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    EDUCATION
    September 14, 2020

    What Are Nursing Theories?

    By: Kathleen Gaines MSN, BA, RN, CBC

    Nursing theories were first identified by Florence Nightingale, the founder of modern nursing, and were rooted in nursing education. Her 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: 

    • Fresh air 
    • Pure water
    • Efficient drainage 
    • Cleanliness or sanitation
    • Light or direct sunlight

    These factors were essential to decrease the spread of contagious diseases and decrease 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 is increased. 

    What is Nursing Theory?

    Theory is defined as “a belief, policy, or procedure proposed or followed as the basis of action.” Nursing theory is "a creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomena". Nursing theories provide 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.

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    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 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. 

    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, 

    1. Person
    2. Environment
    3. Health
    4. Nursing

    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. 

    1. Person

    Person (also referred to as Client or Human Beings) 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.

    3. Health

    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.

    4. Nursing

    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. 

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    Nursing Theory in Practice

    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. 

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