Evolution of Nursing Theories

What Are Nursing Theories?

Nursing theories offer frameworks that give shape to the scope of nursing care and practice. These consist of concepts, such as collaboration or respect, descriptions of relationships, and definitions. Nursing theories guide nurses in their practice and give them a foundation to make clinical decisions. They also offer a systematic approach to developing key practices that promote quality patient care.

To get a stronger grasp of what nursing theories are, explore how they:

• Impact a nurse’s daily work
• Set nursing apart from other health care disciplines
• Shape nursing strategies

How Nursing Theories Impact What Nurses Do

Nursing theories impact what nurses do daily. By defining characteristics of the nurse-patient relationship, nursing theories shape how nurses interact with patients. They help nurses:

• Identify who needs nursing care
• Articulate what they do for patients and why they do it
• Determine what information to gather
• Understand and assess health situations
• Explain and anticipate patient responses
• Pinpoint actual and possible issues that need consideration
• Map out objectives and expected outcomes
• Determine which interventions to deliver
• Establish best practices
• Select productive areas for research

Nursing theories help inform every interaction between nurses and their patients. As lenses that color and shape how nurses interpret situations, nursing theories influence the decisions nurses make and the relationships they form with patients.

For example, nurses who root their practice in a theory emphasizing patient autonomy will likely encourage certain types of participation from patients and may pay extra attention to patient education.

Evolution of Nursing Theories

Early Theories (1800s-1950s)

1. Florence Nightingale’s Environmental Theory (1860)
2. Clara Barton’s Humanitarian Theory (1881)
3. Dorothea Orem’s Self-Care Deficit Theory (1940s)

Mid-20th Century Theories (1950s-1970s)

1. Hildegard Peplau’s Interpersonal Relations Theory (1952)
2. Virginia Henderson’s Need Theory (1955)
3. Betty Neuman’s Systems Model (1972)
4. Jean Watson’s Theory of Human Caring (1979)

Late 20th Century Theories (1980s-1990s)

1. Patricia Benner’s Novice to Expert Theory (1984)
2. Rosemarie Parse’s Human Becoming Theory (1987)
3. Margaret Newman’s Health as Expanding Consciousness Theory (1986)
4. Martha Rogers’ Science of Unitary Human Beings (1990)

21st Century Theories (2000s-present)

1. Deborah Gardner’s Synergy Model (2002)
2. The American Nurses Association (ANA) Social Policy Statement (2010)
3. The Nursing Theory of Bureaucratic Caring (2013)

Concepts and Influences of Nursing Theories

1. Humanism
2. Holism
3. Systems thinking
4. Interpersonal relations
5. Self-care
6. Cultural competence
7. Evidence-based practice

What Are the Different Types of Nursing Theories?

Nursing theories allow nurses to explain how they care for patients and provide reasons and evidence for their methodologies. Each one of the various types of nursing theories has a separate purpose and typical components.

Grand Nursing Theories

Grand nursing theories offer a broad framework for addressing complex ideas and concepts about nursing. These types of nursing theories set forth abstract and general ideas about the different components of the nursing metaparadigm: person, nursing, environment, and health.

Grand nursing theories can guide research. However, due to their broad scope, they don’t guide particular nursing interventions and aren’t meant for empirical testing. Instead, they provide a wide-ranging perspective on what nursing looks like in different situations and environments.

Typically, grand nursing theories originate from:

• A theorist’s own nursing experience
• Conceptual models
• Nursing philosophies

Middle-Range Nursing Theories

Unlike grand nursing theories and their broad perspectives, middle-range nursing theories focus their lenses more narrowly, making more concrete connections to nursing practice. These nursing theories present precise concepts and propositions addressing specific areas of nursing. They typically aim to:

• Answer specific questions about nursing practice
• Describe and predict nursing practice phenomenon

Due to their more limited scope and less abstract nature, middle-range nursing theories can be tested. Grand nursing theorists typically use grand nursing theories as the basis of their work. However, the ideas in middle-range nursing theories may also come from nursing experience or research.

Ethical Theories

Ethical theories in nursing address the dilemmas that arise in health care and offer guidance about making good judgments. They also explore what integrity looks like and the ethical obligations of those in the nursing profession.

These theories may consider how to address ethical issues in nursing as they relate to:

• Advances in technology
• Changes in society
• Health policy
• Healthy nursing work environments

Ethical theories in nursing may stem from philosophies in other fields and experience in nursing practice.

Change Theories

Change theories in nursing explore ways to make planned shifts in nursing services. Nurse leaders and others use these theories to help them drive changes within nursing practices. These changes can encompass long-term broad initiatives or more simple adjustments to established processes in a nursing environment.

Change theories often consider the forces that drive and resist change and how to handle each. Typically, these theories consist of various stages or steps leading to the successful implementation of change projects.

Influential Nursing Theorists & and Summary of their Theory

1.Florence Nightingale’s Environmental Theory (1860)

• Focus: Environmental factors influencing patient health
• Key concepts: Ventilation, sanitation, lighting, noise, and cleanliness
• Application: Hospital design, infection control, and patient safety

2.Virginia Henderson’s Need Theory (1955)

• Focus: Patients’ basic needs and nurse-patient interaction
• Key concepts: 14 basic needs (e.g., breathing, eating, sleeping)
• Application: Individualized care planning, patient-centered care

3.Dorothea Orem’s Self-Care Deficit Theory (1940s)

• Focus: Patients’ ability to perform self-care activities
• Key concepts: Self-care, self-care deficit, nursing systems
• Application: Health promotion, disease prevention, and patient education

4.Hildegard Peplau’s Interpersonal Relations Theory (1952)

• Focus: Nurse-patient relationships and communication
• Key concepts: Interpersonal relations, therapeutic relationship
• Application: Building trust, empathy, and effective communication

5.Jean Watson’s Theory of Human Caring (1979)

• Focus: Caring and compassion in nursing practice
• Key concepts: Caritative factors, transpersonal caring
• Application: Holistic care, spiritual care, and end-of-life care

6.Betty Neuman’s Systems Model (1972)

• Focus: Patient as a system, stress, and coping
• Key concepts: Primary prevention, secondary prevention, tertiary prevention
• Application: Stress management, health promotion, and disease prevention

7.Patricia Benner’s Novice to Expert Theory (1984)

• Focus: Nurse professional development and expertise
• Key concepts: Novice, advanced beginner, competent, proficient, expert
• Application: Nursing education, mentorship, and professional development

8.Rosemarie Parse’s Human Becoming Theory (1987)

• Focus: Human experiences, meaning, and quality of life
• Key concepts: Human becoming, Parse’s principles
• Application: Holistic care, patient-centered care, and quality of life

Nursing Theories in Practice

1. Patient-Centered Care: Virginia Henderson’s Need Theory, Jean Watson’s Theory of Human Caring
2. Health Promotion: Dorothea Orem’s Self-Care Deficit Theory, Betty Neuman’s Systems Model
3. Holistic Care: Martha Rogers’ Science of Unitary Human Beings, Rosemarie Parse’s Human Becoming Theory
4. Nurse-Patient Relationships: Hildegard Peplau’s Interpersonal Relations Theory
5. Professional Development: Patricia Benner’s Novice to Expert Theory

Clinical Applications

1. Critical Care: Betty Neuman’s Systems Model, Deborah Gardner’s Synergy Model
2. Pediatrics: Virginia Henderson’s Need Theory, Dorothea Orem’s Self-Care Deficit Theory
3. Gerontology: Jean Watson’s Theory of Human Caring, Rosemarie Parse’s Human Becoming Theory
4. Mental Health: Hildegard Peplau’s Interpersonal Relations Theory
5. Community Health: Betty Neuman’s Systems Model

Education and Research

1. Curriculum Development: Patricia Benner’s Novice to Expert Theory
2. Research Methodologies: Rosemarie Parse’s Human Becoming Theory
3. Evidence-Based Practice: Deborah Gardner’s Synergy Model
4. Nursing Informatics: Betty Neuman’s Systems Model
5. Health Policy: Jean Watson’s Theory of Human Caring

Case Studies

1. Patient with Chronic Illness: Dorothea Orem’s Self-Care Deficit Theory
2. Family Coping with Loss: Hildegard Peplau’s Interpersonal Relations Theory
3. Community Disaster Response: Betty Neuman’s Systems Model
4. Patient with Mental Health Issues: Jean Watson’s Theory of Human Caring
5. New Graduate Nurse: Patricia Benner’s Novice to Expert Theory

REFERENCES

1. Virginia Henderson—Nursing theorist. (n.d.). Nursing Theory. https://nursing-theory.org/nursing-theorists/Virginia-Henderson.php
2. Von Bertalanffy, L. (1972). The history and status of general systems theory. The Academy of Management Journal, 15(4), 407–426.
3. Wakefield, M. K., Williams, D. R., Le Menestrel, S., & Lalitha Flaubert, J. (Eds.). (2021). The future of nursing 2020–2030: Charting a path to achieve health equity . National Academy of Medicine. https://nap.nationalacademies.org/catalog/25982/the-future-of-nursing-2020-2030-charting-a-path-to
4. Watson Caring Science Institute. (n.d.a). Jean Watson, PhD, RN, AHN-BC, FAAN, LL (AAN). https://www.watsoncaringscience.org/jean-bio/
5. Watson Caring Science Institute. (n.d.b). Watson’s caring science & human caring theory. https://www.watsoncaringscience.org/jean-bio/caring-science-theory/
6. Western Governor’s University. (2021, September 20). Understanding nursing theories. https://www.wgu.edu/blog/understanding-nursing-theories2109.html#close
7. Younas, A., & Quennell, S. (2019). Usefulness of nursing theory-guided practice: An integrative review. Scandinavian Journal of Caring Sciences, 33(3), 540–555. https://doi.org/10.1111/scs.12670

Stories are the threads that bind us; through them, we understand each other, grow, and heal.

JOHN NOORD

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