Quite simply, theories are words or phrases (concepts) joined together in sentences, with an overall theme, to explain, describe, or predict something. A more complex definition of a theory is “a set of interrelated concepts, definitions, and propositions that present a systematic way of viewing facts/events by specifying relations among the variables, with the purpose of explaining and predicting the fact event” (Kerlinger, cited in Hickman, 2003).

Theories help us understand and find meaning in our nursing experience and also provide a foundation to direct questions that provide insights into best practices and safe patient care. Ellis (1997) stated, “A theory is a coherent set of hypothetical, conceptual and pragmatic principles forming a general frame of reference for a field of study” (p 373). You might see theory referred to as a conceptual model or a conceptual framework.

Nursing theory is, according to Meleis (cited in Hickman, 2003), “an articulated and communicated conceptualization of invented or discovered reality in or pertaining to nursing for the purpose of describing, explaining, predicting or prescribing nursing care” (p 16).

The bottom line is that words and phrases (concepts) are put together into sentences (propositions that show the relationships among the words/concepts), with an overall theme, to create theories. Theories also have some basic assumptions (jumping-off points; what is assumed to be true), such as the idea that patients need nurses. Nursing theories also define four metaparadigms (metaparadigms refer to big, comprehensive concepts) and address the nursing process.

Consider all that you do as a nurse. What you do is based on principles from many different professions, such as biology, sociology, medicine, ethics, business, theology, psychology, and philosophy. What is specifically based on nursing? Also, if nursing is a science (and it is), there must be some scientific basis for it. Furthermore, theory helps define nursing as a profession (Figure 8-1).

Theory is a means to gather information, to more clearly and specifically identify ideas, to guide research, to show how ideas are connected to each other, to make sense of what we observe or experience, to predict what might happen, and to provide answers. A nurse is not a “junior physician,” although for years nursing care has been based on the medical model. Because nursing is a science (as well as an art) and a unique profession in its own right, nurses need nursing theory on which to base their principles of care (Critical Thinking Box 8-1; Evidence-Based Practice Box 8-1).

In studying nursing theories and the people who created them, it is important to look at the background of the theorist, as well as how life experiences, beliefs, and education influenced the resulting theory. What are the overall theme and main ideas of the theory, and how does the theorist define the four nursing metaparadigms (Box 8-1)?

Florence Nightingale is considered to be the first nursing theorist. She saw nursing as “A profession, a trade, a necessary occupation, something to fill and employ all my faculties, I have always felt essential to me, I have always longed for; consciously or not … The first thought I can remember, and the last was nursing work …” (cited in Dunphy, 2002). Now, you might not feel that dedicated, but Nightingale also stated, “Nursing is an art … It is one of the Fine Arts; I had almost said, the finest of the Fine Arts” (cited in Dunphy, 2002).

Nightingale had various influences, including her education (which was fairly comprehensive for a 19th century English woman), her religion (Unitarianism), the history of the time (the Crimean War and invention of the telegraph), and her social status. The Unitarian belief involved salvation through health and wholeness, or our modern-day “holism.” Nightingale believed that there was no conflict between science and spirituality. Science was necessary for the development of a mature concept of God. She also studied many other religions throughout her lifetime and considered starting a Protestant religious order of nuns (Dunphy, 2002).

Nightingale came from a very wealthy family and enjoyed traveling throughout Europe, one of the destinations being Kaiserwerth in Germany, where she observed and was moved by nuns caring for the ill. Nightingale felt a “calling” to care for others and began training with various groups, usually nuns who cared for the sick. When the Crimean War broke out, Nightingale was asked and volunteered to go to care for the wounded English soldiers. The Crimean War was the first war since the invention of the telegraph, so news of the war was more immediate than had been previously experienced (Dunphy, 2002).

The overall theme of Nightingale’s theory was that the person is influenced by the environment. When she went to help soldiers during the Crimean War, her initial intent was to feed the soldiers healthy food and to clean the place (Figure 8-2). When soldier mortality rates fell, a legend was born (Dunphy, 2002)!

Nightingale believed that nursing was separate from medicine and that nurses should be trained (although we prefer the word educated). She also believed that the environment was important to the health of the person and that the nurse should support the environment to assist the patient in healing (Dunphy, 2002).

To define the metaparadigms, Nightingale noted that the person is the center of the model and incorporated a holistic view of the person, someone with psychological, intellectual, and spiritual components. The nurse was a woman (because only women were nurses in Nightingale’s day) who had charge of the health of a person, whether in providing wellness care, such as with a newborn, or in providing care to the sick. Health was the result of environmental, physical, and psychological factors, not just the absence of disease (Dunphy, 2002).

No other theories were identified or published until the 1950s when Peplau published her theory based on the interpersonal process. Other nurses were working on theories during that time and into the 1960s. In the 1970s, nursing was beginning to see itself as a scientific profession based on theoretical ideas (Table 8-1). In 1972, the National League for Nursing (NLN) required that nursing curricula be based on conceptual frameworks (McEwen, 2011).

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