theories categorized in this level are the most focused. They deal with very situation-specific concepts that are narrow in scope and home in on a specific patient population.

There are many nursing theories out there, but here are some of the most common:

Environmental Theory

Known as the first nursing theorist and the founder of modern nursing, Florence Nightingale created the Environmental Theory in 1860, and its principles are still used today. She served as a nurse during the Crimean War, where she observed a connection between patients who died and their environmental conditions. As a result, the Environment Theory was born. In it, Florence Nightingale identifies five environmental factors—fresh air, pure water, efficient drainage, cleanliness, and sunlight—as essential factors in human health.

Casey’s Model of Nursing

Developed by Anne Casey in 1988, Casey’s Model of Nursing is considered one of the earliest nursing theories developed specifically for child health nursing. This theory focuses on the nurse working in partnership with the child and their family. The philosophy is that the best people to care for a child are their family with the assistance of health professionals.

Patient-Centered Approach to Nursing

Faye Abdellah’s patient-centered approach was created in the 1940s to help with nursing education and is intended to guide care in hospitals. Her theory outlines 10 steps to identify a patient’s problem and expands into additional skills to develop a treatment. The 10 steps include:

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 their nursing problems.
7. Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting their behavior.
8. Explore the patient and their 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.

Theory of Comfort

Katharine Kolcaba’s Theory of Comfort was developed in the 1990s. According to the model, comfort is an immediate desirable outcome of nursing care. Kolcaba described comfort in three forms: relief, ease, and transcendence. If a patient’s comfort needs are met, they’re provided a sense of relief. As a patient’s comfort needs change, the nurse’s interventions change too.

Tidal Model

Developed by nurse and psychotherapist Phil Barker in the 1990s, this model is widely used in mental health nursing and psychiatry. It focuses on the fundamental care process and draws on values about relating to people to help others in moments of distress. The Tidal Model draws from Ten Commitments, which are to value the voice, respect the language, develop genuine curiosity, become the apprentice, use the available toolkit, craft the step beyond, give the gift of time, reveal personal wisdom, know that change is constant, and be transparent.

Self Care Deficit Theory

Developed by Dorothea Orem, self care deficit theory is a health care theory developed between 1959 and 2001. This nursing model holds that people want to take care of themselves, and that those in the nursing profession can enhance patient care by allowing the patient to do as much of their own self care as they are capable of. The Orem self care nursing model is intended to help patients recover by moving them through the recovery process in a maturational way. Meaning that as the patient becomes more capable, the patient is allowed to do more of their own care.

Cultural Care Theory

The Cultural Care Theory created by Madeleine Leininger, focuses on the idea that patient care should be culturally congruent. In other words, care should be in harmony with the patients' cultural or religious beliefs, practices, and values.

Theories provide a foundation for all professions, and health care theories provide the same foundation for nursing students and professionals. As the field of nursing continues to grow, theories are key in structuring patient care—however, that’s just the start. Here are more reasons why nursing theories are important:

• Provide nurses with rationale in making healthcare decisions
  
• Guide evidence-based research, which then leads to best practices and policies
• Help nurses evaluate patient care
• Give nurses a better understanding of their purpose and role in a healthcare setting
• Ensure nursing best practices are being used
• Provide an identity to nurses that differentiates nursing practice from the medical practice
• Help patients and other healthcare professional recognize the contribution nurses make

This article only scratches the surface on this topic. There’s so much more to explore. A nursing degree program is a great way to gain a deeper understanding of nursing theories and expand your knowledge in the field—whether you’re an aspiring student nurse, just starting nursing school, or looking to elevate your current nursing position.