Nursing Theory

There are many nursing theories available to help guide my practice.

After completing this chapter, you should be able to:

• Identify the purposes of nursing theory.

• Distinguish between grand theory, middle-range theory, and practice theory.

• Describe the origins of nursing theory.

• Describe key concepts associated with nursing theory.

• Identify some of the more well-known and well-developed nursing theories.

• Discuss some of the main points of each of these theories.

Just mentioning the word theory, let alone nursing theory, can make many nurses’ yawn reflexes start to work overtime. What is theory? Who are nursing theorists? What are the different nursing theories? Nursing theories are a way to organize and think about nursing, and the people who wrote theories are part of our nursing history. Theory provides an overall “theme” to what nurses do. In this chapter, the key words related to theory are defined, and the main elements of eight nursing theories are summarized. Buckle your seatbelts—we might be in for a bumpy ride. And no yawning!

Nursing Theory

What Is Theory?

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. You might see theory referred to as a conceptual model or a conceptual framework in nursing textbooks and journals. Meleis offered a definition of nursing theory with the following: “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” (cited in Hickman, 2003, 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 nurses contribute to the patient’s wellness and recovery from illness. Nursing theories also define four metaparadigms (metaparadigms refer to big, comprehensive concepts) and address the nursing process. Finally, nursing theories can be categorized as grand theory, middle-range theory, or practice theory. Each theory level is based on the abstractness of the concept or phenomena presented. For example, grand theories offer broad and abstract concepts about nursing practice, research, and education, which provide a more global view of nursing. Middle-range theories are not as abstract as grand theories; their focus is concentrated on the relationship between concepts with a narrower scope. Last, practice theories guide nursing practice by examining specific issues in nursing practice (Research for Best Practice Box 8.1).

What Nursing Theory Is Not

Nursing theory is not managed care, primary nursing, team nursing, or any other more business-related method of delivering care. Nursing theory is not obstetric nursing, surgical nursing, home health nursing, or any other nursing specialty; however, nursing theory can be applied to all areas of nursing, including administration, education, patient care, and research. Nursing theory is by nurses and for nurses, providing quality care to their patients, either directly or indirectly.

Why Theory?

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 (Fig. 8.1).

Theory is a means to gather information, to identify ideas more clearly and specifically, 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 patient care (Critical Thinking Box 8.1; Research for Best Practice Box 8.2).



Practice Issue

There are a limited number of studies reporting an examination of the use of a nursing theory to guide the care of school-age children with special health care needs in a school setting. Using Orem’s Self-Care Deficit theory, Green (2012) discussed how school nurses can assist children with special health care needs in gaining independence with self-care and daily activities. Using Orem’s Self-Care Deficit theory, researchers Wong, Wan, Choi, and Lam examined the relationship between basic conditioning factors (BCFs), self-care agency, and self-care behaviors in adolescent girls with dysmenorrhea (Wong et al., 2015). Findings from the study suggest that BCFs such as age, knowledge about medications used to treat menstrual pain (self-medication), and educational level of parents, along with self-care agency can influence an adolescent with dysmenorrhea to perform self-care measures associated with menstruation problems.

Implications for Nursing Practice

Application of Orem’s self-care deficit nursing theory can be used by school nurses to identify, plan, and implement nursing care measures that will assist children with special health care needs and their families in developing independence with self-care needs. School nurses can educate adolescent girls on common health-related issues such as menstruation, so that the adolescent is informed about self-care measures that can be used to alleviate associated symptoms of dysmenorrhea.

In practice settings where vulnerable populations are present (such as school nursing), use of a nursing theory serves as an ideal theoretical framework for the nurse to identify self-care needs of the population and provide optimal nursing care with a goal of promoting self-care.


Wong C.L, Wan Y, Choi K.C, Lam L. Examining self-care behaviors and their associated factors among adolescent girls with dysmenorrhea: An application of Orem’s self-care deficit nursing theory. Journal of Nursing Scholarship. 2015;47(3):219–227.

Green R. Application of the self-care deficit nursing theory to the care of children with special healthcare needs in the school setting. Self-Care, Dependent-Care Nursing. 2012;19(1):35–40.


FIG. 8.1 Theory guides both research and nursing practice.



What advantages and disadvantages do you see for using nursing theory in your nursing practice?



Practice Issue

Although the focus of health care institutions in improving patient outcomes is based on evidenced-based practice, little research has investigated the use of a theoretical framework guided by nursing theory in examining patient perceptions in living and managing a medical condition.

Desanto-Madeya (2006) examined perceptions of family members of individuals who had sustained a spinal cord injury about the “meaning of living” (p.240) using Roy’s Adaptation Model. In her qualitative ethnographic study, seven themes emerged from the data analysis in addressing the following research question of what the meaning of living is to the family of an individual with a spinal cord injury.

“The seven themes were (a) looking for understanding to a life that is unknown, (b) stumbling along an unlit path, (c) viewing self through a stained-glass window, (d) challenging the bonds of love, (e) being chained to the injury, (f) moving forward in a new way of life, and (g) reaching normalcy” (Desanto-Madeya, 2006, p.241). Using Roy’s adaptation model, each theme was categorized into one or more modes of adaptation.

Seah and Tham (2015) suggested that the use of Roy’s Adaptation Model could be used by nurses in managing patients with bulimia nervosa. The authors contended that Roy’s Adaptation Model supports a multidisciplinary team approach in the context of providing patient care.

Implications for Nursing Practice

Implementation of a nursing theory to examine patient and family experiences when faced with an illness or injury that may cause both physical and emotional life-altering changes can serve as a framework for nurses in guiding their practice.

As part of the multidisciplinary health care team, nurses can assist patients and their families in adapting to the physiologic and psychosocial factors affected by a life-altering injury and/or illness.

Nursing theories can assist nurses in providing holistic nursing care.


DeSanto-Madeya S. A secondary analysis of the meaning of living with spinal cord injury using Roy’s adaptation model. Nursing Science Quarterly. 2006;19(3):240–246.

Seah X.Y, Tham X.C. Management of bulimia nervosa: A case study with the Roy adaptation model. Nursing Science Quarterly. 2015;28(2):136–141. doi: 10.1177/0894318415571599.

What Is the History of Nursing Theory?

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)?


The four metaparadigms for nursing are nursing, person, health, and environment.

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…” (Florence Nightingale as cited in Dunphy, 2015, p.38). Now, you might not feel as dedicated as she, 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” (Florence Nightingale, as cited in Una and the Lion, 1871, p.6).


BOX 8.1Definition of Metaparadigms


Individuals, families, communities, and other groups who are participants in nursing and who receive nursing care.


The patient environment includes any setting and influencing factors that can alter the setting where the patient receives care. Factors influencing the environment include room temperature, family members’ presence or lack of presence in the plan of care, work, and school.


The patient’s state of well-being. A patient’s health is influenced by many physical and psychosocial factors.


Nursing involves the use of the nursing process to assess, diagnose, plan, implement, and evaluate an individualized plan of care for providing patient care and education.

From Potter, P. A., Perry, A. G., Stockert, P., Hall, A., & Ostendorf, W. R. (2017). Fundamentals of nursing (9th ed.), St. Louis: Elsevier, p.42.

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 (Dunphy, 2015). She also studied many other religions throughout her life, including Anglicanism, and considered starting a Protestant religious order of nuns.

Nightingale came from a very wealthy, prominent 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 after the invention of the telegraph, so news of the war was more immediately circulated than had been previously experienced (Dunphy, 2015).

The overall theme of Nightingale’s theory was that the environment influences the person. When she went to help soldiers during the Crimean War, her initial intent was to feed the soldiers healthy food, maintain cleanliness in the barrack hospital, and ensure proper sanitary and hygiene care (Dunphy, 2015) (Fig. 8.2). When soldier mortality rates fell, a legend was born!

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Apr 20, 2017 | Posted by in NURSING | Comments Off on Nursing Theory
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