Before the 1950s, the medical model dominated psychiatric–mental health nursing practice. Physicians and psychiatrists assessed, diagnosed, and planned care for individuals with psychiatric disorders. Nurse practitioners were taught and supervised mainly by physicians and psychiatrists who incorporated the theories of individuals such as Freud, Sullivan, Skinner, Bowen, or Erikson into their practice. However, during this same period, nursing leaders began to emerge to provide impetus for the development of psychiatric nursing as an independent discipline (Fitzpatrick, Whall, Johnston, & Floyd, 1982). Table 3-1 describes how various theoretical frameworks of other disciplines influenced the development of psychiatric nursing theory. Specific theoretical models of personality development are discussed in Chapter 24.

Terminology such as conceptual models or frameworks and theories have been used freely and interchangeably to refer to any conceptualization of nursing reality. The interchangeable use of these terms has presented a problem to the pure semanticists in the field of nursing. For example, although it is a paper written to describe her view of nursing, Florence Nightingale’s Notes on Nursing: What It Is, and What It Is Not (1859), is considered to be nursing’s first environmental theory (Gropper, 1990).

Conceptual frameworks (a group of concepts linked together to describe a specific viewpoint) were developed by theorists such as Hildegard Peplau in 1952, Virginia Henderson in 1955, Martha Rogers in 1970, Imogene King in 1971, Dorothea Orem in 1971, and Sister Callista Roy in 1971. These frameworks provided a foundation and strategy for theory development by introducing orderliness into the research process and providing ideas for statements of theoretical hypotheses (ie, predicted relationships among variables under investigation). Hypotheses lead to empirical studies that seek to confirm or discredit predictions. Theoretical hypotheses eventually lead to the development of theories, which are abstract generalizations that present systematic explanations about the relationships among variables.

Early theorists focused on interpersonal relationships between client and nurse, behavioral responses to stress and the environment, and approaches to self-care
deficit. The phrase systems-oriented theory also evolved at this time. For example, in systems-oriented theory the individual is considered part of the family system. Stress in one part of the system (eg, family) affects other parts of the system. Changes in family structure contribute to changes in the behavior of individuals.

Since the 1970s, nursing theories based on caring, cultural care diversity and universality, modeling and role modeling, energy fields, and human becoming have emerged. Table 3-2 provides a chronology of nursing theorists and theories.

This chapter highlights the major theories and nursing theorists and describes the application of nursing theory to psychiatric–mental health nursing practice.