Nursing theory provides a framework for nurses by defining concepts, describing relationships between variables, and guiding practice, research, education and communication. There are four levels of theory from metatheory to practice theory. Common nursing theories were developed to explain phenomena like human caring, adaptation to illness, and achieving self-care. Theories influence assessment, intervention, and evaluation in nursing and help define the profession.

1. UNDERSTANDING THE WORK OF NURSE THEORISTS
…………….. A Creative Beginning
Theories of Nursing
• Theory is "an internally consistent group of relational statements (concepts,
definitions and propositions) that present a systematic view about a
phenomenon and which is useful for description, explanation, prediction
and control".
• Theories are road maps that provide a framework for selecting and
organizing information:
o What to ask
o What to observe
o What to focus on
o What to think about
• Nursing theory is an organized and systematic articulation of a set of
statements related to questions in the discipline of nursing.
Uses of Theory
Theory is used to:
• Describe
• Explain
• Predict
• Prescribe
Uses of Nursing Theory
• Define relationships among the variables of a given field of inquiry
• Guide research, practice and communication
• Allow the prediction of the consequences of care
• Allow the prediction of a range of patient responses
Levels of Theory
There are four levels of theory
• Metatheory
• Grand Theory
• Middle Range Theory
• Practice Theory
Types of Theory
In Nursing there are four types of theories:
• Needs
• Interaction
• Outcome
• Humanistic
Practice value of theory
• Enhances understanding and explanation for events
• Influence our behavior.
• Makes to think differently about a problem or a situation

2. • Helps to try new approaches or altering behavior.
• We can gain a new perspective of events
• Basis for challenge of its speculative tenets or propositions
• Challenges subsequent discovery of new ideas or knowledge that might
explain and predict events not yet understood
In practice
• Assist nurses to describe, explain, and predict everyday experiences.
• Serve to guide assessment, intervention, and evaluation of nursing care.
• Provide a rationale for collecting reliable and valid data about the health
status of clients, which are essential for effective decision making and
implementation.
• Help to establish criteria to measure the quality of nursing care
• Help build a common nursing terminology to use in communicating with
other health professionals. Ideas are developed and words defined.
• Enhance autonomy (independence and self-governance) of nursing by
defining its own independent functions.
In education
• Provide a general focus for curriculum design.
• Guide curricular decision making
In research
• Offer a framework for generating knowledge and new ideas.
• Assist in discovering knowledge gaps in specific field of study.
• Offer a systematic approach to identify questions for study, select variables,
interpret findings, and validate nursing interventions.
An illustration……
The germ theory
• Explains the phenomenon of disease transmission
• Means of speculative explanation and prediction of certain observable events
• Allows us to effectively function to prevent transmission of communicable
disease.
• Viable basis upon which to make decisions about how to prevent certain
illnesses.
• There are phenomena we do not understand that are related to germ
transmission,
• Example-the communicability of cancer.
"Nursing Practice."
All experiences and events a practicing nurse encounters in the process of
providing nursing care.
Events…..
• Some may be experienced by the client,
• Others by the nurse
• Some may be observed in the environment
• May be observed in the nurse-client interaction.
• In situations of daily work or living,

3. …………..but as long as they are observable during the process of providing direct
nursing care, they are considered part of nursing practice.
Approaches to inter relationships between practice and theory
• How nursing practice contributes to the process of theory development..
• How theory contributes to nursing practice…
Contribution of practice to theory development
• Theory development within nursing occurs in the context of practice.
• Two activities contribute significantly to the overall process of developing
theory in nursing.
• Concept analysis and
• Practical validation of theory.
Concept analysis
• Identify and verify abstract concepts
• "what events in practice can be linked with abstract concept x"
• Application of theory in practice
• Nursing process operation of analysis of assessment data.
• Used as scientific rationale supporting judgments in nursing care plans.
Concepts
• Concepts may be (a) readily observable, or concrete, ideas such as
thermometer, rash, and lesion; (b) indirectly observable, or inferential,
ideas such as pain and temperature; or c) non-observable, or abstract,
ideas such as equilibrium, adaptation, stress, and powerlessness
• nursing theories address and specify relationships among four major
abstract concepts referred to as the metaparadigm of nursing.
• Four concepts are considered to be central to nursing :
• Person or client, the recipient of nursing care (includes individuals, families,
groups, and communities).
• Environment, the internal and external surroundings that affect the client.
This includes people in the physical environment, such as families, friends,
and significant others.

4. • Health, the degree of wellness or well-being that the client experiences.
• Nursing, the attributes, characteristics, and actions of the nurse providing
care on behalf of, or in conjunction with, the client
Nightingale’s environmental theory
• "the act of utilizing the environment of the patient to assist him in his
recovery"
• She linked health with five environmental factors :
• Pure or fresh air
• Pure water
• Efficient drainage
• Cleanliness
• Light, especially direct sunlight
• Deficiencies in these five factors produced lack
• Of health or illness.
Peplau’s interpersonal relations model
• Nurses enter into a personal relationship with an individual when a felt need
is present
Henderson’s definition of nursing
• Henderson conceptualized the nurse’s role as assisting sick or well
individuals to gain independence in meeting 14 fundamental needs
(Henderson)
• Breathing normally
• Eating and drinking adequately
• Eliminating body wastes
• Moving and maintaining a desirable position
• Sleeping and resting
• Selecting suitable clothes
• Maintaining body temperature within normal range by adjusting clothing and
modifying the environment.
• Keeping the body clean and well groomed to protect the integument.
• Avoiding dangers in the environment and avoiding injuring others
• Communicating with others in expressing emotions, needs, fears, or
opinions
• Worshipping according to one’s faith
• Working in such a way that one feels a sense of accomplishment
• Playing or participating in various forms of recreation.
• Learning, discovering, or satisfying the curiosity that leads to normal
development and health, and using available health facilities
Roger’s science of unitary human beings
• She states that humans are dynamic energy fields in continuous exchange
with environmental fields, both of which are infinite.
• Nurses applying Roger's theory in practice (a) focus on the person’s
wholeness, (b) seek to promote symphonic interaction between the two
energy fields (human and environment) to strengthen the coherence and

5. integrity of the person, c) coordinate the human field with the
rhythmicities of the environmental field, and (d) direct and redirect
patterns of interaction between the two energy fields to promote maximum
health potential
Orem’s general theory of nursing
• Orem’s self-care deficit theory explains not only when nursing is needed but
also how people can be assisted through five methods of helping: acting or
doing for, guiding, teaching, supporting, and providing an environment
that promotes the individual’s abilities to meet current and future
demands.
King’s goal attainment theory
• King’s theory offers insight into nurses’ interactions with individuals and
groups within the environment. It highlights the importance of client’s
participation in decision that influence care and focuses on both the
process of nurse-client interaction and the outcomes of care.
Neuman’s systems model
• The model is based on the individual’s relationship to stress, the reaction to
it, and reconstitution factors that are dynamic in nature.
• Betty Neuman's model of nursing is applicable to a variety of nursing
practice settings involving individuals, families, groups, and communities.
Roy’s adaptation model
• Roy focuses on the individual as a biopsychosocial adaptive system that
employs a feedback cycle of input (stimuli), throughput (control
processes), and output (behaviors or adaptive responses).
Watson’s human caring theory
• Jean Watson (1979) believes the practice of caring is central to nursing; it is
the unifying focus for practice.
• Nursing interventions related to human care are referred to as carative
factors.
• Watson’s theory of human caring has receiving worldwide recognition and is
a major force in redefining nursing as a caring-healing health model.
Parse’s human becoming theory
• Parse’s model of human becoming emphasizes how individuals choose and
bear responsibility for patterns of personal health.
Leininger’s cultural care diversity and universality theory
• She emphasizes that human caring, although a universal phenomenon,
varies among cultures in its expressions, processes, and patterns; it is
largely culturally derived.
Orem’s general theory of nursing
Assessing
• Involves collecting data about the client’s capacities (knowledge, skills, and
motivation) to perform universal, developmental, and health-deviation
self-care requisites. Determine self-care deficits.
Diagnosing
• Stated in terms of the client’s limitations for maintaining self care (a deficit
in self-care agency)
Planning

6. • Involves considering and designing, with the client’s participation, an
appropriate nursing system (wholly compensatory, partially compensatory,
supportive-educative, or a mix) that will help the client achieve an optimal
level of self care
Implementing
• Assisting the client
Evaluating
• Determining the client’s level of achievement
References
1.Phipps J Wilma, Sands K Judith. Medical Surgical Nursing: concepts & clinical
practice.6th edition. Philadelphia. Mosby publications. 1996.
2.Black M. Joice, Hawks hokanson Jane. Medical Surgical Nursing: Clinical
Management for positive outcomes. St Lois, Missouri. 2005.
3.Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.).
Mosby, Philadelphia, 2002
4.Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd
Ed. Mosby, Philadelphia, 2002.

7. • Involves considering and designing, with the client’s participation, an
appropriate nursing system (wholly compensatory, partially compensatory,
supportive-educative, or a mix) that will help the client achieve an optimal
level of self care
Implementing
• Assisting the client
Evaluating
• Determining the client’s level of achievement
References
1.Phipps J Wilma, Sands K Judith. Medical Surgical Nursing: concepts & clinical
practice.6th edition. Philadelphia. Mosby publications. 1996.
2.Black M. Joice, Hawks hokanson Jane. Medical Surgical Nursing: Clinical
Management for positive outcomes. St Lois, Missouri. 2005.
3.Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.).
Mosby, Philadelphia, 2002
4.Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd
Ed. Mosby, Philadelphia, 2002.