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Nursing Theories and Models

Nursing is a profession with roots at the beginning of civilization. While nursing has changed dramatically over the centuries, it remains centered on caring for those who are suffering from illness or disease. Famous nurses in history have helped to change and mold the nursing profession into its current form, both through their actions and through the formation of nursing theories. Nursing theories help to guide nursing practice, providing a framework of principles that nurses use to care for patients. Nursing theories have been formed through reflection and observation, nursing research and application of scientific principles.

Virginia Henderson is one of the most famous nurses of the twentieth century. Among many significant nursing accomplishments, she also formulated a nursing theory or concept to further define the role of nurses. In 1966, she conceptualized the role of the nurse as "to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge". This definition of Need Theory was further defined with fourteen components: nine physiological, two psychological, two sociological and one spiritual and moral. She believed the nurse's role as substitutive, supplementary, and complementary. The nurse's goal should be to help the person become as independent as possible.

Helen C. Erickson is the primary author of the Modeling and Role Modeling Theory. She based her theory on her clinical experiences, with input from Evelyn M. Tomlin, and Mary Anne P. Swain. According to Erickson's theory, there are five goals of nursing practice: build trust, promote patient's positive orientation, promote patient's control, affirm and promote patient's strength and set mutual, health-directed goals. The theory also seeks to outline commonalities and differences among people. Recognizing commonalities and differences helps the nurse understand the patient's perspective of his or her own world.

Dorothy E. Johnson proposed her Behavioral System Model in 1968. She believed that nursing should focus on the client, not on the disease or illness. She postulated that healthy people are in "equilibrium" and that illness and disease cause an imbalance in effective behavioral functions. There are seven different behavioral subsystems. The role of the nurse in the Behavioral System Model is to restore equilibrium. She defined nursing as "an external regulatory force which acts to preserve the organization and integration of 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".

Imogene King authored the Theory of Goal Attainment. She believed that nurses and clients communicate to share information, form goals together and then take action to meet those goals. She defined nursing as the "process of action, reaction and interaction by which nurse and patient share information about their perception in nursing situations". Within the Theory of Goal Attainment are three interacting systems: the personal system, the interpersonal system, and the social system. These systems are further defined with individual concepts to guide nurses in practice.

Betty Neuman penned "The Neuman Systems Model", her first book, in 1982, though she started to formulate her theory in 1970. Her Systems Theory follows a universal concept, addressing nursing practice on an international level. She referred to patients as clients, and felt they should be treated as people, not as a disease or illness. Her theory presented a holistic view of the client and focused on the client's relationship to stress and his or her reaction to stress and dynamic reconstitution factors. The model highlights three levels of prevention in order protect against stressors.

Ida Jean Orlando recognized that nursing care is a dynamic process and there should be a method to refine and reformulate nursing care plans if needed. Her theory, the Deliberative Nursing Process, allows for easy adaptations to a nursing care plan should the need occur. The theory encompasses five stages of the nursing process: assessment, diagnosis, planning, implementation, and evaluation. Using these tools, the theory guides nurses to interpret patient behavior and determine the needs of the patient. Once these needs are determined, the goal of nurses is to act deliberately to meet the patient's needs. As the patient progresses, the nursing plan can be modified allowing for flexibility in case of complications.

Dorothea E. Orem believed that patients should be encouraged to be independent and proficient in self-care. The Self-Care Deficit Nursing Theory, also known as the Orem Model of Nursing, postulates that patients want to care for themselves and if allowed to do so, will recover more quickly and holistically. It is known as a grand nursing theory, meaning that it can be applied to all aspects of nursing practice. It is particularly helpful in the rehabilitation setting where patients are preparing to leave the hospital setting after a prolonged stay and will be starting to perform more self-care functions. According to Orem, nursing is art, a helping service, and a technology. Patients are human beings who are the focus of nurses only when there is a deficit in self-care abilities.

Hildegard Peplau was greatly affected by her experience as a child during the 1918 flu epidemic, which in turn impacted her nursing practice. Her Theory of Interpersonal Relationships postulates that the nurse-patient relationship is central to nursing care. Nurses that understand this important relationship that can provide more effective patient care. The theory centers on seven different nursing roles: the stranger role, the resource role, the teaching role, the counseling role, the surrogate role, the active leadership role and the technical expert role. Nurses apply these roles based on the situation, ensuring that patient receive effective nursing care.

Isabel Hampton Robb is known as the founder of modern nursing. She laid the foundation for future nursing theories with her education reforms. She developed and implemented a grading system for nurses, requiring them to prove proficiency prior to being awarded a degree or diploma. She advocated for improvement in nursing education which lead to better patient care and better prepared graduate nurses. Her reforms are still widely used in nursing education today.

Sister Callista Roy recognized that nursing is not an exact science as each patient and situation is different. She believed that nursing practice needs to adapt in order to best care for patients. She formulated the Adaptation of Nursing theory which approaches the patient from a holistic perspective. The theory centers on three components: human being, adaptation and nursing. She believed the goal of nursing is facilitate adaptation during both health and illness. Nurses can promote adaptation by making adjustments to the nursing care plan including manipulation of the environment or patient system.

Nursing at its core is based on caring and compassion. Jean Watson recognized the importance of caring and its impact on patient care. She authored the Philosophy and Science of Caring, emphasizing a holistic approach patient care. She believes that caring is essential to nursing care and resulted in improved patient outcomes. Her nursing process takes cues from the traditional scientific process; prompting nurses assess, observe, review and hypothesize. The four major concepts of the theory are human being, health, environment/society, and nursing. Caring is further defined by Watson through ten carative factors.

Martha E. Rogers looked at patients as whole people that cannot be divided, whom she defined as "unitary human beings". These "unitary human beings" interact with and become one with the environment, which is also indivisible. Her theory, the Science of Unitary Human Beings, teaches that nurses must combine art and science to effectively care for patients. They must take into account both the whole person and the whole environment when formulating a nursing care plan. In Roger's theory, health and illness are on a continuum and are indicative of the patient's health potential.

Margaret A. Newman expanded on Roger's Science of Unitary Human Beings theory, taking into account those patients who cannot escape disease and illness. Her theory, Health as Expanding Consciousness, claims that all people, regardless of disease severity or hopeless situation, are expanding their consciousness, finding meaning in life and forming relationships with other people. The theory takes into consideration time, space and movement and their relationship to patients and disease. She believed nurses should search for patterns of individual patients and assist people to get in touch with their own pattern of expanding consciousness.

Fay Abdellah believed that nursing should have a patient-centered approach. Abdellah was an accomplished nurse, becoming the first nurse and first woman to serve as a Deputy Surgeon General. In her theory, Twenty-one Nursing Problems, she explained, "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". Originally developed to guide nursing care in the hospitals, it can also be applied to the community setting. She identifies ten steps to identify the patient's problem and eleven nursing skills that can be used to address the problem.

Phil Barker is an accomplished British nurse with a special interest in psychiatric nursing. With over 40 years in the psychiatric field, he used his experience and expertise to co-author the Tidal Model of nursing. The Tidal Model of nursing is most commonly used in the mental health setting. The theory takes its cues from nature, recognizing that health and illness are fluid, and that life is a journey taken on an ocean of experience. Water, as a metaphor for inevitable change, is a common theme through the model. It also emphasizes the need for nurses to adapt to a patient's changing health status.

Lydia E. Hall was a nurse with a professional background in psychiatry, nursing education, clinical nursing and research. She formed the Care, Cure, Core Theory of Nursing, also known as the "Three C's of Lydia Hall". The theory consists of the three "C's" within interconnected, yet independent circles. The three circles are meant to be viewed as interacting parts that function together. It also encourages nurses to approach patients as a whole, rather than in parts.

Katharine Kolcaba emphasizes the importance of caring in nursing. She believes the best way to help patients is by caring for them and making them comfortable. In her theory, the Comfort Theory of Nursing, comfort exists in three manifestations: relief, ease, and transcendence. These three forms of comfort are applied by nurses in four different situations: physical, psychospiritual, environmental, and sociocultural. By using this theory, nurses can properly and effectively care for and comfort their patients which in turn will aid in the patient's healing and recovery.

Madeliene Leininger recognized the importance of viewing the patient from a holistic perspective. Published in 1991, the Transcultural Nursing theory takes a patient's culture and cultural background into account when approaching nursing care. In order to provide culturally competent care, she outlined three nursing actions: cultural preservation, cultural care accommodation, and cultural care. She also encourages nurses to do self-reflection, identifying his or her own cultural values and beliefs. Her theory has continued to evolve over time and transcultural nursing is now its own subspecialty of nursing practice.

Ramona Mercer's strong nursing background in pediatrics and maternal-child nursing guided her to develop the Maternal Role Attainment Theory. She noted the importance of the mother-child relationship and felt that nurses should help to foster and facilitate the health of the relationship. This theory is most applicable to nursing care before, during and after pregnancy. Mercer outlines four stages to attainment including the anticipatory stage, the formal stage, the informal stage and the personal stage. Maternal Role Attainment Theory teaches that development of the maternal-child relationship is a process that occurs over time.

Rosemarie Rizzo Parse is a visionary nurse with accomplishments in nursing theory, research, education, and practice. She developed the Human Becoming Theory of Nursing and founded the Institute of Human Becoming. First introduced in 1981, it centers on three themes: meaning, rhythmicity, and transcendence. The theory emphasizes the importance of nurses understanding the patient's quality of life from the patient's perspective. Understanding how a patient experiences his or her environment allows the nurse to form a stronger bond with the patient, rather than focusing on fixing the patient's problem.

Nola Pender began studying health promotion in the 1970s. In 1982, she first published the Health Promotion Model theory. In an effort to support evidence-based nursing practice using the Health Promotion Model, Pender conducted research using adolescents and adults. She identified five key concepts that impact patient health: person, environment, nursing, health, and illness. The Health Promotion Model is particularly appropriate for use in community and outpatient settings as it focuses on prevention, which could ultimately save millions of dollars in health care costs.

Nancy Roper has always known she wanted to be a nurse. Born in the United Kingdom, she realized her dream of becoming a nurse and recognized the importance of taking the individuality of each patient into account when formulating a nursing care plan. Drawing from her experiences, she co-developed the Roper-Logan-Tierney Model of Nursing in 1976. The Roper-Logan-Tierney Model of Nursing is currently the most widely using nursing theory in the United Kingdom. By understanding the effect an illness has on a patient's ability to perform activities of daily living, the nurse can better understand how disease impacts independence and self-care ability. Identifying areas of deficit allows nurses to formulate nursing care plans to help restore independence and quality of life.

Harry Stack-Sullivan, also referred to as Henry Stack-Sullivan, is known as the father of interpersonal psychiatry. His interest in psychiatry may have stemmed from his isolated childhood in Norwich, New York. After earning his medical degree, he specialized in treating patients with schizophrenia and other mental illnesses. His theory, the Interpersonal Theory, explains how personality is shaped by interpersonal relationships. Interpersonal relationships continue to mold personalities throughout the developmental period, which he divided into six "epochs": infancy, childhood, juvenile era, preadolescence, early adolescence, and late adolescence. His theory was the first American theory to explain personality development.

Joyce Travelbee's clinical experience focused on the psychiatric nursing field. Her experiences led to her to develop the Human-to-Human Relationship Model of Nursing. It focuses on the importance of the nurse-patient relationship and the interaction process by which it is formed. She outlined five stages that lead to formation of the relationship, helping nurses to form effective and strong nurse-patient relationships. The Human-to-Human Relationship Model of Nursing is widely used in hospice nursing settings and have greatly impacting hospice nursing care in the United States.

Ernestine Wiedenbach developed the Helping Art of Clinical Nursing theory, influenced in part by the earlier work of Ida Orlando. She identified a patient as "any individual who is receiving help of some kind, be it care, instruction or advice from a member of the health profession or from a worker in the field of health". It is the nurse's job, through observation and exploration, to identify the patient's need for help. In order to care for patients, the theory postulates that nurses use both clinical and sound judgment when making patient care decisions.

Patricia Benner is currently serving as a professor emerita at the University of California at San Francisco School of Nursing, where she has taught and done research since 1979. Her nursing career began in the 1960s and led her to develop the concept, From Novice to Expert. The theory explains how nurses become expert in patient care through a career-long process divided into five stages: novice, advanced beginner, competent, proficient, and expert. She recognizes that some skills and knowledge are gained through informal learning processes, because a nurse can "know how" without having the theoretical foundation of "knowing that". An expert nurse is one who best knows how to care for his or her patients, not necessarily the highest-paid nurse.

Myra Estrine Levine's experience in oncology nursing influenced her development of the Four Conservation Principles. The theory focuses on patients at the most basic, organism level. In this model, the goal of nursing is to assist patients in adapting to illness or disease in order remain whole, using the four conservation principles: conservation of energy, structure, and personal and social integrity. She recognized nursing as both a profession and an academic science and advocated for collaboration between various health care specialties to provide the best care for the patient.

Kurt Lewin is known as the founding father of social psychology. He was raised in Germany, but later immigrated to the United States and became a naturalized citizen. After World War II, he was involved in psychological rehabilitation at Harvard Medical School. He developed the Change Model nursing theory. His model encompasses three central concepts: driving forces, restraining forces, and equilibrium. These concepts are forces Lewin refers to in his definition of behavior, "a dynamic balance of forces working in opposing directions". The process of change is described as unfreezing-change-refreezing. In this process, old knowledge is displaced, new knowledge is learned and is then committed to memory.

Katie Ericksson developed the Theory of Caritative Caring. The theory encompasses both nursing ethics and nursing practice concepts. It emphasizes a holistic approach to nursing care, taking into account spirituality, dignity and holiness. She notes that it is a basic human function to care for others, and that illness and suffering are an inevitable and unavoidable part of life. Nurses, by applying the Theory of Caritative Caring, are alleviating suffering through charity, love, faith and hope.

Nursing theorists come from many different nursing backgrounds, yet all feel the need to help define and delineate nursing practice. Theories range from broad grand nursing theories to narrow, specialized theories. Some are grounded in clinical observations and research, while others are metaphysical and existential. Currently practicing nurses can draw on these theories, choosing one that best fits their practice and patient population. Others may choose to apply concepts from several different theories as they see fit. Still others may build upon these nursing theories to create a new nursing theory. Many nursing theories have undergone change and growth from their inception, as nursing research and practice has changed with time. As nursing continues to grow as an academic field, nursing theories will continue to be refined and clarified. Ultimately, nurse theorists will continue to guide nurses to grow as professionals and provide better care to patients using guidelines within nursing theories.

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