Introduction to Nursing Theories

Nursing theories play a significant role in nursing education, practice and patient interaction. Developed over hundreds of years, nursing theories have evolved to inform the nursing field today.

This guide explains what nursing theory is and who practices it, the various levels and concepts of nursing theory, and notable nurse theories and theorists who have influenced nursing in the present day.

What Is Nursing Theory?

One nursing theory definition is that it’s a set of frameworks and principles that guides the field of nursing and nursing practice. Based on evidence and research, nursing theory helps provide a foundation for sound decision-making in nursing.

As a report from the Nordic College of Caring Science points out, nursing theory is a way to explain what nurses do for patients and why they do it. Nurses use nursing theories to provide optimal patient care.

According to American Nursing History, Florence Nightingale is considered to be the first nursing theorist and is often called “the founder of modern nursing.” The Florence Nightingale nursing theory she is perhaps best known for is her Environmental Theory that is still practiced today. This theory states that effective nursing relies on the patient’s environment to assist them in recovery.

Nursing theories evolve and emerge over time as they’re put into practice and tested. In nursing school, students learn nursing theories so they can provide the most effective, appropriate care to patients.

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Who Practices Nursing Theory?

Many who work in the nursing profession use nursing theories at some point in their practice. Nurses learn these theories in their formal education and may apply them during their careers.

Nurse researchers and nurse educators also rely heavily on nursing theories. For example, many university nursing programs will have courses dedicated to nursing theory or will integrate nursing theories in the curriculum.

A master’s of science in nursing program might have a class like theoretical practice, which focuses on how nursing healthcare has developed due to historical, social and political factors. A class on family development and functioning may cover nursing theories relevant to family-centered nursing care.

In research, nursing theories may be tested and evaluated so researchers can make conclusions about their efficacy and make recommendations on how they can be more successful in practice. Nursing researchers may also use nursing theories as background for new trends in nursing, to compare past results and current developments in nursing healthcare.

Three Levels of Nursing Theory

There are generally three levels of nursing theory, which begin with abstract ideas and become more specific according to each level. The three main categories of nursing theories are grand nursing theories, middle-range nursing theories and practice-level nursing theories. Different levels of nursing theories may influence others. The following details each type.

Grand Nursing Theories

Grand nursing theories are the broadest category. They’re the most abstract and complex concepts and propositions that provide a general nursing care framework. A grand nursing theory can apply to a variety of nursing care environments and situations.

An example of a grand nursing theory is Ida Jean Orlando-Pelletier’s Deliberative Nursing Process Theory. This theory examines the definition of the function of nursing and the interaction between the nurse and the patient. It explains how to use the nursing process to improve patient outcomes.

Using a broad theory like this one, nurses, nurse educators and nurse researchers can apply the theory in a variety of patient settings and use it with other more specific nursing theories to determine the most optimal outcomes.

Middle-Range Nursing Theories

Middle-range nursing theories are more specific in focus compared to grand nursing theories, but they’re broader than the more specific practice-level nursing theories. Middle-range nursing theories may derive from theories of similar disciplines, nursing research or nursing practice.

Since they’re less abstract than grand nursing theories, middle-range theories tend to be more verifiable through testing. These theories attempt to explain, describe or predict specific issues in clinical nursing practice.

An example of a middle-range nursing theory is Imogene King’s Theory of Goal Attainment. This theory focuses on the factors that affect the attainment of certain life goals and explains how a nurse and a patient can communicate, set goals together and take actions to achieve goals. The theory examines how the personal system, the interpersonal system and the social system affect goal attainment.

Practice-Level Nursing Theories

Practice-level nursing theories are situation-specific. They’re the most narrow in scope and focus of the three levels of nursing theories. They may be based on concepts from grand nursing theories and middle-range nursing theory but provide specific frameworks for specific nursing interventions.

Nurses and nurse researchers may apply a practice-level nursing theory when it relates to a defined patient population at a specific time. Since these theories are more specific and unique, they may draw upon multiple theories to create the optimal recommended practice for that particular patient group.

For example, a nurse who is working with a patient who is a mother may draw upon elements of middle-range nursing theories like the Maternal Role Attainment Theory by Ramona Mercer and the Life Perspective Rhythm Model by Dr. Joyce Fitzpatrick to provide optimal maternal patient care.

Four Concepts of Nursing Theory

Most nursing theories focus on four main concepts or metaparadigms, according to the College of New Jersey. A nursing metaparadigm definition is that it’s a set of propositions or concepts that serve as a framework from which conceptual models develop. Nursing theories tend to consider each nursing metaparadigm to apply how the principles in each theory relate to them.

In nursing, the four main metaparadigms, according to the Journal of Medical Ethics and History of Medicine, are person, environment, health and nursing. These four frameworks inform grand nursing theories, middle-range nursing theories and practice-level nursing theories.

Person

The person is at the center of the four key concepts of nursing theory, because the person refers to the patient who is being cared for. The person may also be referred to as “client” and represent a group of individuals, families or communities.

Since every human being is different and has unique experiences, it’s important for nurses to take into account individual characteristics when making healthcare recommendations. Also, it’s beneficial for nurses to apply a human-focused strategy to care, involving emotional care components like empathy and compassionate communication.

Humans are constantly changing in reaction to factors like their environment. This framework takes into account biological, intellectual, psychological and sociocultural dimensions of the human patient.

Environment

A nursing environment is the setting in which nursing healthcare is provided. It affects both the patient and their ability to heal, as well as the nursing team due to factors like nursing unit morale. A nursing environment can be affected by issues such as noise levels, lighting, scent, the amount of space in rooms and access to nature.

In nursing, the environment also extends beyond the healthcare setting. It relates to the patient’s everyday life and social experience. The environment metaparadigm in nursing includes personal, social, national and global aspects, as well as societal beliefs and customs.

Health

Health in nursing relates to both improving a patient’s immediate healthcare state and helping them maintain their overall health and well-being. Certain factors in a nursing environment can improve a patient’s health, including cleanliness, preparedness and a sense of caring. Basic medical needs like food and clean water can also impact a person’s health.

Health impacts the entire lifespan. This metaparadigm looks at the overall life of a client, including physical as well as social, moral and aesthetic areas. Health is contextual, relating to a human’s current state in their environment.

For example, how health is characterized in a theory related to senior care will look different to how health is characterized in a theory related to newborn babies.

Nursing

Finally, the nursing practice metaparadigm refers to nursing as a practice profession and as an academic discipline. At its core, nursing is a practice that promotes health and advocates for patients. It’s a professional calling that requires training and education to provide optimal direct patient care. Nurses use nursing theory to inform their decisions and to think critically to determine the best treatment in any situation.

Nursing is based on scientific theory, but it also takes into account the human element to apply the best evidence-based care in diverse settings. Nurses use logical analysis, research and nursing theories to provide care that also factors in human choice and responsibility.

For example, a nurse whose patient is a smoker may recommend one form of smoking cessation over another, due to the patient’s overall health and decision-making patterns.

The Importance of Nursing Theory

Nursing theory is based on centuries of nursing practice and research. Nursing theories have been tested and evaluated over time, providing modern-day nurses, nurse educators and nurse researchers with more insights to inform their practices. Nursing theories help to contextualize nursing practice and provide examples of how different types of care can affect patients in diverse populations.

Using nursing theories can also help improve patient outcomes. The Nordic College of Caring Science’s review of 35 nursing theory studies found theory-guided interventions improved all of the studied outcomes in 26 studies and at least one outcome in the remaining nine studies. No studies reported that nursing theory-guided interventions weren’t useful. The study review recommends nurses continue to use nursing theories to guide their practice.

List of Notable Theories and Theorists

Florence Nightingale: A British nurse who served in the Crimean War, Nightingale is considered the pioneer of nursing. She established the Nightingale Training School for Nurses in 1860. The Florence Nightingale nursing theory on the environment includes the idea that environmental factors such as fresh air, pure water, efficient drainage, cleanliness and direct sunlight affect health. Her theory suggested that a deficiency in any of these factors could negatively impact patient health outcomes.
Lewin’s Change Theory of Nursing: Kurt Lewin was a social psychologist whose theories have impacted the nursing field. Lewin’s Change Theory of Nursing is a three-stage model of change that requires that prior learning be rejected and replaced in order for meaningful change to be achieved. It uses the terms “unfreezing,” “change” and “refreezing” to describe the stages in this theory. Unfreezing makes it possible for people to let go of old patterns. Change is adopting a new process of behaviors, feelings or thoughts. Refreezing is establishing the new process as a habit. Using this theory, nurses can help patients let go of unhealthy habits and adopt new processes that support improved well-being.
Virginia Avenel Henderson: This nurse theorist, researcher, educator and author developed what’s called the Nursing Need Theory. This Virginia Henderson nursing theory emphasizes helping patients become more independent so that when they’re released from a hospital or healthcare setting, their progress isn’t delayed. The theory focuses on how nurses can help meet patients’ basic human needs so their treatment can progress optimally. The 14 human needs outlined in the Nursing Need Theory include normal breathing, adequate eating and drinking, sleep and rest, the ability to communicate freely with others and grooming. The theory also presents the patient as a sum of parts with biophysical needs, rather than as a consumer or client.
Dorothea Orem: Credited with creating the Self-Care Deficit Nursing Theory, Dorothea Orem’s nursing theory involves the interrelated theory of self-care, theory of self-care deficit and theory of nursing systems. The theory provides guidance for nurses on how to help their patients perform self-care to maintain their health and well-being. The theory suggests patient recovery improves when patients have some autonomy over self-care practices. If a patient is unable to perform certain self-care duties, due to mobility issues, for example, a nurse can look for ways to help while also promoting autonomy.
Jean Watson: The founder of the Watson Caring Science Institute and a dean emerita at the University of Colorado, she held the title of “Distinguished Professor of Nursing,” the highest honor accorded its faculty for scholarly work. She is credited with creating the Jean Watson Nursing Theory of Caring. This theory focuses on the role of caring and love in nurse-patient interactions. The theory draws upon clinical, educational and social psychology to explain the benefits of practicing loving kindness in nursing care. The Theory of Caring sets the foundation for nurses to integrate compassion, altruism, spirituality, trust, listening skills and human dignity in their nursing practice.

Explore Nursing Theories in Nursing School

There are dozens of nursing theories that have been researched, put into practice and evolved over time to help nurses deliver better care to patients. You may learn about the theories outlined here if you study nursing. In healthcare settings, you can use nursing theories to inform your own nursing care.

Last updated September 2021