The overarching goal of nursing theories is to define what nursing is, how and why nurses do what they do, and to provide a framework for making decisions. This chapter will review the different levels of nursing theory, evaluate the assumptions made by different nursing theorists, and learn how to apply nursing theory to practice situations.

The primary purpose of creating nursing theories are to guide nursing practice. Nursing theory can be integrated into any nursing setting, such as a hospital or community-based clinic. Theories can also be integrated into specific clinical settings, such as labor and delivery. Theories are beneficial to nursing practice in numerous ways. When nurses incorporate theory into personal nursing practice, it allows for creativity and implementation of innovative interventions. Many nursing behaviors are based on theory, such as caring and patient education. Nursing theory helps nurses organize their care

The first step to understanding nursing theory is to understand the attributes of a theory. The list below shares the attributes found in every nursing theory, and while uncommon, some theories may not share assumptions depending on the year they were created.

Theory Attributes

• Building block of all theories
• Components of every theory
• Variables that are tested during research (Mintz-Binder, 2019)
• For example, anxiety is a concept, which may or may not be easy to identify. Though anxiety can be identified through behaviors or symptoms. A patient who has anxiety may exhibit rapid breathing, palpitations, or irritation.

• Weaves together concepts to describe their relationships with each other
• Explains the relationships among the concepts
• Explains how these relationships interrelate with each other (Mintz-Binder, 2019)

• A diagram of concepts and their relationship with each other (Morse, 2017)

• Used for conducting research or the underpinning of policy
• Represents what the researcher thinks will happen in the study based on the chosen theory
• Way of organizing the concepts (called variables in research) and their relationship with each other
• By creating a model, a framework visually illustrates how a research study will be conducted, based on the theory (Morse, 2017)

• Premise without proof
• Something usually unspoken, believed to be the truth, though no hard proof
• Something taken for granted (Morse, 2017)

• Statements that link the concepts together
• Beliefs about the theory shared as statements
• Explains the reasoning for the relationship between the concepts (Mintz-Binder, 2019)

• A process by which an academic discipline communicates its fundamental characteristics
• All nursing theories address each concept by defining the concept and applying it to concepts or tenets of the theory
• Nursing metaparadigm consists of four concepts:
  1. Person: The focus of nursing care
     • Example: Watson’s Theory of Human Caring views the patient holistically, while Johnson’s Behavioral System model views the person through a lens of seven different subsystems
  2. Health: Depending on the theorist, health and illness can be perceived as two separate constructs (or concepts) or health and illness is viewed as a continuum (changes slowly over time)
     • Example: King’s Theory of Goal Attainment views health a functional state throughout a person’s life (a continuum), while Neuman’s Systems model views health and illness as two separate constructs
  3. Nursing: A process whereby nurses provide care. The process changes based on the theorist.
     • Example: Watson’s Theory of Human Caring views nursing as provision of care using the 10 carative factors whereas Orem’s Self-Care Deficit theory where nurses’ focus of care is assisting patients to meet their self-care needs
  4. Environment: the person’s environment within a global context (Mintz-Binder, 2019)

(Karp, 2019)

Two Types of Nursing Theories

Nursing theories are differentiated between grand and middle-range theories. Theories are placed in one of the two categories based on the following:

• Relevancy to nursing situations and clinical settings
• Broad or narrow focus
• Abstract or concrete concepts
• Detailed descriptions (Mintz-Binder, 2019)

Grand Theory

• Broad focus
• Abstract concepts and descriptions
• Represents ideas and thinking about nursing as a whole (Mintz-Binder, 2019)
  • Examples:
    • Johnson’s Behavioral System’s model
    • Roy’s Adaptation model
    • Rogers’ Science of Unitary Beings
    • Orem’s Self-Care Deficit Nursing theory
    • Watson’s Theory of Human Caring

Middle-Range Theory

• Created in the 1990s
• Narrower focus, more concrete, specific
• Focused on a clinical specialty
• Created with less depth and detail than grand theories (Mintz-Binder, 2019)
  • Examples:
    • Kolcaba’s Comfort theory
    • Pender’s Health Promotion model
    • Swanson’s Theory of Caring
    • Leininger’s Culture Care Theory
    • Peplau’s Theory of Interpersonal Relations

Nursing Theory and Research

The following is a basic introduction to research and the use of a theoretical framework using nursing theory. Nursing research studies are often designed using a theoretical framework. This means a nursing theory (that aligns with the focus of the study) is chosen as the theoretical framework. Research studies are conducted to offer new knowledge and generate new evidence-based interventions.

For example, Meleis’ Transitions Theory is focused on the different transitions that occur in people’s lives, how people are supported during a role change and how they understand the transition (Meleis, Sawyer, Im, Messias, & Schumacher, 2000). A researcher who wants to understand the transition for a woman giving birth, becoming a mother for the first time, may use Meleis’ Transitions Theory as a theoretical framework to guide the design of the study.

Research studies may create models to design the study. The model incorporates all the major concepts of the theory. The major concepts of each theory are the core elements of each theory.

Nursing Theory for Policy Creation

As discussed above, nursing theorists create new knowledge by designing and testing theories through conducting research. The knowledge gleaned from research is used to create policies that provide nursing practice with best practice standards. Since there are many types of nursing theories and models, with a varying focus, different types of policies can be created based on many different nursing theories. The examples below demonstrate how knowledge gathered from nursing theory can guide policy creation, and in turn, positively impact nursing practice:

• Pain management: the Acute Pain Management Theory offers guidance on the role of the patient participating in pain management, such balancing the side effects of pain medication and reduced pain.
• Staffing: when nurse-patient ratios are based on acuity, the Self-care Deficit Nursing Theory helps nurses determine the number of nurses needed for staffing based on patients’ level of self-care. More than one theory can be used to assist with creating a ratio.
• Health Promotion: concepts of Pender’s Health Promotion Model offer knowledge about patient behaviors that are associated with engaging in health-promotion activities.

(Karp, 2019)

Nursing Theory and Personal Nursing Philosophy

Nursing theory is a vital component of nursing practice and can positively impact practice especially when part of a nurse’s personal nursing philosophy. Nurses can choose one or more theories that align to their practice and add additional statements about the theory to their nursing philosophy. For example, nurses working hospice may choose Watson’s Theory of Human Caring. Applying the caritas #4, “Developing and sustaining a helping-trusting, authentic, caring relationship” (Watson, 2008, p. 31) can help the nurse instill certain attributes during interactions with the patient and family.