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What Is Nursing Theory?

3 min read • July, 05 2023

Nursing theories provide a foundation for clinical decision-making. These theoretical models in nursing shape nursing research and create conceptual blueprints, ultimately determining the how and why that drive nurse-patient interactions.

Nurse researchers and scholars naturally develop these theories with the input and influence of other professionals in the field.

Why Is Nursing Theory Important?

Nursing theory concepts are essential to the present and future of the profession. The first nursing theory — Florence Nightingale's Environmental Theory — dates back to the 19th century. Nightingale identified a clear link between a patient's environment (such as clean water, sunlight, and fresh air) and their ability to recover. Her discoveries remain relevant for today's practitioners. As health care continues to develop, new types of nursing theories may evolve to reflect new medicines and technologies.

Education and training showcase the importance of nursing theory. Nurse researchers and scholars share established ideas to ensure industry-wide best practices and patient outcomes, and nurse educators shape their curricula based on this research. When nurses learn these theories, they gain the data to explain the reasoning behind their clinical decision-making. Nurses position themselves to provide the best care by familiarizing themselves with time-tested theories. Recognizing their place in the history of nursing provides a validating sense of belonging within the greater health care system. That helps patients and other health care providers better understand and appreciate nurses’ contributions.

Types of Nursing Theories

Nursing theories fall under three tiers: grand nursing, middle-range, and practical-level theories . Inherent to each is the nursing metaparadigm , which focuses on four components:

• The person (sometimes referred to as the patient or client)
• Their environment (physical and emotional)
• Their health while receiving treatment
• The nurse's approach and attributes

Each of these four elements factors into a specific nursing theory.

Grand Nursing Theories

Grand theories are the broadest of the three theory classifications. They offer wide-ranging perspectives focused on abstract concepts, often stemming from a nurse theorist’s lived experiences or nursing philosophies. Grand nursing theories help to guide research in the field, with studies aiming to explore proposed ideas further.

Hildegard Peplau's Theory of Interpersonal Relations is an excellent example of a grand nursing theory. The theory suggests that for a nurse-patient relationship to be successful, it must go through three phases: orientation, working, and termination. This grand theory is broad in scope and widely applicable to different environments.

Middle-Range Nursing Theories

As the name suggests, middle-range theories lie somewhere between the sweeping scope of grand nursing and a minute focus on practice-level theories. These theories are often phenomena-driven, attempting to explain or predict certain trends in clinical practice. They’re also testable or verifiable through research.

Nurse researchers have applied the concept of Dorothea E. Orem's Self-Care Deficit Theory to patients dealing with various conditions, ranging from hepatitis to diabetes. This grand theory suggests that patients recover most effectively if they actively and autonomously perform self-care.

Practice-Level Nursing Theories

Practice-level theories are more specific to a patient’s needs or goals. These theories guide the treatment of health conditions and situations requiring nursing intervention. Because they’re so specific, these types of nursing theories directly impact daily practices more than other theory classifications. From patient education to practicing active compassion, bedside nurses use these theories in their everyday responsibilities.

Nursing Theory in Practice

Theory and practice inform each other. Nursing theories determine research that shapes policies and procedures. Nurses constantly apply theories to patient interactions, consciously or due to training. For example, a nurse who aims to provide culturally competent care — through a commitment to ongoing education and open-mindedness — puts Madeleine Leininger's Transcultural Nursing Theory into effect. Because nursing is multifaceted, nurses can draw from multiple theories to ensure the best course of action for a patient.

Applying theory in nursing practice develops nursing knowledge and supports evidence-based practice. A nursing theoretical framework is essential to understand decision-making processes and to promote quality patient care.

Images sourced from Getty Images

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Nursing Theories & Theorists Explained

What is nursing theory.

• Nursing Theory Users
• Metaparadigms

Nursing Theorists

Nursing theory in practice.

Nursing theory is "a creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomena," per the book  Integrated Theory and Knowledge Development in Nursing.

Nursing theory provides the foundational knowledge that enables nurses to care for their patients and guides their actions. Theories are in place, regardless of nursing specialization, to establish guidelines for both broad and specific nursing practices.

Nursing theory is heavily influenced by Florence Nightingale's pioneering work, which significantly influenced the modern  nursing definition . Nightingale's Environmental Theory stated that nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the least expense of vital power to the patient.” 

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By identifying potential risk factors for illness or conditions that would exacerbate an illness and potentially lead to death, Nightingale saw the importance of a patient’s environment to their overall health and well-being. As a result, healthcare professionals, including nurses, began to treat patients differently and the start of population health and public health is seen. 

In Florence Nightingale’s Environmental Theory, she identified five environmental factors: 

• Efficient drainage 
• Cleanliness or sanitation
• Light or direct sunlight

These factors were essential to decrease the spread of contagious diseases and decreasing mortality and morbidity. 

While Florence Nightingale may have introduced the first nursing theory in 1860, it is still extremely relevant today. In countries where fresh air, pure water, efficient drainage, cleanliness or sanitation, and light or direct sunlight are not present, morbidity and mortality are increased. 

What are Nursing Theories Used For?

Nursing theories provide the foundation for nursing practice and are essential to the care of patients. Academic hospitals and Magnet hospitals will consistently ensure that nursing theories are incorporated into their policies and procedures to ensure best practice is being used. 

Most nurses and institutions will employ a variety of nursing theories within their everyday practice versus just one theory. Most do it unknowingly. 

Nursing theories help bedside nurses evaluate patient care and base nursing interventions on the evaluation of the findings. 

The theories can also provide nurses with the rationale to make certain decisions. An example of a nursing theory in use is seen in the care of a Jehovah’s Witnesses patient that does not believe in blood transfusions. While the patient may need a blood transfusion, Dorothea Orem’s Self-Care theory provides nurses with a solid basis for assisting their patients and giving them the opportunity to express independence and control in caring for themselves. While the nurse may not agree with the patient’s decision to not receive a blood transfusion, Orem’s theory suggests the importance of allowing the patient to make the decision and respecting it as their own choice. 

Oftentimes, the integration of nursing theory is not as obvious as in the aforementioned example. However, it is important for nurses and nursing students to understand and respect the importance of nursing theories and their impact on modern-day nursing and healthcare. 

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Who are Nursing Theories Used By?

While all nurses, regardless of position and specialty, utilize nursing theories in their practice, not all nurses are aware of their implications. Generally speaking, most nursing theories are used by nurse educators and nurse researchers. 

Nurse educators will utilize nursing theories in designing course curriculums based on educational principles, research, and theories to provide nursing students with the knowledge and skills needed to provide care to their patients. 

Nurse researchers will conduct theory-guided research in order to create best practices and to predict potential clinical problems or explain existing knowledge. 

Nursing Metaparadigms

There have been countless nursing theories introduced since Florence Nightingale's Environmental Theory, including Imogene King‘s Theory of Goal and Dorothy Johnson’s Behavioral System Model. What they all have in common is they center around the nursing metaparadigm.

A metaparadigm is a set of theories or ideas that provide structure for how a discipline should function. Nursing metaparadigms were first classified by Fawcett into four specific categories, 

• Environment

These four concepts are fundamental to all nursing theories and without identification of them and their relevance to the theory, it is incomplete.

Furthermore, these four basic nursing metaparadigms point to the holistic care of a patient and their medical health is interconnected to the four concepts. 

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The Four Main Concepts of Nursing Theory

Fawcett’s four specific concepts help define nursing and set it apart from other disciplines and professions. These four concepts have been used to define the context and content of the nursing profession. The person is the most important concept in nursing theory, but each theorist's interpretation of the other concepts is how to differentiate between them. 

Person (also referred to as Client or Human Being) is the recipient of nursing care and may include individuals, patients, groups, families, and communities.

2. Environment

Environment or situation is defined as the internal and external surroundings that affect the patient. It includes all positive or negative conditions that affect the patient, the physical environment, such as families, friends, and significant others, and the setting for where they go for their healthcare.

Health is defined as the degree of wellness or well-being that the client experiences. It may have different meanings for each patient, the clinical setting, and the health care provider.

The attributes, characteristics, and actions of the nurse providing care on behalf of or in conjunction with, the client. 

Levels of Nursing Theory

Nursing theories are categorized into three levels including, 

• Grand Nursing Theories
• Mid-range Nursing Theories
• Nursing Practice Theories

Grand Nursing Theories 

These are theories based on broad, abstract, and complex concepts. They provide the general framework for nursing ideas pertaining to components such as people and health. These theories typically stem from a nurse theorist’s own experience.

Mid-Range Nursing Theories 

These are theories that drill down into specific areas of nursing rather than deal with sweeping concepts. They can emerge from nursing practice, research, or from the theories of similar disciplines.

Nursing Practice Theories 

These are theories that narrow their focus even further, specifically focusing on concepts concerning a defined patient population. These theories tend to directly affect patients more than the other two types of theories. Bedside nurses will often use these theories in their everyday practice. 

We talked about Nightingale and Orems' role as nursing theorists and reviewed their respective theories. Let's explore the work of some other notable nursing theorists and how their work helps nurses and other healthcare providers give better patient care.

Virginia Henderson: Nursing Need Theory

Virginia Henderson's Nursing Need Theory centers around the concept of basic human needs. Henderson believed that the role of a nurse is to assist individuals in meeting their fundamental needs and help them increase their independence. 

Her theory emphasizes the nurse's role in supporting patients in activities such as:

Maintaining desired postures

Dress and undress

Cleanliness

Communicating fears, opinions, and needs, and

Worshiping according to their faith

Jean Watson:  Theory of Human Caring

Jean Watson is a contemporary nursing theorist renowned for her Theory of Human Caring . Watson emphasizes the importance of creating a caring and compassionate relationship between the nurse and the patient. 

Her theory focuses on  ten factors:

Upholding humanistic-altruistic values by practicing kindness and compassion

Being genuinely present and fostering faith, hope, and belief systems while respecting the subjective experiences of oneself and others

Cultivating self-awareness and spiritual practices, transcending ego-centeredness to achieve a transpersonal presence.

Developing and nurturing loving, trusting, and caring relationships

Encouraging the expression of both positive and negative emotions, actively listening to others' stories without judgment

Applying creative problem-solving through the caring-healing process

Engaging in transpersonal teaching and learning within a caring relationship, adapting to the individual's perspective and transitioning towards a coaching approach for enhanced health

Creating a healing environment on various levels, fostering an atmosphere of authentic caring presence at an energetic and subtle level.

Acknowledging the interconnectedness of mind, body, and spirit while upholding human dignity

Embracing the spiritual, mysterious, and unknown aspects of life

Madeleine Leininger: Transcultural Nursing Theory

Leininger's Transcultural Nursing Theory , also called Culture Care Theory, focuses on providing culturally congruent care by understanding and respecting the values, beliefs, and practices of diverse individuals and groups.

Hildegard Peplau: Interpersonal Relations Theory

Peplau's Interpersonal Theory of Interpersonal Relations emphasizes that the journey of nurse-patient relationships involves three pivotal stages that are essential for their success: 

The initial orientation

A dynamic working phase, and

A  thoughtful termination process

According to Peplau, the nurse's role is to facilitate the patient's growth and development by utilizing therapeutic communication, empathy, and understanding.

Betty Neuman: Neuman Systems Model

The Neuman Systems Model focuses on identifying stressors that have the potential to negatively impact an individual's health and overall well-being. It incorporates various factors such as physiological, psychological, sociocultural, and developmental aspects. 

The theory also provides a flexible structure for assessment, intervention, and evaluation in nursing practice. 

Sister Callista Roy: Adaptation Model

The Roy Adaptation Model is based on the belief that individuals are adaptive systems, constantly interacting with their environment to maintain their physiological and psychosocial integrity. It views the person as a holistic being, consisting of four interconnected adaptive modes:

Physiological Mode: Deals with physical and biological aspects of adaptation, including the body's response to stressors, maintaining homeostasis, and meeting basic physiological needs.

Self-Concept Mode: Focuses on individuals' perception of themselves, including self-esteem and self-image.

Role Function Mode: Considers the roles people have in their lives, such as spouse, parent, employee, or student. 

Interdependence Mode: Emphasizes the importance of social relationships and how individuals interact with others, such as support from social networks.

Martha Rogers: Science of Unitary Human Being

Rogers' Science of Unitary Human Beings believed that nursing should focus on promoting harmony and balance within the individual and their environment. 

Her theory emphasizes the interconnectedness of human beings with their surroundings and the importance of energy fields in health and healing. Spoken another way, patients cannot be considered as “separate” from their environment.

Patricia Benner: Novice to Expert Theory

Benner's Novice to Expert Theory describes the stages of nursing skill from novice to advanced beginner, and finally, to competent. 

She emphasizes the importance of practical experience and clinical judgment in nursing practice and highlights that expertise develops over time through practice and reflection.

Imogene King: Theory of Goal Attainment

King's Theory of Goal Attainment focuses on the nurse-patient relationship and the mutual goal-setting process. Her theory emphasizes that nurses and patients should collaborate to establish goals that promote the patient's well-being and health.

Katharine Kolcaba: Comfort Theory

Kolcaba's Comfort Theory highlights the significance of providing comfort to patients as a central goal of nursing care. 

Her theory defines comfort as the immediate experience of being strengthened in physical, psychospiritual, environmental, and sociocultural dimensions.

Kolcalba’s framework proposes that healthcare providers:

Assess if patient’s comfort needs are not being met

Create interventions to meet those needs

Measure comfort prior to and after the interventions

Nursing theories are used every day in practice even if nurses aren’t aware of their use. Theories help guide evidence-based research which then leads to best practices and policies. These policies and procedures keep patients safe, while providing the best care possible. 

Nursing theories also allow nurses to positively influence the health and well-being of their patients beyond taking care of them at the bedside. Nursing theory-guided practice helps improve the quality of care delivered and helps continue to move the nursing profession forward into the 21st century. 

Most bedside nurses will not necessarily know the theories behind their practice so their usefulness is often dismissed. Advanced practice nurses, nurse scholars, nurse educators, and nurse researchers are most likely going to be up to date on current nursing theories and their impact on the nursing profession. 

Nursing theories should continue to guide nursing practice both in academia and at the bedside. It allows nurses to provide current best-practice care to their patients while also impacting them beyond the bedside. Florence Nightingale’s Environmental Theory was groundbreaking during the 1860s and helped change the course of nursing and healthcare while changing the outcomes of patients through the identification of environmental factors that may hinder their health and well-being. 

Nursing Theory FAQs

What are the major nursing theories .

• All nursing theories encompass person, environment, health, and the nurse and are categorized into three hierarchies: grand nursing theories, middle-range nursing theories, and practice level nursing theories.  

What are examples of nursing theory? 

• Some examples of nursing theories include the Environmental Theory, the Casey Model of Nursing, the Martha Rogers Theory, the Tidal Model, and the Cultural Care Theory. 

What is the Casey model of nursing?

• The Casey Model of Nursing is a model of nursing designed to encompass the child-health relationship with five focuses: child, family, health, environment, and the nurse. 

What is Martha Roger's Theory?

• The Martha Rogers Theory of nursing looks at people as “unitary” human beings that can’t be divided into parts and nursing as a blend of both art and science. 

What is a partnership model in nursing?

• It’s a patient and family-centered care system that focuses on partnership between the two, along with education, support, communication, and collaborative practice.

What are the principles of the tidal model? 

• The tidal model of nursing has 6 principles: curiosity, virtue, mystery investigation, respect of the person, crisis as an opportunity, possessing goals, and pursuit of elegance.

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Nursing Theories and Theorists: The Definitive Guide for Nurses

In this guide for nursing theories and nursing theorists , we aim to help you understand what comprises a nursing theory and its importance, purpose, history, types, or classifications, and give you an overview through summaries of selected nursing theories.

Table of Contents

• What are Nursing Theories?

Defining Terms

History of nursing theories, environment, definitions, relational statements, assumptions, why are nursing theories important, in academic discipline, in research, in the profession, grand nursing theories, middle-range nursing theories, practice-level nursing theories, factor-isolating theory, explanatory theory, prescriptive theories, other ways of classifying nursing theories, florence nightingale, hildegard e. peplau, virginia henderson, faye glenn abdellah, ernestine wiedenbach, lydia e. hall, joyce travelbee, kathryn e. barnard, evelyn adam, nancy roper, winifred logan, and alison j. tierney, ida jean orlando, jean watson.

• Marilyn Anne Ray 

Patricia Benner

Kari martinsen, katie eriksson, myra estrin levine, martha e. rogers, dorothea e. orem, imogene m. king, betty neuman, sister callista roy, dorothy e. johnson, anne boykin and savina o. schoenhofer, afaf ibrahim meleis, nola j. pender, madeleine m. leininger, margaret a. newman, rosemarie rizzo parse, helen c. erickson, evelyn m. tomlin, and mary ann p. swain, gladys l. husted and james h. husted, ramona t. mercer, merle h. mishel, pamela g. reed, carolyn l. wiener and marylin j. dodd, georgene gaskill eakes, mary lermann burke, and margaret a. hainsworth, phil barker, katharine kolcaba, cheryl tatano beck, kristen m. swanson, cornelia m. ruland and shirley m. moore, wanda de aguiar horta, recommended resources, what are nursing theories.

Nursing theories are organized bodies of knowledge to define what nursing is, what nurses do, and why they do it. Nursing theories provide a way to define nursing as a unique discipline that is separate from other disciplines (e.g., medicine). It is a framework of concepts and purposes intended to guide nursing practice at a more concrete and specific level.

Nursing, as a profession, is committed to recognizing its own unparalleled body of knowledge vital to nursing practice—nursing science. To distinguish this foundation of knowledge, nurses need to identify, develop, and understand concepts and theories in line with nursing. As a science, nursing is based on the theory of what nursing is, what nurses do, and why. Nursing is a unique discipline and is separate from medicine. It has its own body of knowledge on which delivery of care is based.

The development of nursing theory demands an understanding of selected terminologies, definitions, and assumptions.

• Philosophy. These are beliefs and values that define a way of thinking and are generally known and understood by a group or discipline.
• Theory . A belief, policy, or procedure proposed or followed as the basis of action. It refers to a logical group of general propositions used as principles of explanation. Theories are also used to describe, predict, or control phenomena.
• Concept. Concepts are often called the building blocks of theories. They are primarily the vehicles of thought that involve images.
• Models. Models are representations of the interaction among and between the concepts showing patterns. They present an overview of the theory’s thinking and may demonstrate how theory can be introduced into practice.
• Conceptual framework. A conceptual framework is a group of related ideas, statements, or concepts. It is often used interchangeably with the conceptual model and with grand theories .
• Proposition. Propositions are statements that describe the relationship between the concepts.
• Domain . The domain is the perspective or territory of a profession or discipline.
• Process. Processes are organized steps, changes, or functions intended to bring about the desired result.
• Paradigm. A paradigm refers to a pattern of shared understanding and assumptions about reality and the world, worldview, or widely accepted value system.
• Metaparadigm. A metaparadigm is the most general statement of discipline and functions as a framework in which the more restricted structures of conceptual models develop. Much of the theoretical work in nursing focused on articulating relationships among four major concepts: person, environment, health, and nursing.

The first nursing theories appeared in the late 1800s when a strong emphasis was placed on nursing education.

• In 1860, Florence Nightingale defined nursing in her “ Environmental Theory ” as “the act of utilizing the patient’s environment to assist him in his recovery.”
• In the 1950s, there is a consensus among nursing scholars that nursing needed to validate itself through the production of its own scientifically tested body of knowledge.
• In 1952, Hildegard Peplau introduced her Theory of Interpersonal Relations that emphasizes the nurse -client relationship as the foundation of nursing practice.
• In 1955, Virginia Henderson conceptualized the nurse’s role as assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs. Thus her Nursing Need Theory was developed.
• In 1960, Faye Abdellah published her work “Typology of 21 Nursing Problems,” which shifted the focus of nursing from a disease-centered approach to a patient-centered approach.
• In 1962, Ida Jean Orlando emphasized the reciprocal relationship between patient and nurse and viewed nursing’s professional function as finding out and meeting the patient’s immediate need for help.
• In 1968, Dorothy Johnson pioneered the Behavioral System Model and upheld the fostering of efficient and effective behavioral functioning in the patient to prevent illness.
• In 1970, Martha Rogers viewed nursing as both a science and an art as it provides a way to view the unitary human being, who is integral with the universe.
• In 1971, Dorothea Orem stated in her theory that nursing care is required if the client is unable to fulfill biological, psychological, developmental, or social needs.
• In 1971, Imogene King ‘s Theory of Goal attainment stated that the nurse is considered part of the patient’s environment and the nurse-patient relationship is for meeting goals towards good health.
• In 1972, Betty Neuman , in her theory, states that many needs exist, and each may disrupt client balance or stability. Stress reduction is the goal of the system model of nursing practice.
• In 1979, Sr. Callista Roy viewed the individual as a set of interrelated systems that maintain the balance between these various stimuli.
• In 1979, Jean Watson developed the philosophy of caring, highlighted humanistic aspects of nursing as they intertwine with scientific knowledge and nursing practice.

The Nursing Metaparadigm

Four major concepts are frequently interrelated and fundamental to nursing theory: person, environment, health, and nursing. These four are collectively referred to as metaparadigm for nursing .

Person (also referred to as Client or Human Beings) is the recipient of nursing care and may include individuals, patients, groups, families, and communities.

Environment (or situation) is defined as the internal and external surroundings that affect the client. It includes all positive or negative conditions that affect the patient, the physical environment, such as families, friends, and significant others, and the setting for where they go for their healthcare.

Health is defined as the degree of wellness or well-being that the client experiences. It may have different meanings for each patient, the clinical setting, and the health care provider.

The nurse’s attributes, characteristics, and actions provide care on behalf of or in conjunction with the client. There are numerous definitions of nursing, though nursing scholars may have difficulty agreeing on its exact definition. The ultimate goal of nursing theories is to improve patient care .

You’ll find that these four concepts are used frequently and defined differently throughout different nursing theories. Each nurse theorist’s definition varies by their orientation, nursing experience , and different factors that affect the theorist’s nursing view. The person is the main focus, but how each theorist defines the nursing metaparadigm gives a unique take specific to a particular theory. To give you an example, below are the different definitions of various theorists on the nursing metaparadigm:

Components of Nursing Theories

For a theory to be a theory, it has to contain concepts, definitions, relational statements, and assumptions that explain a phenomenon. It should also explain how these components relate to each other.

A term given to describe an idea or response about an event, a situation, a process, a group of events, or a group of situations. Phenomena may be temporary or permanent. Nursing theories focus on the phenomena of nursing.

Interrelated concepts define a theory. Concepts are used to help describe or label a phenomenon. They are words or phrases that identify, define, and establish structure and boundaries for ideas generated about a particular phenomenon. Concepts may be abstract or concrete.

• Abstract Concepts . Defined as mentally constructed independently of a specific time or place.
• Concrete Concepts . Are directly experienced and related to a particular time or place.

Definitions are used to convey the general meaning of the concepts of the theory. Definitions can be theoretical or operational.

• Theoretical Definitions . Define a particular concept based on the theorist’s perspective.
• Operational Definitions . States how concepts are measured.

Relational statements define the relationships between two or more concepts. They are the chains that link concepts to one another.

Assumptions are accepted as truths and are based on values and beliefs. These statements explain the nature of concepts, definitions, purpose, relationships, and structure of a theory.

Nursing theories are the basis of nursing practice today. In many cases, nursing theory guides knowledge development and directs education, research, and practice. Historically, nursing was not recognized as an academic discipline or as a profession we view today. Before nursing theories were developed, nursing was considered to be a task-oriented occupation. The training and function of nurses were under the direction and control of the medical profession. Let’s take a look at the importance of nursing theory and its significance to nursing practice:

• Nursing theories help recognize what should set the foundation of practice by explicitly describing nursing.
• By defining nursing, a nursing theory also helps nurses understand their purpose and role in the healthcare setting.
• Theories serve as a rationale or scientific reasons for nursing interventions and give nurses the knowledge base necessary for acting and responding appropriately in nursing care situations.
• Nursing theories provide the foundations of nursing practice, generate further knowledge, and indicate which direction nursing should develop in the future (Brown, 1964).
• By providing nurses a sense of identity, nursing theory can help patients, managers, and other healthcare professionals to acknowledge and understand the unique contribution that nurses make to the healthcare service (Draper, 1990).
• Nursing theories prepare the nurses to reflect on the assumptions and question the nursing values, thus further defining nursing and increasing the knowledge base.
• Nursing theories aim to define, predict, and demonstrate nursing phenomenon (Chinn and Jacobs, 1978).
• It can be regarded as an attempt by the nursing profession to maintain and preserve its professional limits and boundaries.
• Nursing theories can help guide research and informing evidence-based practice.
• Provide a common language and terminology for nurses to use in communication and practice.
• Serves as a basis for the development of nursing education and training programs.
• In many cases, nursing theories guide knowledge development and directs education, research, and practice, although each influences the others. (Fitzpatrick and Whall, 2005).

Purposes of Nursing Theories

The primary purpose of theory in nursing is to improve practice by positively influencing the health and quality of life of patients. Nursing theories are essential for the development and advancement of the nursing profession. Nursing theories are also developed to define and describe nursing care, guide nursing practice, and provide a basis for clinical decision-making . In the past, the accomplishments of nursing led to the recognition of nursing in an academic discipline, research, and profession.

Much of the earlier nursing programs identified the major concepts in one or two nursing models, organized the concepts, and build an entire nursing curriculum around the created framework. These models’ unique language was typically introduced into program objectives, course objectives, course descriptions, and clinical performance criteria. The purpose was to explain the fundamental implications of the profession and enhance the profession’s status.

The development of theory is fundamental to the research process, where it is necessary to use theory as a framework to provide perspective and guidance to the research study. Theory can also be used to guide the research process by creating and testing phenomena of interest. To improve the nursing profession’s ability to meet societal duties and responsibilities, there needs to be a continuous reciprocal and cyclical connection with theory, practice, and research. This will help connect the perceived “gap” between theory and practice and promote the theory-guided practice.

Clinical practice generates research questions and knowledge for theory. In a clinical setting, its primary contribution has been the facilitation of reflecting, questioning, and thinking about what nurses do. Because nurses and nursing practice are often subordinate to powerful institutional forces and traditions, introducing any framework that encourages nurses to reflect on, question, and think about what they do provide an invaluable service.

Classification of Nursing Theories

There are different ways to categorize nursing theories. They are classified depending on their function, levels of abstraction, or goal orientation.

By Abstraction

There are three major categories when classifying nursing theories based on their level of abstraction: grand theory, middle-range theory, and practice-level theory.

• Grand theories are abstract, broad in scope, and complex, therefore requiring further research for clarification.
• Grand nursing theories do not guide specific nursing interventions but rather provide a general framework and nursing ideas.
• Grand nursing theorists develop their works based on their own experiences and their time, explaining why there is so much variation among theories.
• Address the nursing metaparadigm components of person, nursing, health, and environment.
• More limited in scope (compared to grand theories) and present concepts and propositions at a lower level of abstraction. They address a specific phenomenon in nursing.
• Due to the difficulty of testing grand theories, nursing scholars proposed using this level of theory.
• Most middle-range theories are based on a grand theorist’s works, but they can be conceived from research, nursing practice, or the theories of other disciplines.
• Practice nursing theories are situation-specific theories that are narrow in scope and focuses on a specific patient population at a specific time.
• Practice-level nursing theories provide frameworks for nursing interventions and suggest outcomes or the effect of nursing practice.
• Theories developed at this level have a more direct effect on nursing practice than more abstract theories.
• These theories are interrelated with concepts from middle-range theories or grand theories.

By Goal Orientation

Theories can also be classified based on their goals. They can be descriptive or prescriptive .

Descriptive Theories

• Descriptive theories are the first level of theory development. They describe the phenomena and identify its properties and components in which it occurs.
• Descriptive theories are not action-oriented or attempt to produce or change a situation.
• There are two types of descriptive theories: factor-isolating theory and explanatory theory .
• Also known as category-formulating or labeling theory.
• Theories under this category describe the properties and dimensions of phenomena.
• Explanatory theories describe and explain the nature of relationships of certain phenomena to other phenomena.
• Address the nursing interventions for a phenomenon, guide practice change, and predict consequences.
• Includes propositions that call for change.
• In nursing, prescriptive theories are used to anticipate the outcomes of nursing interventions.

Classification According to Meleis

Afaf Ibrahim Meleis (2011), in her book  Theoretical Nursing: Development and Progress , organizes the major nurse theories and models using the following headings: needs theories, interaction theories, and outcome theories. These categories indicate the basic philosophical underpinnings of the theories.

• Needs-Based Theories. The needs theorists were the first group of nurses who thought of giving nursing care a conceptual order. Theories under this group are based on helping individuals to fulfill their physical and mental needs. Theories of Orem, Henderson, and Abdella are categorized under this group. Need theories are criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position.
• Interaction Theories. These theories emphasized nursing on the establishment and maintenance of relationships. They highlighted the impact of nursing on patients and how they interact with the environment, people, and situations. Theories of King, Orlando, and Travelbee are grouped under this category.
• Outcome Theories . These theories describe the nurse as controlling and directing patient care using their knowledge of the human physiological and behavioral systems. The nursing theories of Johnson , Levine , Rogers , and Roy belong to this group.

Classification According to Alligood

In her book, Nursing Theorists and Their Work, Raile Alligood (2017) categorized nursing theories into four headings: nursing philosophy, nursing conceptual models, nursing theories and grand theories, and middle-range nursing theories.

• Nursing Philosophy . It is the most abstract type and sets forth the meaning of nursing phenomena through analysis, reasoning, and logical presentation. Works of Nightingale, Watson, Ray, and Benner are categorized under this group.
• Nursing Conceptual Models . These are comprehensive nursing theories that are regarded by some as pioneers in nursing. These theories address the nursing metaparadigm and explain the relationship between them. Conceptual models of Levine, Rogers, Roy, King, and Orem are under this group.
• Grand Nursing Theories. Are works derived from nursing philosophies, conceptual models, and other grand theories that are generally not as specific as middle-range theories. Works of Levine, Rogers, Orem, and King are some of the theories under this category.
• Middle-Range Theories. Are precise and answer specific nursing practice questions . They address the specifics of nursing situations within the model’s perspective or theory from which they are derived. Examples of Middle-Range theories are that of Mercer, Reed, Mishel, and Barker.

List of Nursing Theories and Theorists

You’ve learned from the previous sections the definition of nursing theory, its significance in nursing, and its purpose in generating a nursing knowledge base. This section will give you an overview and summary of the various published works in nursing theory (in chronological order). Deep dive into learning about the theory by clicking on the links provided for their biography and comprehensive review of their work.

See Also: Florence Nightingale: Environmental Theory and Biography

• Founder of Modern Nursing and Pioneer of the Environmental Theory. 
• Defined Nursing as “the act of utilizing the environment of the patient to assist him in his recovery.”
• Stated that nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the least expense of vital power to the patient.”
• Identified five (5) environmental factors: fresh air, pure water, efficient drainage, cleanliness or sanitation, and light or direct sunlight.

See Also: Hildegard Peplau: Interpersonal Relations Theory

• Pioneered the Theory of Interpersonal Relations
• Peplau’s theory defined Nursing as “An interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse specially educated to recognize, respond to the need for help.”
• Her work is influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow , and Neal Elgar Miller.
• It helps nurses and healthcare providers develop more therapeutic interventions in the clinical setting.

See Also: Virginia Henderson: Nursing Need Theory 

• Developed the Nursing Need Theory
• Focuses on the importance of increasing the patient’s independence to hasten their progress in the hospital.
• Emphasizes the basic human needs and how nurses can assist in meeting those needs.
• “The nurse is expected to carry out a physician’s therapeutic plan, but individualized care is the result of the nurse’s creativity in planning for care.”

See Also: Faye Glenn Abdellah: 21 Nursing Problems Theory

• Developed the 21 Nursing Problems Theory
• “Nursing is based on an art and science that molds 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.”
• Changed the focus of nursing from disease-centered to patient-centered and began to include families and the elderly in nursing care.
• The nursing model is intended to guide care in hospital institutions but can also be applied to community health nursing, as well.
• Developed The Helping Art of Clinical Nursing conceptual model.
• Definition of nursing reflects on nurse-midwife experience as “People may differ in their concept of nursing, but few would disagree that nursing is nurturing or caring for someone in a motherly fashion.”
• Guides the nurse action in the art of nursing and specified four elements of clinical nursing: philosophy, purpose, practice, and art.
• Clinical nursing is focused on meeting the patient’s perceived need for help in a vision of nursing that indicates considerable importance on the art of nursing.

See Also: Lydia Hall: Care, Cure, Core Theory

• Developed the Care, Cure, Core Theory is also known  as the “ Three Cs of Lydia Hall . “
• Hall defined Nursing as the “participation in care, core and cure aspects of patient care , where CARE is the sole function of nurses, whereas the CORE and CURE are shared with other members of the health team.”
• The major purpose of care is to achieve an interpersonal relationship with the individual to facilitate the development of the core.
• The “care” circle defines a professional nurse’s primary role, such as providing bodily care for the patient. The “core” is the patient receiving nursing care. The “cure” is the aspect of nursing that involves the administration of medications and treatments.
• States in her Human-to-Human Relationship Model that the purpose of nursing was to help and support an individual, family, or community to prevent or cope with the struggles of illness and suffering and, if necessary, to find significance in these occurrences, with the ultimate goal being the presence of hope.
• Nursing was accomplished through human-to-human relationships.
• Extended the interpersonal relationship theories of Peplau and Orlando.
• Developed the Child Health Assessment Model .
• Concerns improving the health of infants and their families.
• Her findings on parent-child interaction as an important predictor of cognitive development helped shape public policy.
• She is the founder of the Nursing Child Assessment Satellite Training Project (NCAST), which produces and develops research-based products, assessment , and training programs to teach professionals, parents, and other caregivers the skills to provide nurturing environments for young children.
• Borrows from psychology and human development and focuses on mother-infant interaction with the environment.
• Contributed a close link to practice that has modified the way health care providers assess children in light of the parent-child relationship.
• Focuses on the development of models and theories on the concept of nursing.
• Includes the profession’s goal, the beneficiary of the professional service, the role of the professional, the source of the beneficiary’s difficulty, the intervention of the professional, and the consequences.
• A good example of using a unique basis of nursing for further expansion.
• A Model for Nursing Based on a Model of Living
• Logan produced a simple theory, “which actually helped bedside nurses.”
• The trio collaborated in the fourth edition of The Elements of Nursing: A Model for Nursing Based on a Model of Living and prepared a monograph entitled The Roper-Logan-Tierney Model of Nursing: Based on Activities of Daily Living.
• Includes maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleansing and dressing , controlling body temperature, mobilizing, working and playing, expressing sexuality, sleeping , and dying .

See Also: Ida Jean Orlando: Nursing Process Theory

• She developed the Nursing Process Theory.
• “Patients have their own meanings and interpretations of situations, and therefore nurses must validate their inferences and analyses with patients before drawing conclusions.”
• Allows nurses to formulate an effective nursing care plan that can also be easily adapted when and if any complexity comes up with the patient.
• According to her, persons become patients requiring nursing care when they have needs for help that cannot be met independently because of their physical limitations, negative reactions to an environment, or experience that prevents them from communicating their needs.
• The role of the nurse is to find out and meet the patient’s immediate needs for help.

See Also: Jean Watson: Theory of Human Caring

• She pioneered the Philosophy and Theory of Transpersonal Caring .
• “Nursing is concerned with promoting health, preventing illness, caring for the sick, and restoring health.”
• Mainly concerns with how nurses care for their patients and how that caring progresses into better plans to promote health and wellness, prevent illness and restore health.
• Focuses on health promotion , as well as the treatment of diseases.
• Caring is central to nursing practice and promotes health better than a simple medical cure.

Marilyn Anne Ray

• Developed the Theory of Bureaucratic Caring
• “Improved patient safety , infection control, reduction in medication errors , and overall quality of care in complex bureaucratic health care systems cannot occur without knowledge and understanding of complex organizations, such as the political and economic systems, and spiritual-ethical caring, compassion and right action for all patients and professionals.”
• Challenges participants in nursing to think beyond their usual frame of reference and envision the world holistically while considering the universe as a hologram.
• Presents a different view of how health care organizations and nursing phenomena interrelate as wholes and parts in the system.
• Caring, Clinical Wisdom, and Ethics in Nursing Practice
• “The nurse-patient relationship is not a uniform, professionalized blueprint but rather a kaleidoscope of intimacy and distance in some of the most dramatic, poignant, and mundane moments of life.”
• Attempts to assert and reestablish nurses’ caring practices when nurses are rewarded more for efficiency, technical skills, and measurable outcomes.
• States that caring practices are instilled with knowledge and skill regarding everyday human needs.
• Philosophy of Caring
• “Nursing is founded on caring for life, on neighborly love, […]At the same time, the nurse must be professionally educated.”
• Human beings are created and are beings for whom we may have administrative responsibility.
• Caring, solidarity, and moral practice are unavoidable realities.
• Theory of Carative Caring
• “Caritative nursing means that we take ‘caritas’ into use when caring for the human being in health and suffering […] Caritative caring is a manifestation of the love that ‘just exists’ […] Caring communion, true caring, occurs when the one caring in a spirit of caritas alleviates the suffering of the patient.”
• The ultimate goal of caring is to lighten suffering and serve life and health.
• Inspired many in the Nordic countries and used it as the basis of research, education, and clinical practice.

See Also: Myra Estrin Levine: Conservation Model for Nursing

• According to the Conservation Model , “Nursing is human interaction.”
• Provides a framework within which to teach beginning nursing students.
• Logically congruent, externally and internally consistent, has breadth and depth, and is understood, with few exceptions, by professionals and consumers of health care.

See Also: Martha Rogers: Theory of Unitary Human Beings

• In Roger’s Theory of Human Beings , she defined Nursing as “an art and science that is humanistic and humanitarian.
• The Science of Unitary Human Beings contains two dimensions: the science of nursing, which is the knowledge specific to the field of nursing that comes from scientific research; and the art of nursing, which involves using nursing creatively to help better the lives of the patient.
• A patient can’t be separated from his or her environment when addressing health and treatment.

See Also: Dorothea E. Orem: Self-Care Theory

• In her Self-Care Theory , she defined Nursing as “The act of assisting others in the provision and management of self-care to maintain or improve human functioning at the home level of effectiveness.”
• Focuses on each individual’s ability to perform self-care .
• Composed of three interrelated theories: (1) the theory of self-care , (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partially compensatory, and supportive-educative.

See Also: Imogene M. King: Theory of Goal Attainment

• Conceptual System and Middle-Range Theory of Goal Attainment
• “Nursing is a process of action, reaction and interaction by which nurse and client share information about their perception in a nursing situation” and “a process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication , they set goals, explore means, and agree on means to achieve goals.”
• Focuses on this process to guide and direct nurses in the nurse-patient relationship, going hand-in-hand with their patients to meet good health goals.
• Explains that the nurse and patient go hand-in-hand in communicating information, set goals together, and then take actions to achieve those goals.

See Also: Betty Neuman: Neuman’s Systems Model

• In Neuman’s System Model , she  defined nursing as a “unique profession in that is concerned with all of the variables affecting an individual’s response to stress.”
• The focus is on the client as a system (which may be an individual, family, group, or community) and on the client’s responses to stressors.
• The client system includes five variables (physiological, psychological, sociocultural, developmental, and spiritual). It is conceptualized as an inner core (basic energy resources) surrounded by concentric circles that include lines of resistance, a normal defense line, and a flexible line of defense.

See Also: Sister Callista Roy:  Adaptation Model of Nursing

• In Adaptation Model , Roy defined nursing as a “health care profession that focuses on human life processes and patterns and emphasizes the promotion of health for individuals, families, groups, and society as a whole.”
• Views the individual as a set of interrelated systems that strives to maintain a balance between various stimuli.
• Inspired the development of many middle-range nursing theories and adaptation instruments.

See Also: Dorothy E. Johnson:  Behavioral Systems Model

• The Behavioral System Model defined Nursing as “an external regulatory force that acts to preserve the organization and integrate the patients’ behaviors at an optimum level under those conditions in which the behavior constitutes a threat to the physical or social health or in which illness is found.”
• Advocates to foster efficient and effective behavioral functioning in the patient to prevent illness and stresses the importance of research-based knowledge about the effect of nursing care on patients.
• Describes the person as a behavioral system with seven subsystems: the achievement, attachment-affiliative, aggressive-protective, dependency, ingestive, eliminative, and sexual subsystems.
• The Theory of Nursing as Caring: A Model for Transforming Practice
• Nursing is an “exquisitely interwoven” unity of aspects of the discipline and profession of nursing.
• Nursing’s focus and aim as a discipline of knowledge and a professional service are “nurturing persons living to care and growing in caring.”
• Caring in nursing is “an altruistic, active expression of love, and is the intentional and embodied recognition of value and connectedness.”
• Transitions Theory
• It began with observations of experiences faced as people deal with changes related to health, well-being, and the ability to care for themselves.
• Types of transitions include developmental, health and illness, situational, and organizational.
• Acknowledges the role of nurses as they help people go through health/illness and life transitions.
• Focuses on assisting nurses in facilitating patients’, families’, and communities’ healthy transitions.

See Also: Nola Pender: Health Promotion Model

• Health Promotion Model
• Describes the interaction between the nurse and the consumer while considering the role of the health promotion environment.
• It focuses on three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes.
• Describes the multidimensional nature of persons as they interact within their environment to pursue health.

See Also:  Madeleine M. Leininger: Transcultural Nursing Theory

• Culture Care Theory of Diversity and Universality
• Defined transcultural nursing as “a substantive area of study and practice focused on comparative cultural care (caring) values, beliefs, and practices of individuals or groups of similar or different cultures to provide culture-specific and universal nursing care practices in promoting health or well-being or to help people to face unfavorable human conditions, illness, or death in culturally meaningful ways.”
• Involves learning and understanding various cultures regarding nursing and health-illness caring practices, beliefs, and values to implement significant and efficient nursing care services to people according to their cultural values and health-illness context.
• It focuses on the fact that various cultures have different and unique caring behaviors and different health and illness values, beliefs, and patterns of behaviors.
• Health as Expanding Consciousness
• “Nursing is the process of recognizing the patient in relation to the environment, and it is the process of the understanding of consciousness.”
• “The theory of health as expanding consciousness was stimulated by concern for those for whom health as the absence of disease or disability is not possible . . . “
• Nursing is regarded as a connection between the nurse and patient, and both grow in the sense of higher levels of consciousness.
• Human Becoming Theory
• “Nursing is a science, and the performing art of nursing is practiced in relationships with persons (individuals, groups, and communities) in their processes of becoming.”
• Explains that a person is more than the sum of the parts, the environment, and the person is inseparable and that nursing is a human science and art that uses an abstract body of knowledge to help people.
• It centered around three themes: meaning, rhythmicity, and transcendence.
• Modeling and Role-Modeling
• “Nursing is the holistic helping of persons with their self-care activities in relation to their health . . . The goal is to achieve a state of perceived optimum health and contentment.”
• Modeling is a process that allows nurses to understand the unique perspective of a client and learn to appreciate its importance.
• Role-modeling occurs when the nurse plans and implements interventions that are unique for the client.
• Created the Symphonological Bioethical Theory
• “Symphonology (from ‘ symphonia ,’ a Greek word meaning agreement) is a system of ethics based on the terms and preconditions of an agreement.”
• Nursing cannot occur without both nurse and patient. “A nurse takes no actions that are not interactions.”
• Founded on the singular concept of human rights, the essential agreement of non-aggression among rational people forms the foundation of all human interaction.
• Maternal Role Attainment—Becoming a Mother
• “Nursing is a dynamic profession with three major foci: health promotion and prevention of illness, providing care for those who need professional assistance to achieve their optimal level of health and functioning, and research to enhance the knowledge base for providing excellent nursing care.”
• “Nurses are the health professionals having the most sustained and intense interaction with women in the maternity cycle.”
• Maternal role attainment is an interactional and developmental process occurring over time. The mother becomes attached to her infant, acquires competence in the caretaking tasks involved in the role, and expresses pleasure and gratification. (Mercer, 1986).
• Provides proper health care interventions for nontraditional mothers for them to favorably adopt a strong maternal identity.
• Uncertainty in Illness Theory
• Presents a comprehensive structure to view the experience of acute and chronic illness and organize nursing interventions to promote optimal adjustment.
• Describes how individuals form meaning from illness-related situations.
• The original theory’s concepts were organized in a linear model around the following three major themes: Antecedents of uncertainty, Process of uncertainty appraisal, and Coping with uncertainty.
• Self-Transcendence Theory
• Self-transcendence refers to the fluctuation of perceived boundaries that extend the person (or self) beyond the immediate and constricted views of self and the world (Reed, 1997).
• Has three basic concepts: vulnerability, self-transcendence, and well-being.
• Gives insight into the developmental nature of humans associated with health circumstances connected to nursing care.
• Theory of Illness Trajectory
• “The uncertainty surrounding a chronic illness like cancer is the uncertainty of life writ large. By listening to those who are tolerating this exaggerated uncertainty, we can learn much about the trajectory of living.”
• Provides a framework for nurses to understand how cancer patients stand uncertainty manifested as a loss of control.
• Provides new knowledge on how patients and families endure uncertainty and work strategically to reduce uncertainty through a dynamic flow of illness events, treatment situations, and varied players involved in care organization.
• Theory of Chronic Sorrow
• “Chronic sorrow is the presence of pervasive grief -related feelings that have been found to occur periodically throughout the lives of individuals with chronic health conditions, their family caregivers and the bereaved.”
• This middle-range theory defines the aspect of chronic sorrow as a normal response to the ongoing disparity created by the loss.
• Barker’s Tidal Model of Mental Health Recovery is widely used in mental health nursing.
• It focuses on nursing’s fundamental care processes, is universally applicable, and is a practical guide for psychiatry and mental health nursing.
• Draws on values about relating to people and help others in their moments of distress. The values of the Tidal Model are revealed in the Ten Commitments: 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.
• Theory of Comfort
• “Comfort is an antidote to the stressors inherent in health care situations today, and when comfort is enhanced, patients and families are strengthened for the tasks ahead. Also, nurses feel more satisfied with the care they are giving.”
• Patient comfort exists in three forms: relief, ease, and transcendence. These comforts can occur in four contexts: physical, psychospiritual, environmental, and sociocultural.
• As a patient’s comfort needs change, the nurse’s interventions change, as well.
• Postpartum Depression Theory
• “The birth of a baby is an occasion for joy—or so the saying goes […] But for some women, joy is not an option.”
• Described nursing as a caring profession with caring obligations to persons we care for, students, and each other.
• Provides evidence to understand and prevent postpartum depression .
• Theory of Caring
• “Caring is a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility.”
• Defines nursing as informed caring for the well-being of others.
• Offers a structure for improving up-to-date nursing practice, education, and research while bringing the discipline to its traditional values and caring-healing roots.
• Peaceful End-of-Life Theory
• The focus was not on death itself but on providing a peaceful and meaningful living in the time that remained for patients and their significant others.
• The purpose was to reflect the complexity involved in caring for terminally ill patients.
• Also known as Wanda Horta, she introduced the concepts of nursing that are accepted in Brazil.
• Wrote the book Nursing Process which presents relevance to the various fields of Nursing practice for providing a holistic view of the patient.
• Her work was recognized in all the teaching institutions called the Theory of Basic Human Needs . It is based on Maslow’s Theory of Human Motivation, whose primary concept is the hierarchy of Basic Human Needs (BHN).
• Horta’s Theory of Basic Human Needs is considered the highest point of her work, and the summary of all her research concludes sickness as a science and art of assisting a human being in meeting basic human needs, making the patient independent of this assistance through education in recovery, maintenance, and health promotion .
• Classified basic human needs into three main dimensions – psychobiological, psychosocial and psychospiritual – and establishes a relationship between the concepts of human being, environment, and nursing.
• The theory describes nursing as an element of a healthcare team and states that it can function efficiently through a scientific method. Horta referred this method as the nursing process .
• She defined the nursing process as the dynamics of systematic and interrelated actions to assist human beings. It is characterized by six phases: nursing history, nursing diagnosis , assistance plan, care plan or nursing prescription, evolution, and prognosis.

Recommended books and resources to learn more about nursing theory:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

• Nursing Theorists and Their Work (10th Edition) by Alligood Nursing Theorists and Their Work, 10th Edition provides a clear, in-depth look at nursing theories of historical and international significance. Each chapter presents a key nursing theory or philosophy, showing how systematic theoretical evidence can enhance decision making, professionalism, and quality of care.
• Knowledge Development in Nursing: Theory and Process (11th Edition) Use the five patterns of knowing to help you develop sound clinical judgment. This edition reflects the latest thinking in nursing knowledge development and adds emphasis to real-world application. The content in this edition aligns with the new 2021 AACN Essentials for Nursing Education.
• Nursing Knowledge and Theory Innovation, Second Edition: Advancing the Science of Practice (2nd Edition) This text for graduate-level nursing students focuses on the science and philosophy of nursing knowledge development. It is distinguished by its focus on practical applications of theory for scholarly, evidence-based approaches. The second edition features important updates and a reorganization of information to better highlight the roles of theory and major philosophical perspectives.
• Nursing Theories and Nursing Practice (5th Edition) The only nursing research and theory book with primary works by the original theorists. Explore the historical and contemporary theories that are the foundation of nursing practice today. The 5th Edition, continues to meet the needs of today’s students with an expanded focus on the middle range theories and practice models.
• Strategies for Theory Construction in Nursing (6th Edition) The clearest, most useful introduction to theory development methods. Reflecting vast changes in nursing practice, it covers advances both in theory development and in strategies for concept, statement, and theory development. It also builds further connections between nursing theory and evidence-based practice.
• Middle Range Theory for Nursing (4th Edition) This nursing book’s ability to break down complex ideas is part of what made this book a three-time recipient of the AJN Book of the Year award. This edition includes five completely new chapters of content essential for nursing books. New exemplars linking middle range theory to advanced nursing practice make it even more useful and expand the content to make it better.
• Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice This book offers balanced coverage of both qualitative and quantitative research methodologies. This edition features new content on trending topics, including the Next-Generation NCLEX® Exam (NGN).
• Nursing Research (11th Edition) AJN award-winning authors Denise Polit and Cheryl Beck detail the latest methodologic innovations in nursing, medicine, and the social sciences. The updated 11th Edition adds two new chapters designed to help students ensure the accuracy and effectiveness of research methods. Extensively revised content throughout strengthens students’ ability to locate and rank clinical evidence.

Recommended site resources related to nursing theory:

• Nursing Theories and Theorists: The Definitive Guide for Nurses MUST READ! In this guide for nursing theories, we aim to help you understand what comprises a nursing theory and its importance, purpose, history, types or classifications, and give you an overview through summaries of selected nursing theories.

Other resources related to nursing theory:

• Betty Neuman: Neuman Systems Model
• Dorothea Orem: Self-Care Deficit Theory
• Dorothy Johnson: Behavioral System Model
• Faye Abdellah: 21 Nursing Problems Theory
• Florence Nightingale: Environmental Theory
• Hildegard Peplau: Interpersonal Relations Theory
• Ida Jean Orlando: Deliberative Nursing Process Theory
• Imogene King: Theory of Goal Attainment
• Jean Watson: Theory of Human Caring
• Lydia Hall: Care, Cure, Core Nursing Theory
• Madeleine Leininger: Transcultural Nursing Theory
• Martha Rogers: Science of Unitary Human Beings
• Myra Estrin Levine: The Conservation Model of Nursing
• Nola Pender: Health Promotion Model
• Sister Callista Roy: Adaptation Model of Nursing
• Virginia Henderson: Nursing Need Theory

Suggested readings and resources for this study guide :

• Alligood, M., & Tomey, A. (2010). Nursing theorists and their work, seventh edition (No ed.). Maryland Heights: Mosby-Elsevier.
• Alligood, M. R. (2017).  Nursing Theorists and Their Work-E-Book . Elsevier Health Sciences.
• Barnard, K. E. (1984). Nursing research related to infants and young children. In  Annual review of nursing research  (pp. 3-25). Springer, Berlin, Heidelberg.
• Brown, H. I. (1979).  Perception, theory, and commitment: The new philosophy of science . University of Chicago Press. [ Link ]
• Brown M (1964) Research in the development of nursing theory: the importance of a theoretical framework in nursing research. Nursing Research.
• Camacho, A. C. L. F., & Joaquim, F. L. (2017). Reflections based on Wanda Horta on the basic instruments of nursing. Rev Enferm UFPE [Internet], 11(12), 5432-8.
• Chinn, P. L., & Jacobs, M. K. (1978). A model for theory development in nursing.  Advances in Nursing Science ,  1 (1), 1-12. [ Link ]
• Colley, S. (2003). Nursing theory: its importance to practice. Nursing Standard (through 2013), 17(46), 33. [ Link ]
• Fawcett, J. (2005). Criteria for evaluation of theory. Nursing science quarterly, 18(2), 131-135. [ Link ]
• Fitzpatrick, J. J., & Whall, A. L. (Eds.). (1996).  Conceptual models of nursing: Analysis and application . Connecticut, Norwalk: Appleton & Lange.
• Kaplan, A. (2017).  The conduct of inquiry: Methodology for behavioural science . Routledge. [ Link ]
• Meleis, A. I. (2011).  Theoretical nursing: Development and progress . Lippincott Williams & Wilkins.
• Neuman, B. M., & Fawcett, J. (2002). The Neuman systems model .
• Nightingale F (1860) Notes on Nursing. New York NY, Appleton.
• Perão, O. F., Zandonadi, G. C., Rodríguez, A. H., Fontes, M. S., Nascimento, E. L. P., & Santos, E. K. A. (2017). Patient safety in an intensive care unit according to Wanda Horta’s theory. Cogitare Enfermagem, 22(3), e45657.
• Peplau H (1988) The art and science of nursing: similarities, differences, and relations. Nursing Science Quarterly
• Rogers M (1970) An Introduction to the Theoretical Basis of Nursing. Philadelphia PA, FA Davis.

52 thoughts on “Nursing Theories and Theorists: The Definitive Guide for Nurses”

Great work indeed

Amazing and simple post I have ever come across about nursing theories.

Thank you for the simplicity

where do i find the reference page in apa format?

The reference listed below the article is in APA format.

i love this. insightful. Comprehensive ,Well researched .

Thank you for these theories they are a life saver and simplified. My school require us to write about 2 nursing theorist from memory for a Comprehensive exam in which if you do not pass it you are required to wait for a year to retake the exam.

Merci beaucoup, puisque je suis très satisfait.

I’m pleased to congratulate you about your work! I really appreciate it! From: Cameroon

An entire’s semester worth of a nursing theory class, expertly and succinctly summarized in one paper. I wish my instructor were as easy to understand. Good work.

I thought this was in a chronological order based on their published works date? Then why Orlando’s theory comes at the later part? Can someone englighten me please because I am making a timeline for our project.

Great job. Very clear and succinct.

I like it. Well explained!

easy to understand and very helpful

thankyou very much.

The article was beneficial to me to understand nursing theories

This is amazing and I love it so enriching!

Thanks for the article may God bless you more Plus More Power and Protection

Thanks so much

Please can someone help me with a nursing theory related to “teamwork” please

Thank you so much !

I loved the text and saw that the nursing theorist Wanda Aguiar Horta, a Brazilian nurse and great theorist regarding basic human needs, was not included.

I suggest reviewing and including it to be more complete.

If you need, I can help with inclusion!

Best Regards

Hi João Carlos, we’d love to hear about her work. Please send us the details via our contact page: https://nurseslabs.com/contact/

Excellent study guide! Detailed, Informative and Valued! Thank you!

hi can someone help me which theorist can relate in Ear, Nose, Throat nursing care.

Wonderful contribution of shared knowledge- now how do we get the word out for nurses that are not able to afford a BSN?

Thanks for the work. It’s very helpful

This has helped me understand theories a bit better, however, there is one that is eluding me. Where does the normative theory fit in?

very educative.I have understood theories more than before.Thanks

hard work. great work in deed

I love reading your material, plain concise and easy

Very informative, more knowledgeable about the theorist

Thank you for your information. This material is great and when I have looked for material for nursing theory. I got is material with complete

A big hand of applause 👏🏿 This is a treasure for nurses of the world. Thank you so much

Hi G. ALex,

Wow, thanks for the awesome feedback! 😊 Super glad you found it to be a treasure. Just curious, was there a particular section that stood out to you or something you’d love to see more of? Always keen to hear what resonates with fellow nurses!

This is really hard work put together in a very easy to understand way.Thank you so much.It came handy

Hi Sigala, Thanks a ton for noticing the effort! 😊 Super happy to hear it came in handy for you. If you ever have suggestions or topics you’d like to see, give me a shout. Cheers to making things understandable!

Absolutely helpful. Thank you.

So glad to hear the nursing theories guide was a hit for you! 😊 If you have any other topics or questions in mind, just give a shout. Always here to help. Keep rocking your studies! Thanks Ishe!

Am happy, to read these theories, very educating. Am going to make use of it when caring for my patients. GREAT NURSES GREAT! I LOVE YOU ALL.

Hi Eboh, I’m thrilled to hear you’re excited about applying these nursing theories in practice! They can really enhance the care we provide. It’s all about putting that knowledge to good use. By the way, which theory resonated with you the most, or which do you see being most applicable in your day-to-day patient care?

How do I relate one of the theories to effective management of intravenous lines? Which theory and how to relate to the above?

Hi wanted to ask you who wrote this page who is the autor because i need to write them on footnotes and i can’t find autor of the page,neither the year it was published. Thank you. Btw this article was really helpful i never understood nursing theories this good.

Hey there Innaya, I’m glad to hear the article on nursing theories was so helpful to you! Here’s how you can cite it in APA format:

Vera, M. (2019, September 11). Nursing Theories and Theorists: The Definitive Guide for Nurses Nurseslabs. https://nurseslabs.com/nursing-theories/

If you need any more help with citations or have other questions, feel free to ask. Happy to assist!

Please is there an app I could download all these from?

Hi Felicia, Thanks for your interest! As of now, we don’t have a dedicated app for downloading our content. However, our website is mobile-friendly, so you can easily access all our resources from your smartphone or tablet browser.

wonderful insights, and very precise and easy to understand, I even got to know and learn about other new theorists of Nursing I didn’t know before.

Thank you so much for this wonderful work.

Its so amazing and very helpful. Please how can I cite any of these theory using Vancouver?

thanls for good informatiom need to explain example

Great!. Useful information to the lecturers, and educators toward delivery info to our young generation nursing.

So detailed 👌🏽 I love it

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There are no ifs, ands, or buts about it: Nursing theories are important to understand both in practice and during study for key nursing exams while enrolled in a nursing school.

Nursing theories serve as the foundation of clinical decision-making from what nursing is to what and why nurses do what they do. And because nursing practices have evolved alongside nursing science, nursing theories continue to emerge to provide valuable insights.

Each nursing theory organizes a particular philosophy and framework of nursing that helps identify what nurses should do and the purpose of their actions in treating clients. The application of nursing theory in clinical practice can improve their professional nursing decision-making skills by following these system processes.

What is nursing theory?

The 4 main concepts of nursing theory, change theory, environmental theory, patient-centered approach to nursing, casey’s model of nursing, theory of comfort, tidal model, self-care deficit theory, cultural care theory, theory of interpersonal relations, adaptation theory, nursing need theory.

We’ll walk you through what you need to know about these theories.

Nursing theories are the cornerstone of quality nursing practice. They’ve been used for a long time — since Florence Nightingale introduced the first nursing theory around 1860. In short, a nursing theory outlines clients’ needs and explains how nurses should respond to different situations. Over the years, different nursing theorists have created guidelines for understanding the nursing role, the relationship between a nurse and their client, and the best treatment options for clients. These different theories reflect nursing research and work to improve clients’ overall well-being.

What is the nursing metaparadigm?

The nursing metaparadigm is the idea that four main components interact, and are generally interrelated when treating clients. The metaparadigm provides structure and key areas of focus that help define how nurses should evaluate a client and their needs and then determine the appropriate nursing care.

The metaparadigm is reflected in the different nursing systems. When nurses use all four components when evaluating and treating clients, they provide holistic care. The major components of the metaparadigm look at the client’s health from all angles.

Those interested in the nursing profession should make sure they understand the four components.

The nursing metaparadigm identifies four main concepts of nursing theory — first named by Jacqueline Fawcett — that outline how nurses need to evaluate their patients and provide care.

We’ll walk you through these four main components so you can see how they interact to create the full picture of a patient’s health and needs.

What Are the 4 Nursing Theories?

In a nursing theory, the Person can also be referred to as a Patient or Human Being. These terms all reference the patient or other people receiving care offered by the nurse.

For example, when caring for a patient in a hospital, the patient will have the title of Person. If the nurse offers HIV education programs in a community health center, on the other hand, the group would receive this classification.

When nurses work to define who the person is receiving their care, they should take a holistic look at the individual or the group. This means considering their social, spiritual, and physical needs.

Environment

The Environment can also be referred to as the Situation. You can define this classification by looking at all the different surroundings and conditions that impact the patient or people receiving care.

For example, the Environment includes the physical place where the person is and the people in their lives that impact their health. All of these environmental factors should be recognized in the conceptual framework of each nursing theory.

Health describes the current physical health of the person receiving care. This classification looks at the overall wellness of the person or people in question. Looking at the patient’s overall health requires not only collecting vitals but also looking at their emotional health and even their social conditions.

The Nursing classification describes the actions the nurse takes to provide care to the person or people in question. This might take the form of nursing care in a clinical setting, such as putting in an IV, or educational care that nurses provide to community members or family members of patients.

There are a variety of nursing theories that nurses consult to help them better understand their patients and provide optimal care. Most theories fall under three main categories, though.

Grand Nursing Theories  

Grand Nursing Theories describe abstract nursing theories that focus on providing frameworks for understanding nursing behavior and don’t have too many details.

• Abstract and complex frameworks that require further research for clarification.
• Offer general conceptualizations of nursing phenomena without prescribing specific interventions.
• Developed based on personal experiences and historical contexts, addressing key components of the nursing metaparadigm.

Middle-Range Nursing Theories

Middle-Range Nursing Theories are slightly more specific than Grand Nursing Theories and provide more details about behavior and specific patient populations that each theory focuses on.

• Focus on specific nursing phenomena with less complexity than grand theories.
• Proposed as more testable alternatives to grand theories, bridging the gap between theory and practice.
• Often derived from existing grand theories or empirical research in nursing or related disciplines.

Practice-Level Nursing Theories

Practice-Level Nursing Theories provide more minute details about specific types of patients and situations.

• Narrow in scope and tailored to specific patient populations and contexts.
• Offer practical frameworks for nursing interventions and predict outcomes of nursing practices.
• Directly impact nursing practice and are informed by concepts from middle-range and grand theories.

Let’s now explore some of the most common nursing theories you can expect to encounter as you begin your nursing career.

Change theory is a set of principles and concepts that explain how change occurs in individuals and organizations. It provides a roadmap for understanding the change process and the factors that influence it. Change theory is based on the idea that change is a process, not an event. It involves a series of stages that individuals and organizations go through as they adopt new behaviors or practices.

The Environmental Nursing Theory is the first framework developed by Florence Nightingale during the Crimean War. Nightingale discovered connections between the environment in which the patient was situated and their recovery and health.

Nightingale focused on the importance of providing patients with five key requirements:

• Efficient drainage
• Sanitation or cleanliness
• Light or direct sunlight

The Patient-Centered Approach to Nursing theory was developed in the 1940s by Faye Abdellah. The goal of this approach lies in guiding the care that nurses provide in hospitals and clinical settings.

This approach walks nurses through 10 specific steps:

• Get to know the patient and their health problems and needs.
• Gather data and sort out the most relevant information.
• Use past experiences and insights into the nursing profession to compare the patient with other patients who have presented similarly.
• Create a therapeutic plan to treat the patient.
• Create tests and run them to see how the patient compares and what new generalizations need to be made.
• Speak with the patient about what they view as their nursing problems.
• Observe the patient throughout the treatment period to see if there are any changes in their behavior.
• Observe how the patient and their loved ones react to the nursing treatment plan.
• Determine the nurse’s perceptions of the nursing problems facing the patient.
• Create a comprehensive nursing care plan based on the information gathered throughout this process.

Anne Casey’s Model of Nursing emerged in the late 1980s and focused on nursing as it pertains to children. It helps nurses connect with both the pediatric patient and their family to provide optimal care. At the core of this theory is the idea that children are cared for best by their family members while receiving help from health care professionals.

The Theory of Comfort emerged in the 1990s by Katherine Kolcaba. With this theory, nurses focus on providing clients with comfort as their primary objective. The idea behind this focus is that if the client’s basic needs are met, the client will naturally experience some relief, which is the first step in the three stages of comfort.

After relief comes to ease and then transcendence.

The Tidal Model also emerged in the 1990s. It was spearheaded by Phil Barker, who worked to combine nursing with psychiatry by helping people through experiences of distress. This model helps patients navigate these negative moments through the 10 Commitments of:

• Valuing the voice and experiences of the patient
• Respecting the language used by the patient
• Having a true curiosity about the patient and their experiences
• Having an outlook like an apprentice to learn
• Using the tools available to help the patient
• Helping the patient see the next step
• Helping the patient understand and experience the gift of time
• Using personal insights and wisdom
• Understanding that the only thing constant in life is change
• Being transparent throughout the process

Dorothea Orem developed the Self-Care Deficit Nursing Theory throughout her career from the early 1950s to 2001. Under this understanding of nursing, patients want to care for themselves but need assistance sometimes.

In the Theory of Self-Care Deficit, nurses can help patients by empowering them to do as much as they can independently. According to Orem’s self-care model, as the patient improves, the nurse encourages the transition for the patient to do even more by themselves.

The Cultural Care Theory, created by Madeleine Leininger, states that nursing care needs to align closely with the patient’s personal beliefs. In other words, the individual’s religious beliefs, cultural practices, and values should play an important role in the nursing interventions the patient receives.

This can be particularly important for those working in transcultural nursing and can help nurses put their nursing knowledge to use in a way that benefits the patient directly.

The Theory of Interpersonal Relations arose from the work of Hildegard Peplau. Peplau believed that nursing should revolve around the back and forth in the relationship between the patient and the nurse.

Instead of seeing the nurse as simply fulfilling the doctor’s orders and the patient simply receiving treatment, this modern nursing theory shifts the role of nurses by emphasizing the relationship between the nurse and the patient.

The Adaptation Theory was developed by Sister Callista Roy, and focuses on the interconnected systems that a patient experiences as part of the nursing process. The interrelated systems of patients within their families and social groups, as well as various human life processes, form the focus of this nursing theory.

In the adaptation model, nurses help patients navigate and maintain balance in spite of these different conditions.

The Nursing Need Theory emerged from works by Virginia Henderson. Henderson and the Need Theory focused on the patient’s basic human needs and encouraged their independence throughout their time in the hospital.

The hope is that by following this model, patients don’t need to be hospitalized longer than necessary and that progress in the patient’s condition isn’t delayed.

Study Smarter for Nursing Exams Like the NCLEX

These nursing models will play an important role in your nursing education, so you’ll want to carefully review them when studying for exams.

Graduating from a nursing program — whether you’ve earned a BSN to become an RN or earned an MSN to become a nurse practitioner — is just one part of the process.

You’ll also need to pass tests for licensure. The good news is that SimpleNursing is here to simplify the process of helping nursing students prepare for major exams like the NCLEX with top-notch NCLEX practice questions , video-based rationales, and comprehensive assessments.

Knowing how to study, identifying your weak points, and targeting the areas where you need the most review can help build your skills.

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What Are Nursing Theories?

Nursing theories help guide and define nursing care and provide a foundation for clinical decision-making . Some nursing theories have impacted the field of public health for hundreds of years and are still being used in modern hospitals and healthcare settings.

If you’re thinking about going to school to become a nurse, nursing theory will likely make up part of your curriculum. To help prepare yourself, read on to learn more about some of the most influential nursing theories.

The Metaparadigm of Nursing

A metaparadigm is a set of ideas that provides structure for how a healthcare discipline should function. The metaparadigm of nursing refers to the four main concepts tied to nursing theory: person, health, environment, and nursing.

The “person” component of the metaparadigm focuses on the receiver of care and the people in their life. It considers a 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.

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

Environment

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

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

There are a host of different research-based nursing models and theories that drive the practice and profession at large. These theories each incorporate the concepts of the metaparadigm of nursing, with specific nursing practice being shaped by the ideas of various nursing theorists and their models for nursing education and implementation.

What Are the Types of Nursing Theories?

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

Grand Nursing Theories

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

Middle-Range Nursing Theories

Middle-range theories deal with specific areas of nursing as opposed to grand theories. These areas might stem from day-to-day nursing practices, research, or theories from similar disciplines.

Practice-Level Nursing Theories

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

What Are Some Examples of Nursing Theories?

Some of the most common nursing theories include the following:

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.

Nightingale’s Environmental Theory 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. 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 members with the assistance of health professionals.

Patient-Centered Approach to Nursing

Originating in the 1940s, Faye Abdellah’s patient-centered approach helps guide nursing education and is intended to direct how care is given in hospitals. Her theory outlines 10 steps to identifying a patient’s problem and discusses key skills to develop a proper treatment. The 10 steps include the following:

• Learn to know the patient.
• Sort out relevant and significant data.
• Make generalizations about available data in relation to similar nursing problems presented by other patients.
• Identify the therapeutic plan.
• Test generalizations with the patient and then make additional generalizations.
• Validate the patient’s conclusions about their nursing problems.
• Observe and evaluate the patient over time to identify attitudes and other clues affecting their behavior.
• Explore the patient’s reaction—and that of their family—to the therapeutic plan and involve them in the plan.
• Identify how relevant nurses feel about the patient’s nursing problems.
• 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, patient comfort is an immediate and desirable outcome of nursing care. Kolcaba describes comfort in three forms: relief, ease, and transcendence. If a patient’s comfort needs are met, they experience a sense of relief. As a patient’s comfort needs change, their nurse’s interventions adjust accordingly.

Tidal Model

Developed by nurse and psychotherapist Phil Barker in the 1990s, this model is widely used in mental health nursing and psychiatry. It centers on the fundamental care process, emphasizing values of social relationships and connection to help others in moments of distress. The Tidal Model draws from the “ Ten Commitments ,” which are designed to foster effective communication, empathy, honesty, and problem-solving between patient and nurse.

Self-Care Deficit Theory

Developed by Dorothea Orem between 1959 and 2001, the self-care deficit theory posits that those in the nursing profession can enhance patient care by allowing the patient to perform as much of their own self-care as they are capable of. This nursing model views patient recovery in a maturational way, meaning that as patients become more and more able, they are encouraged to take care of themselves while relying increasingly less on direct nursing involvement.

Cultural Care Theory

Madeleine Leininger’s cultural care theory promotes the idea that patient care should be culturally congruent. In other words, care should be administered in harmony with the patient's cultural or religious beliefs, practices, and values.

Peplau’s Therapeutic Nurse-Patient Theory

Hildegard Peplau’s theory of interpersonal relations highlights the importance of the various roles that nurses take on when caring for patients. Nurses that study and apply this theory can better understand how to establish expectations, answer questions, educate on relevant topics, offer support and encouragement, and advocate for patient success.

Virginia Henderson’s Need Theory

This theory teaches the significance of patient independence, especially after they’ve received all the care and treatment needed to recover. Henderson’s theory discusses the basic activities and practices that nurses must instill in their patients so that they will continue to be in good health once they’ve left healthcare facilities and returned to their day-to-day lives. At its core, need theory underscores the importance of patient self-reliance.

Why Are Nursing Theories Important?

Nursing theories provide a structural foundation for nursing students and professionals. As the field of nursing continues to grow, nursing theories play a key role in guiding patient care toward the most favorable possible outcomes. These theories...

• Provide nurses with rationale in making crucial healthcare decisions.
• Guide evidence-based research, which may then lead to the establishment of best nursing practices and policies.
• Help nurses evaluate patient care.
• Offer nurses a clear understanding of their purpose and role in a healthcare setting.
• Help patients, their families, and other healthcare professionals recognize the invaluable contributions of nurses.

If you’re looking to become a nurse in any number of healthcare fields, consider studying at WGU. An online nursing degree program at WGU is a great way to gain a deeper understanding of nursing theories and acquire the career-relevant skills you’ll need to thrive, whether you’re an aspiring student nurse or hoping to advance in your current nursing position.

Additionally, WGU’s competency-based learning model lets you advance through coursework as quickly as you show mastery of the material, so you can potentially graduate faster and save money. Learn more today.

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Nursing Theory

Grand Nursing Theories

• Middle-Range Nursing Theories
• Finding Theory Journals
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What makes it Grand ?

These nursing theories have the broadest scope for addressing a variety of concepts and propositions that nurses may encounter in the practice of care. They tend to be oriented around models and conceptual frameworks for defining practice in a variety of situations and care environments and ways of examining phenomena based on these perspectives.

Grand Theories of Nursing

• General Systems Theory - Imogene King
• Modeling and Role Modeling Theory - Erickson, Tomlin, and Swain
• Transcultural Nursing (formerly Culture-Care) - Madeleine Leininger
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Usefulness of nursing theory-guided practice: an integrative review

Affiliations.

• 1 School of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada.
• 2 Shifa College of Nursing, Islamabad, Pakistan.
• 3 Clinical Nursing Instructor, Nipissing University, North Bay, ON, Canada.
• PMID: 30866078
• DOI: 10.1111/scs.12670

Background: Nursing theory-guided practice helps improve the quality of nursing care because it allows nurses to articulate what they do for patients and why they do it. However, the usefulness of nursing theory-guided practice has been questioned and more emphasis has been placed on evidence-based nursing and traditional practice. Therefore, an examination of experimental studies was undertaken to analyse the extent of use and usefulness of nursing theories in guiding practice. We reviewed experimental studies because in this era of evidence-based practice, these designs are given more weightage over other research designs. This examination would corroborate the usefulness of nursing theory-guided practice compared to traditional practice.

Methods: An integrative review was conducted. Literature search was performed within multiple databases, and 35 studies were reviewed and appraised.

Results: Majority of the studies were from Iran, the United States and Turkey and used Orem's self-care model, Roy's adaptation model and Peplau's theory of interpersonal relations. The effect of theory-guided interventions was evaluated in improving quality of life, self-efficacy, self-care and stress of patients with chronic, acute, cardiac and psychological illnesses. The quality rating was judged to be strong for three studies, moderate for 25 studies and weak for seven studies. All of the strongly rated studies found nursing theory-guided interventions useful. Overall, nursing theory-guided interventions improved all of studied outcomes in 26 studies and at least one outcome in nine studies. None of the studies reported that nursing theory-guided interventions as not useful.

Conclusion: Nursing theories have guided practice in both eastern and Western countries, and theory-guided practice has been found useful compared to traditional nursing practice. Therefore, nurses should continue to guide their nursing practice through the lens of nursing theories and should continue to evaluate the effectiveness of nursing theory-guided practice.

Keywords: experimental studies; nursing theories; nursing theory-guided practice.

© 2019 Nordic College of Caring Science.

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nursing , profession that assumes responsibility for the continuous care of the sick, the injured, the disabled, and the dying. Nursing is also responsible for encouraging the health of individuals, families, and communities in medical and community settings. Nurses are actively involved in health care research, management, policy deliberations, and patient advocacy . Nurses with postbaccalaureate preparation assume independent responsibility for providing primary health care and specialty services to individuals, families, and communities.

Professional nurses work both independently and in collaboration with other health care professionals such as physicians. Professional nurses supervise the work of nurses who have limited licenses, such as licensed practical nurses (LPNs) in the United States and enrolled nurses (ENs) in Australia. Professional nurses also oversee the work of nursing assistants in various settings.

Nursing is the largest, the most diverse , and one of the most respected of all the health care professions. There are more than 2.9 million registered nurses in the United States alone, and many more millions worldwide. While true demographic representation remains an elusive goal, nursing does have a higher proportional representation of racial and ethnic minorities than other health care professions. In some countries, however, men still remain significantly underrepresented.

The demand for nursing remains high, and projections suggest that such demand will substantively increase. Advances in health care technology, rising expectations of people seeking care, and reorganization of health care systems require a greater number of highly educated professionals. Demographic changes, such as large aging populations in many countries of the world, also fuel this demand.

Although the origins of nursing predate the mid-19th century, the history of professional nursing traditionally begins with Florence Nightingale . Nightingale, the well-educated daughter of wealthy British parents, defied social conventions and decided to become a nurse. The nursing of strangers, either in hospitals or in their homes, was not then seen as a respectable career for well-bred ladies, who, if they wished to nurse, were expected to do so only for sick family and intimate friends. In a radical departure from these views, Nightingale believed that well-educated women, using scientific principles and informed education about healthy lifestyles, could dramatically improve the care of sick patients. Moreover, she believed that nursing provided an ideal independent calling full of intellectual and social freedom for women, who at that time had few other career options.

In 1854 Nightingale had the opportunity to test her beliefs during Britain’s Crimean War . Newspaper stories reporting that sick and wounded Russian soldiers nursed by religious orders fared much better than British soldiers inflamed public opinion . In response, the British government asked Nightingale to take a small group of nurses to the military hospital at Scutari (modern-day Üsküdar, Turk.). Within days of their arrival, Nightingale and her nurses had reorganized the barracks hospital in accordance with 19th-century science: walls were scrubbed for sanitation, windows opened for ventilation, nourishing food prepared and served, and medications and treatments efficiently administered. Within weeks death rates plummeted, and soldiers were no longer sickened by infectious diseases arising from poor sanitary conditions. Within months a grateful public knew of the work of the “Lady with the Lamp,” who made nightly rounds comforting the sick and wounded. By the end of the 19th century, the entire Western world shared Nightingale’s belief in the worth of educated nurses.

Nightingale’s achievements overshadowed other ways to nurse the sick. For centuries, most nursing of the sick had taken place at home and had been the responsibility of families, friends, and respected community members with reputations as effective healers. During epidemics , such as cholera , typhus , and smallpox , men took on active nursing roles. For example, Stephen Girard , a wealthy French-born banker, won the hearts of citizens of his adopted city of Philadelphia for his courageous and compassionate nursing of the victims of the 1793 yellow fever epidemic .

As urbanization and industrialization spread, those without families to care for them found themselves in hospitals where the quality of nursing care varied enormously. Some patients received excellent care. Women from religious nursing orders were particularly known for the quality of the nursing care they provided in the hospitals they established. Other hospitals depended on recovering patients or hired men and women for the nursing care of patients. Sometimes this care was excellent; other times it was deplorable, and the unreliability of hospital-based nursing care became a particular problem by the late 19th century, when changes in medical practices and treatments required competent nurses. The convergence of hospitals’ needs, physicians’ wishes, and women’s desire for meaningful work led to a new health care professional: the trained nurse.

Hospitals established their own training schools for nurses. In exchange for lectures and clinical instructions, students provided the hospital with two or three years of skilled free nursing care. This hospital-based educational model had significant long-term implications . It bound the education of nurses to hospitals rather than colleges, a tie that was not definitively broken until the latter half of the 20th century. The hospital-based training model also reinforced segregation in society and in the health care system. For instance, African American student nurses were barred from almost all American hospitals and training schools. They could seek training only in schools established by African American hospitals. Most of all, the hospital-based training model strengthened the cultural stereotyping of nursing as women’s work. Only a few hospitals provided training to maintain men’s traditional roles within nursing.

Still, nurses transformed hospitals. In addition to the skilled, compassionate care they gave to patients, they established an orderly, routine, and systemized environment within which patients healed. They administered increasingly complicated treatments and medication regimes. They maintained the aseptic and infection-control protocols that allowed more complex and invasive surgeries to proceed. In addition, they experimented with different models of nursing interventions that humanized increasingly technical and impersonal medical procedures.

Outside hospitals, trained nurses quickly became critical in the fight against infectious diseases . In the early 20th century, the newly discovered “ germ theory ” of disease (the knowledge that many illnesses were caused by bacteria ) caused considerable alarm in countries around the world. Teaching methods of preventing the spread of diseases, such as tuberculosis , pneumonia , and influenza , became the domain of the visiting nurses in the United States and the district nurses in the United Kingdom and Europe. These nurses cared for infected patients in the patients’ homes and taught families and communities the measures necessary to prevent spreading the infection. They were particularly committed to working with poor and immigrant communities, which often had little access to other health care services. The work of these nurses contributed to a dramatic decline in the mortality and morbidity rates from infectious diseases for children and adults.

At the same time, independent contractors called private-duty nurses cared for sick individuals in their homes. These nurses performed important clinical work and supported families who had the financial resources to afford care, but the unregulated health care labour market left them vulnerable to competition from both untrained nurses and each year’s class of newly graduated trained nurses. Very soon, the supply of private-duty nurses was greater than the demand from families. At the turn of the 20th century, nurses in industrialized countries began to establish professional associations to set standards that differentiated the work of trained nurses from both assistive-nursing personnel and untrained nurses. More important, they successfully sought licensing protection for the practice of registered nursing. Later on, nurses in some countries turned to collective bargaining and labour organizations to assist them in asserting their and their patients’ rights to improve conditions and make quality nursing care possible.

By the mid-1930s the increasing technological and clinical demands of patient care, the escalating needs of patients for intensive nursing, and the resulting movement of such care out of homes and into hospitals demanded hospital staffs of trained rather than student nurses. By the mid-1950s hospitals were the largest single employer of registered nurses. This trend continues, although as changes in health care systems have reemphasized care at home, a proportionately greater number of nurses work in outpatient clinics, home care , public health , and other community-based health care organizations.

Other important changes in nursing occurred during the latter half of the 20th century. The profession grew more diverse. For example, in the United States, the National Organization of Coloured Graduate Nurses (NOCGN) capitalized on the acute shortage of nurses during World War II and successfully pushed for the desegregation of both the military nursing corps and the nursing associations. The American Nurses Association (ANA) desegregated in 1949, one of the first national professional associations to do so. As a result, in 1951, feeling its goals fulfilled, the NOCGN dissolved. But by the late 1960s some African American nurses felt that the ANA had neither the time nor the resources to adequately address all their concerns. The National Black Nurses Association (NBNA) formed in 1971 as a parallel organization to the ANA.

Nursing’s educational structure also changed. Dependence on hospital-based training schools declined, and those schools were replaced with collegiate programs either in community or technical colleges or in universities. In addition, more systematic and widespread programs of graduate education began to emerge. These programs prepare nurses not only for roles in management and education but also for roles as clinical specialists and nurse practitioners. Nurses no longer had to seek doctoral degrees in fields other than nursing. By the 1970s nurses were establishing their own doctoral programs, emphasizing the nursing knowledge and science and research needed to address pressing nursing care and care-delivery issues.

During the second half of the 20th century, nurses responded to rising numbers of sick patients with innovative reorganizations of their patterns of care. For example, critical care units in hospitals began when nurses started grouping their most critically ill patients together to provide more effective use of modern technology. In addition, experiments with models of progressive patient care and primary nursing reemphasized the responsibility of one nurse for one patient in spite of the often-overwhelming bureaucratic demands by hospitals on nurses’ time.

The nursing profession also has been strengthened by its increasing emphasis on national and international work in developing countries and by its advocacy of healthy and safe environments . The international scope of nursing is supported by the World Health Organization (WHO), which recognizes nursing as the backbone of most health care systems around the world.

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What is nursing professionalism? a concept analysis

1 Nursing College of Shanxi Medical University, Taiyuan, 030001 Shanxi People’s Republic of China

2 Linfen Hospital Affiliated to Shanxi Medical University (Linfen People’s Hospital), Linfen, 041000 Shanxi People’s Republic of China

3 The Third Peoples Hospital of Taiyuan, Taiyuan, 030001 Shanxi People’s Republic of China

Yangjie Chen

4 The First Hospital of Shanxi Medical University, Taiyuan, 030001 Shanxi People’s Republic of China

Qiaohong Wang

Associated data.

Data used to support the findings of this study are available from the corresponding author upon request.

Nursing professionalism plays an important role in clinical nursing. However, a clear conceptual understanding of nursing professionalism is lacking.

Walker and Avant’s strategy was used to analyse the concept of nursing professionalism. We searched electronic databases, including PubMed, Scopus, and CINAHL, for studies published from 1965 to 2021. Quantitative or qualitative studies published in English that focused on nursing professionalism were included in the study.

The three attributes of nursing professionalism are multidimensional, dynamic, and culture oriented. Based on the analysis, nursing professionalism is defined as providing individuals care based on the principles of professionalism, caring, and altruism.

Conclusions

This study offers a theoretical definition and conceptual model of nursing professionalism that may be applied to develop standardized assessment tools or nursing professionalism training programs.

Introduction

The COVID-19 outbreak has exposed deficiencies in the underinvestment of the global health system, including the shortage in nursing resources and nursing staff, and a similar situation is noted in China ( https://www.icn.ch/news/investing-nursing-and-respecting-nurses-rights-key-themes-international-nurses-day-2022 ). An unbalanced number of nurses and patients, high work pressure, lack of social occupational identity and other reasons have led to job burnout, low job satisfaction, and even the resignation of many nurses. Research has also shown that the lack of nursing professionalism adversely affects patient care and patient outcomes [ 1 ]. Ohman [ 2 ] pointed out that lower levels of professionalism may cause negative outcomes, such as turnover and attrition and lower productivity.

In recent years, researchers have tried to solve the above problems through professionalism.

However, nursing professionalism plays a more important role in clinical nursing. Some studies have shown that professionalism can improve the professional knowledge and skills of nurses and ameliorate reductions in institutional productivity and quality [ 3 ]. Higher levels of professionalism can improve nurses’ autonomy and empowerment, increase their recognition and facilitate organizational citizenship behaviours, establish nursing care standards and even improve quality services [ 4 , 5 ].

Nursing professionalism has been discussed for several decades. Hall (1968) developed the Professionalism Inventory Scale [ 6 ]. Miller et al [ 7 ] (1993) first specified the 9 standards criteria of nursing professionalism (educational background; adherence to the code of ethics; participation in the professional organization; continuing education and competency; communication and publication; autonomy and self-regulation; community service; theory use, development, and evaluation; and research involvement.). Yeun et al. (2005) summarized five themes regarding nurses’ perceptions of nursing professionalism: self-concept of the profession, social awareness, professionalism of nursing, the roles of nursing services, and originality of nursing [ 8 ]. Yoder defined nursing professionalism based on six components: acting in the patients’ interests; showing humanism; practising social responsibility; demonstrating sensitivity to people’s cultures and beliefs; having high standards of competence and knowledge; and demonstrating high ethical standards [ 9 ]. Although some researchers have explored the concept of professionalism. How can professionalism be evaluated in nursing clinical practice? Few studies have shown a clear conceptualization of nurses’ professionalism [ 10 , 11 ]. To nurture nursing professionalism, the concept of professionalism must be clarified.

Given that the meaning of professionalism varies across time, contexts, or cultures, it is difficult to define, quantify or measure professionalism [ 12 , 13 ]. The operational definition of nursing professionalism in studies has shortcomings. Sullivan et al. [ 14 ] found professionalism to be a multidimensional concept, but some papers have addressed only one dimension, such as values [ 15 ] or behaviours [ 16 ]. Moreover, professionalism is considered a complex concept. The links and dynamic processes between these different inner characteristics have not been included in the concept. Thus, a comprehensive definition of nursing professionalism, including its characteristics and the relations between them, is necessary.

Recognizing and understanding the concept of nursing professionalism may be an essential step towards providing quality care for people. It may also provide more information for further developing nursing professionalism for nurses.

Method of concept analysis

Walker and Avant’s method used linguistic philosophy techniques to contribute to the philosophical understanding of a concept [ 17 ]. The W & A method is considered a mark of the positivist paradigm, which views the concept as a stable factor that can be reduced or extracted from its context of application [ 18 ]. This study used Walker and Avant’s method, which assumes that nursing professionalism is a relatively mature and stable concept (numerous studies on nursing professionalism have been published to date). This approach to conceptual analysis, although not perfect, is helpful in clarifying the concept of nursing professionalism.

Using the structured method of Walker and Avant enables conceptual clarity to be obtained based on an inductive identification of the concept’s attributes, antecedents and consequences. The concept analysis helps to clarify meanings and develop operational definitions, considering evidence from a wide range of information resources for further research or clinical practice [ 17 , 19 ]. These features make this method particularly useful for the analysis of the concept of ‘nursing professionalism’. The conceptual attributes as well as antecedents and consequences are based on the research team's analysis of the literature using Walker and Avant’s strategy and are not the product of a priori theoretical categories.

Walker and Avant’s [ 17 ] eight-step method includes the following: 1) selecting a concept; 2) determining the aims or purposes of analysis; 3) identifying all uses of the concept; 4) determining the defining attributes of the concept; 5) constructing a model case; 6) constructing borderline, contrary, invented, and illegitimate cases; 7) identifying antecedents and consequences; and 8) defining empirical references.

Selection criteria

The inclusion criteria were as follows: related to the concept of nursing professionalism; included nurse professionalism, nursing spirit, or nurse spirit; written in the English language; qualitative, quantitative, mixed methods or systematic reviews; published between 1965 and 2021 (when professionalism was first introduced by nursing in 1965); and published in books or dictionaries. We excluded articles published in nonpeer reviewed journals, editorials and letters to the editor.

Data sources

We searched several online databases, including PubMed, Scopus, and CINAHL, for articles published from 1965 to 2021. We searched the words that appear in the title, abstract, and keyword section of the studies.

(((((((((Nursing professionalism[Title]) OR (Nursing professionalism[Title/Abstract])) OR (Nurse professionalism[Title])) OR (Nurse professionalism[Title/Abstract])) OR (Nursing spirit[Title])) OR (Nursing spirit[Title/Abstract])) OR (Nurse spirit[Title])) OR (Nurse spirit[Title/Abstract])).

TI Nursing professionalism OR AB Nursing professionalism OR TI Nurse professionalism OR AB Nurse professionalism OR TI Nursing spirit OR AB Nursing spirit OR TI Nurse spirit OR AB Nurse spirit.

TITLE-ABS-KEY (Nursing professionalism) OR TITLE-ABS-KEY (Nurse professionalism) OR TITLE-ABS-KEY (Nursing spirit) OR TITLE-ABS-KEY (Nurse spirit).

Any quantitative or qualitative studies published in English focusing on nursing professionalism were included in the study. Two researchers independently screened titles and abstracts to determine the selection criteria for electronic retrieval and application. The study was included only when both researchers agreed that the study met the inclusion and exclusion criteria. If the two researchers’ judgements were different, a third person was consulted to resolve the issue. Researchers identified the different usages of the concept and systematically recorded the characteristics of the concept that appeared repeatedly [ 17 ].

We used definitions and examples in the systematic record (Table ​ (Table2) 2 ) to define a cluster of antecedents, attributes and consequences (Figs. ​ (Figs.1 1 and  2 ) frequently associated with the concept [ 20 ].

Flowchart of the study selection process of the concept analysis

The connotations of nursing professionalism

Antecedents, attributes, and consequences of nursing professionalism

We identified 6013 studies on nursing professionalism. After excluding duplicates, irrelevant studies, studies that were not original scientific studies or articles, and studies published in languages other than English, 138 studies were selected for analysis. Tables 1 and ​ and2 2 show some typical literatures used in this study.

The attributes of the nursing professionalism

Uses of the concept

Dictionary definitions of the concept.

The Merriam-Webster Dictionary defines professionalism as ‘the conduct, aims, or qualities that characterize or mark a profession or a professional person’ [ 48 ], whereas the Cambridge Dictionary [ 49 ] defines professionalism as ‘the combination of all the qualities that are connected with trained and skilled people’. These definitions are generic and difficult to use to clarify the factors involved in nursing professionalism.

Definitions of the concept reported in the literature

Hwang et al. [ 50 ] defined professionalism as commitment to a profession and professional identity level. Health-care workers demonstrate professionalism through attitudes, knowledge, and behaviours, which reflect approaches to the regulations, principles, and standards underlying successful clinical practices [ 33 ]. Nursing professionalism reflects the value orientation, concepts of nursing, work attitude and standards of clinical nurses [ 51 ].

Subconcepts

The Nightingale Spirit, named in honour of the founder of professional nursing, refers to the spirit of altruism, caring, and honesty [ 52 ]. In the past, the Nightingale Spirit advocated that nurses are willing to dedicate themselves, but the term currently encompasses more innovation [ 53 ]. E-professionalism is defined as evidence provided by digital means, attitudes and behaviours reflects the traditional models of professionalism [ 54 ]. Nurses use the internet to communicate about work or daily life, blurring the boundaries between individuals and professions; thus, e-professionalism applies to nurses [ 55 ].

The defining attributes of nursing professionalism

The defining attributes of the concept aim to understand its meaning and differentiate it from other related concepts [ 17 ]. The key defining attributes are as follows.

Nursing professionalism is multidimensional

Nursing professionalism is a three-dimensional concept based on the knowledge, attitudes, and behaviours that underlie successful clinical practice [ 33 ].

Professionalism can be conceptualized as a ‘systematic body of knowledge’ with complex configurations of work expertise [ 21 ].

Professionalism refers to the attitude that represents levels of recognition and commitment to a particular profession [ 22 ]. Hall [ 6 ] noted that nurses’ attitudes have a high correspondence with the behaviours of the respondent. Measuring professionalism at the cognitive level can be thought of as measuring potential professionalism at the behavioural level. Researchers noted that given the reduced restrictions of environmental constraints, measuring professionalism at the cognitive level may be more precise than measuring it at the behavioural level [ 23 ].

Nursing professionalism is often described as a set of professional behaviours [ 11 ]. Some researchers judge whether nurses exhibit professionalism through their behaviours. Miller [ 24 ] (1988) developed the Wheel of Professionalism in Nursing Model. The model is considered a framework for understanding professional behaviours among nurses. Kramer [ 56 ] (1975) quantified professionalism by assessing the number of professional books purchased, subscriptions to journals, and the number of articles published.

In addition, the perspective of professional identity formation complements the behaviour-based and attitude-based perspectives on professionalism [ 57 ].

The formation and development of professionalism are dynamic processes

Nursing professionalism is an inevitable, complex, varied, and dynamic process [ 58 ].The professionalism concept is considered ever-changing, replacing static or definitive views [ 59 ].

Socialization process

Nursing professionalism is instilled through a process of socialization in formal nursing education [ 25 ]. Nurses’ socialization process begins with formal, entry-level education to acquire knowledge and skills.

Yeun et al. [ 8 ] (2005) discussed the developmental process of nursing professionalism in which the individual’s thoughts and beliefs are formed by socialization factors through perception. These thoughts and beliefs may in turn influence the individual’s professional image or self-concept, thereby influencing nurses’ actions and performance.

Process of interaction

The dynamic of professionalism is also reflected in the process of interaction. Dehghani et al. [ 26 ]noted that nursing professionalism means the appropriate interaction of the individual and the workplace and the maintenance of interpersonal communication.

Culture oriented

One study showed that altruism is an essential element of medical professionalism in Asia or North America but not Europe [ 27 ]. In China, medical professionalism was influenced by its longstanding Confucian traditions [ 28 ]. Therefore, any definitions of professionalism should match its rooted culture and be validated with respect to the culture and context in which it is applied [ 60 ].

The connotation of nursing professionalism

Professional, having a systematic nursing knowledge system.

The nursing process is considered a method for solving problems or dilemmas in a logical and scientific manner [ 11 ]. Freidson [ 29 ] (2001) noted that professionals perform their specialized work only with the required training and experience. Professionals have specific, tacit, almost esoteric knowledge to do their work [ 61 ]. Miller et al. [ 7 ] considered that a formal university education with a scientific background is critical for professionalism in nursing.

Professional certification

Nurses actively seek specialty certification given their personal commitment to the nursing profession [ 30 ]. Specialty certification promotes nursing professionalism. When attaining the highest levels of clinical knowledge, nursing professionalism also indicates personal responsibility and dedication to best practices [ 31 ].

Lifelong learning and participation in continuing education

Due to professional and ethical obligations, nurses should sustain continuous professional growth and development to maintain individual competence. Professional growth in nursing requires lifelong learning. Lifelong learning includes continuing education and self‐study, seeking advanced degrees, etc. [ 62 ].

Continuing education is one of the indicators of professionalism. Professionals keep up with the latest developments in the field and partake in continuing education. Additionally, continuing education is as important as other criteria for increasing professionalism in nursing [ 7 , 32 ]. Ongoing education brings fresh knowledge to health care, consequently leading to more efficient and quality service for people.

Evidence-based practice

Evidence-based practice (EBP) is a hallmark of professionalism [ 33 ]. Dollaghan [ 63 ] (2004) reported that we identify and use the highest quality scientific evidence as an integral part of our efforts to provide the best patient care; EBP is a knowledge base that responds to specific clinical issues in a clear, intelligent, and serious manner while considering clinical practice in the context of the highest-quality scientific evidence available.

Innovation in nursing helps to improve patient care quality and improve nurses’ job performance [ 64 ]. Shen et al. [ 34 ] noted that innovative education plays an important role in the professional quality of undergraduate nursing students.

Striving for excellence

Striving for excellence is a requirement and attribute of nursing professionalism. There is a growing need in nursing practice to possess knowledge and skills in quality improvement science, translational research, and implementation science [ 35 ]. Clinical nurses have the same responsibilities as nursing scientists.

Caring is considered the core attribute of nursing professionalism

The practice of caring is central to nursing [ 65 ]. Caring is defined as the moral ideal of nursing [ 36 ]. Therefore, caring is an important core attribute of nursing professionalism.

Creating a caring-healing environment

Nurses devoted to creating a caring-healing environment embody professionalism. Caring means nurses should create a healing environment at all levels by providing a supportive, protective environment as well as a corrective mental, physical, societal, and spiritual environment for patients. People’s basic needs include a clean environment, comfort measures, safety concerns, and feeling safe or protected [ 65 ].

Displaying kindness/concern/empathy for others

A nurse is defined as someone caring for the ill within the hospital setting [ 66 ]. Caring means showing or having compassion, concern and empathy for others [ 37 ]. Caring behaviours are an interactive and mental process between patients and nurses [ 38 ]. Displaying kindness and concern for others is shown by love, compassion, support and involvement [ 39 ].

Using all methods of knowing support and involvement

‘Human problems reside in ambiguity, paradox, and impermanence’. Therefore, suffering, healing, miraculous cures, and synchronicity are all part of knowing support and involvement.

Researchers suggest that nursing comprises Caritas Nursing, Energy Nursing, Transpersonal Nursing, Holistic Nursing, or Contemplative Nursing…… It goes beyond ordinary nursing. Nursing should have higher standards with excellence for caring, healing, and peace in the world. Therefore, caring means using all methods of knowing support and involvement [ 65 ].

Embracing the unknowns and miracles in life and practising loving

Nursing is a special profession. Nurses confront special circumstances daily and witness people’s struggles with life and death. Everyone has his or her own specific story about his or her experiences and predicaments. Each person seeks his or her own meanings to find inner peace and balance in the midst of fear, doubts, despair, and unknowns. Therefore, the care of nurses is not to blindly sacrifice their own needs but to be a real nurse, embracing the unknowns and miracles in life and caring for patients [ 65 ].

The central tenet of professionalism is to put the needs and best interest of others over self-interests. Altruism is an engagement in caring acts towards others without expecting something in return [ 67 ].

Patients first

To be altruistic means to put others’ needs before your own. Altruism is the selfless concern for others and doing things with the other person’s well-being in mind [ 40 ].

During pandemics, nurses were considered to have a high sense of duty and dedication to patient care [ 41 ]. Front-line nurses perceive high work engagement, especially in self-dedication [ 42 ]. Grøthe et al. [ 43 ] showed that cancer patients in a palliative unit appreciate nurses who have the most dedication and expertise characteristics.

• Public service

Due to a strong sense of civic and social responsibility, nurses participate in public service. Nurses volunteer as participants in summer camps, schools, or health-care teams. Nurses are also committed to responding to large-scale crises, such as the terrorist attacks on the World Trade Center in New York, as well as national and international relief efforts, such as tsunamis and Hurricane Katrina [ 44 ].

• Disaster and infectious disease rescue

Individuals involved in providing disaster relief face many challenges, experience fatigue and personal suffering, and encounter numerous personal stories of life and death [ 45 ]. Nurses have played a significant role in the fight against infectious diseases such as severe acute respiratory syndrome (SARS) and the coronavirus disease 2019 (COVID-19) pandemic [ 68 ]. Nurses are closest with patients. Nurses provide intensive care, regularly assessing and monitoring airways, tubes, medications, and physical therapy. Nurses are also devoted to reducing complications. Nurses assist with daily living activities when patients are unable to care for themselves [ 46 ].

• Community service

In addition, emphasizing professionalism means respecting values and commitment to community service delivery [ 69 ].

According to Walker and Avant [ 17 ], cases help further clarify concepts.

Model cases (a real case example)

Model cases help demonstrate all the defining attributes of a concept and helps to better articulate its meaning [ 17 ].

MS A is a 63-year-old nursing director. She worked in clinical nursing and management for 42 years. As she progressed from a new nurse to a nursing expert, she gradually poured her enthusiasm (Multidimensional: Attitudes) into nursing work (Dynamic). She believes that the core of nursing professionalism in China is dedication and responsibility (Culture oriented). In 2020, COVID-19 broke out in Wuhan, China. She led a team to Wuhan to provide support (Multidimensional: Behaviours), reflecting the spirit of altruism (Altruism). She actively promoted exchanges and cooperation among disciplines and the development of academic conferences. She guided students to pay attention to practical innovation and develop evidence-based innovations (Professional). Although she is retired, she still imparts knowledge and experience to students everywhere (Multidimensional: Behaviours). She stated that the development of nursing professionalism is very difficult and requires nursing education and role models. (Multidimensional: Knowledge). The role of a nurse is like that of a mother, bringing care to the people (Caring).

Borderline cases (a real case example)

Borderline cases provide the examples that contain the most defining attributes of the concept [ 17 ].

B is a novice nurse. When working in the infection ward, she was so worried about being infected. She was reluctant to care for patients and wanted to escape from the ward environment. Fortunately, her nurse manager fully understood her situation and helped her adapt to work and reduce her anxiety. B observed that her nurse manager had been helping patients solve problems and giving them comfort and hope. This prompted her to think about what nursing truly means. In 2020, she volunteered to help COVID-19 patients (Altruism).

Related cases (a real case example)

Related cases are related to the concept but do not contain all its defining attributes [ 17 ].

C is a novice nurse. After graduating from nursing school, he became a nurse in the emergency department. He saw many patients who died or recovered, which made him realize the importance of caring (Caring). He said that emergency nurses need strong professionalism (Multidimensional: Attitudes). He participated in social service activities (Multidimensional: Behaviours), for example, promoting knowledge of cardiopulmonary resuscitation (Altruism) in the community. After working for five years, he returned to school for a master’s degree to help the head nurse conduct nursing research or evidence-based practice (Professional). In his Asian cultural milieu, his is embarrassed about his identity as a male nurse (Culture oriented), but he believes he can do well.

Contrary cases (a fictional case example)

A contrary case does not include any defined attributes of the concept [ 17 ].

D is a nurse in paediatrics. She disliked nursing when she was a nursing student and even did enjoy communicating with patients (poor dynamics). She was exhausted after work and felt her life was out of balance. One of the values of the hospital where she worked was dedication, which confused her (Poor culture orientation). She considers it unrealistic to require professionalism (Poor nursing professionalism knowledge) and thinks that taking care of new-borns is particularly troublesome (Poor nursing professionalism attitudes), so she is always careless in her work (Multidimensional: poor attitude). D’s child felt ill last week, so she secretly reduced a patient’s medicine (Poor nursing professionalism behaviours) and took the remaining medicine home for her child (lack of altruism). She stopped doing so after her colleagues sensed something strange. One day, a baby kept crying; D reported it to the doctor and did not make further observations (Poor professional). When the shift nurse took over, she observed abnormal limb activity on one side of the child. The child’s family asked the nurse to bear legal responsibility. D said it was no big deal; she no longer wanted to be a nurse (Poor dynamic, professionalism not established).

Antecedents

Antecedents are events that occur before the intended concept [ 17 ].

Macro antecedents

Jin [ 28 ] suggested that the conceptualization of professionalism is influenced by culture. Employees defined organizational culture underlies an organization’s values and beliefs [ 70 ]. Nursing professionalism may be supported by a variety of cultures, so a firm understanding of and personal congruence with each particular culture is essential [ 71 ].

Religious beliefs

Religiosity is another contributing factor in the cultivation of altruism [ 72 ]. Taylor noted that nurses’ job motivation and views of the patient and nursing services are affected by their religious beliefs [ 73 ].

Micro antecedents

Snizek [ 74 ] (1972) reported that devotion to work is a professional value originating from a sense of calling to the field. Liaw et al. [ 75 ] (2016) found that nursing students who had caring and compassionate qualities as the most common personal characteristics strongly believed that they were called to nursing.

Individuals who pursue excellence in the workplace may be described as motivated and devoted to their work. Attree [ 76 ] (2005) noted that nurses’ perceived lack of autonomy over their practice could impact quality of care.

Personal characteristics

Nursing professionalism is influenced by various factors, such as educational background, personal interests, professional satisfaction, and professional values [ 77 , 78 , 79 ]. In each country, nurses with higher educational levels may have a higher level of professionalism [ 22 ]. Professionalism is thus a trait related to personal character and upbringing [ 80 ]. Researchers [ 81 ] have demonstrated that professionalism is positively associated with female gender, striving for professional goals, and acceptability. One study found that people’s values tend to shift to emphasize altruism over personal gain as they age [ 79 ]. Nursing professionalism is closely associated with personality traits (extraversion, conscientiousness, and agreeableness) [ 82 ].

Consequences of nursing professionalism

Consequences are events or incidents that are the result of the occurrence of a concept [ 17 ].

Consequences for patients 

Professionalism is one of the decisive factors that critically influences patient satisfaction [ 50 ]. Professionalism can also improve practising nurse career development and the quality of service [ 81 ].

Consequences for nurses

Studies have shown that professionalism and a sense of belonging with colleagues and managers affect the satisfaction [ 83 ] and retention rate of nursing students in academic institutions [ 84 ]. Izumi et al. [ 85 ] (2006) found that good nurses felt pride and happiness in caring for patients closely related to their professionalism.

Empirical references

As the last step to concept analysis, empirical references can further clarify the concept and facilitate its measurement [ 17 ].

Hall’s professionalism inventory scale

Hall’s Professionalism Inventory Scale [ 6 ] identified five attitudinal attributes of professionalism: (a) use of professional organizations as major referents, (b) belief in public service, (c) self-regulation, (d) a sense of calling to the field, and (e) autonomy. Nursing researchers used Hall’s Professionalism Inventory Scale to measure professionalism in nursing [ 22 , 47 ]. Snizek [ 74 ] (1972) modified the professionalism scale to more closely match the clinical context of nursing and better reflect the professionalism of nursing staff.

Kramer’s index of professionalism

Kramer (1974) [ 86 ] constructed an index of professionalism that includes indicators of behaviours, such as the number of professional books published, subscriptions to professional journals, hours spent on professional reading, continuing education, participation in professional organizations, number of professional publications, speeches given, committee activity, and participation in research.

The behavioural inventory for professionalism in nursing (BIPN)

The Behavioural Inventory for Professionalism in Nursing [ 7 ] (BIPN) identifies professional behaviours and values among nurses. The nine categories in the BIPN are (1) educational background; (2) adherence to the code of ethics; (3) participation in the professional organization; (4) continuing education and competency; (5) communication and publication; (6) autonomy and self-regulation; (7) community service; (8) theory use, development, and evaluation; and (9) research involvement.

Definition of the concept

Based on the present analysis, we define nursing professionalism as follows: ‘Nursing professionalism is a multidimensional concept manifested by the knowledge, attitudes, and behaviours that underlie successful clinical practice. Nursing professionalism is dynamicized through a process of socialization in formal nursing education. This feature is also reflected in the process of interaction. Therefore, nursing professionalism should match its rooted culture.

The connotations of nursing professionalism include professional, caring, and altruism. These connotations are detailed as follows:

• Possesses a systematic nursing knowledge system; professional certification
• Exhibits lifelong learning and participation
• Participates in evidence-based practice
• Demonstrates innovation
• Strives for excellence
• Creates a caring-healing environment
• Displays kindness/concern/empathy for others
• Uses various methods of knowing support and involvement
• Embraces the unknowns and miracles in life and practices loving
• Patient-first

A conceptual model of nursing professionalism is shown in Fig.  2 .

Defining the connotation of nursing professionalism

Nursing professionalism has been defined as professional, caring, and altruistic.

Professional values are characteristic of nursing professionalism. Nursing work requires rich knowledge and scientific evidence-based work to improve the quality of nursing services for patients. Nurses need lifelong learning, qualification certification, and participation in academic and practical activities.

Caring is regarded as the core of professionalism. This study suggests creating a caring-healing environment, displaying kindness/concern/empathy for others, employing all methods of knowing support and involvement, embracing the unknowns and miracles in life and practising loving to care for people to obtain high professionalism. This study notes that nursing professionalism emphasizes care for the individual patient and that the nurse does everything possible to create a caring and healing environment for patients. In different health systems worldwide, nurses have incorporated caring about nursing professionalism into everything they do. This characteristic is consistent with Nightingale's view that “Nurses need to be sensitive. A nurse must use her brain, heart and hands to create healing environments to care for the patient’s body, mind and spirit” [ 87 , 88 ].

Nursing has an altruistic nature, and people interested in helping patients are attracted to this profession [ 89 ]. However, some studies have shown that altruistic care is equated with self-sacrifice, self-denial, and unidirectional and unconditional care [ 90 ]. Care for a nurse’s own needs is equally important, but nurses should be able to put aside their own needs when required to focus on the needs of others [ 91 ]. Nurses should view self-care and altruism as dialectical. Self-realization and providing care for others are not conflicting concepts [ 92 ].

Defining the attributes of nursing professionalism

In this study, we defined nursing professionalism as multidimensional, dynamic, and culture oriented.

Nursing professionalism is a multidimensional concept that includes knowledge, attitudes, and behaviour. Previous studies have defined professionalism as the degree of commitment by individuals to the values and behavioural characteristics of a specific career identity [ 6 , 7 ]. However, current research on nursing professionalism is mostly single dimensional. The Behavioural Inventory for Professionalism in Nursing (BIPN) is based on Miller’s model and is used to measure professional behaviours among nurses [ 7 ]. Hall’s Professionalism Inventory Scale [ 6 ] identified five attitudinal attributes of professionalism. This study highlights that it is also necessary to focus on the knowledge dimension of professionalism. Nursing students and nurses should first understand the nursing professionalism that is necessary to become a nurse, which may be the first step in developing professionalism. Nursing students and nurses need to know the values that are necessary to practice the nursing and not have vague impressions. Some studies have shown that nursing students or nurses learn values and norms in informal trainings [ 93 ]. Therefore, this study suggests that the development of assessment tools for the knowledge dimension of professionalism is also necessary. Multidimensional evaluation tools are not available for nursing professionalism. Thus, clarifying the multidimensional nature of nursing professionalism will contribute to the development of multidimensional evaluation tools.

Moreover, understanding the dynamics of professionalism is helpful for cultivating nursing professionalism in stages and steps. Inquiries into medical professionalism should be integrated into the culture of social media interaction [ 94 ]. Nursing educators and managers should dynamically cultivate nursing professionalism in their interactions.

Differences in the connotation of nursing professionalism are noted in different cultures. This study suggests that the cultivation and evaluation of nursing professionalism need to consider the cultural attributes of different regions and countries.

Future research directions

• Exploring the antecedents of nursing professionalism can help schools or hospitals cultivate nursing professionalism and develop courses and specific measures.

The macro antecedents of nursing professionalism include culture and religion, and the micro antecedents include calling, autonomy, and personal characteristics. Some researchers have explored methods to cultivate nursing professionalism; for example, role modelling, feedback, group discussions, case-based discussions, reflection, holding ethical rounds, and reports potentially represent more effective methods [ 95 ]. Some researchers have tried to enhance professionalism through social media [ 96 ]. One of the findings this study is that nursing professionalism is complex and its cultivation difficult. Studies have shown that didactic lectures are ineffective for teaching professionalism [ 97 ]. The development of true nursing professionalism requires national advocacy and the immersion of a good professional environment that incorporates professionalism into daily nursing practice. Role modelling is considered an effective method for developing professionalism in nursing [ 98 ]. Therefore, this study suggest that studies should be actively conducted to deeply discuss the causes and processes affecting professionalism and to cultivate and intervene at macro and micro levels as well as the key time periods and populations that form professionalism to truly shape the formation of professionalism. Moreover, an environment for building professionalism [ 99 ] is very important. Williams [ 100 ] (2015) considered that the development of professionalism should begin as early as the first semester of an undergraduate nursing course. One of the themes of nursing students’ professional identity development is ‘doing-learning-knowing-speaking’. Students should develop professionalism in all these areas of nursing practice.

• The relationship between nursing professionalism and health outcomes or nurses’ human resources needs to be further studied.

Our research suggests that the ultimate goal of nursing professionalism is to serve patients with professional knowledge and special professional quality. The public has become increasingly aware of certain possibilities, limitations, and consequences of professionalism. COVID-19 significantly increased the discussion of professionalism and patient outcomes.

Improving professionalism has a positive impact on job satisfaction, professional quality of life, and the willingness to continue in the profession [ 101 , 102 , 103 ]. Therefore, it is important to improve support for nurses, create a good environment for professionalism, and establish a training system for professionalism, thus paving the way to enhance training in professionalism and create opportunities for nurses.

Implications for nursing management

In April 2020, the World Health Organization (2020) issued the First State of the World’s Nursing 2020 [ 104 ]. The report highlighted that nursing professionals are the largest occupational group in the health sector, numbering 27.9 million worldwide. Nurses spend more time with patients than any other health care professionals [ 105 ].

Worldwide, nursing professionalism is considered important and associated with expectations. This study clarifies the concept of nursing professionalism and contributes to a framework for developing a theoretical model as well as instruments to measure the concept. A conceptual model of nursing professionalism may increase nurse managers’ insight into nurses’ behaviours and values, creating a good working environment.

Nurse managers should integrate nursing professionalism into their philosophy, mission, and objectives and provide necessary resources, tools, and projects to develop professionalism among nurses. Nurses should cultivate professionalism to provide good nursing services to patients. Further research should explore the relationship between nursing professionalism and patient health outcomes and formulate effective training programs for professionalism.

Limitations

This conceptual analysis has some limitations. First, research on nursing professionalism published in English may be conducted in different countries and cultures. However, it is also necessary to obtain a more comprehensive and mature concept of the study of different national languages. Second, the lack of research on the combination of all elements of professionalism may lead to overestimation of the impact of these subelements on professionalism. Third, the concept analysis focused on the research process and the researchers’ perspectives, possibly reflecting a lack of other professional understandings of nursing professionalism in medical groups. In addition, the concept analysis included a risk of selection bias, extraction bias, and analysis bias because the study selection process, data extraction, and analysis were all conducted by two researchers. Despite these risk, the studies were all described accurately and systematically.

Nursing professionalism is one of the important foundations of clinical nursing. It is multidimensional, dynamic, and culture oriented. Based on the analysis, nursing professionalism has been defined as providing people care based on principles of professionalism, caring, and altruism. The definition, attributes, antecedents, consequences, and reference analysis of the experience of nursing professionalism determined in this study provide a theoretical basis for future research. This information can be used to evaluate nursing professionalism, develop assessment tools, or generate theory-based training courses and interventions.

Acknowledgements

The authors would like to thank Hui Yang for the great efforts made in designing the research. We would like to thank linbo Li for providing valuable suggestions for this study.

Author’s contributions

Hl C and HY made substantial contributions to conception and design. HL C, YJ S, YM W, YF D Collectioned and analysis the data. Hl C was a major contributor in writing the manuscript. XY H, YJ C, QH W revised it critically for important intellectual content. All authors read and approved the final manuscript.

Postgraduate Education Innovation Program of Shanxi Province in China (No. 2020BY067).

Availability of data and materials

Declarations.

Our study was approved by the ethical committee of The First Hospital of Shanxi Medical University,Shanxi, China,(approval no. 2020K061).

Not applicable.

There is no conflict of interest in this study.

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Contributor Information

Huili Cao, Email: moc.qq@2855838711 .

Yejun Song, Email: moc.qq@9109580601 .

Yanming Wu, Email: moc.621@6927myw .

Yifei Du, Email: moc.qq@3283291401 .

Xingyue He, Email: moc.361@320eHeuygnix .

Yangjie Chen, Email: moc.qq@8011856511 .

Qiaohong Wang, Email: [email protected] .

Hui Yang, Email: moc.361@0202iuhyq .

Trump and Allies Forge Plans to Increase Presidential Power in 2025

The former president and his backers aim to strengthen the power of the White House and limit the independence of federal agencies.

Donald J. Trump intends to bring independent regulatory agencies under direct presidential control. Credit... Doug Mills/The New York Times

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By Jonathan Swan Charlie Savage and Maggie Haberman

• Published July 17, 2023 Updated July 18, 2023

Donald J. Trump and his allies are planning a sweeping expansion of presidential power over the machinery of government if voters return him to the White House in 2025, reshaping the structure of the executive branch to concentrate far greater authority directly in his hands.

Their plans to centralize more power in the Oval Office stretch far beyond the former president’s recent remarks that he would order a criminal investigation into his political rival, President Biden, signaling his intent to end the post-Watergate norm of Justice Department independence from White House political control.

Mr. Trump and his associates have a broader goal: to alter the balance of power by increasing the president’s authority over every part of the federal government that now operates, by either law or tradition, with any measure of independence from political interference by the White House, according to a review of his campaign policy proposals and interviews with people close to him.

Mr. Trump intends to bring independent agencies — like the Federal Communications Commission, which makes and enforces rules for television and internet companies, and the Federal Trade Commission, which enforces various antitrust and other consumer protection rules against businesses — under direct presidential control.

He wants to revive the practice of “impounding” funds, refusing to spend money Congress has appropriated for programs a president doesn’t like — a tactic that lawmakers banned under President Richard Nixon.

He intends to strip employment protections from tens of thousands of career civil servants, making it easier to replace them if they are deemed obstacles to his agenda. And he plans to scour the intelligence agencies, the State Department and the defense bureaucracies to remove officials he has vilified as “the sick political class that hates our country.”

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