7 Nursing Theories To Practice By
September 12th, 2011
By Jennifer Olin, BSN, RN
Nursing theory — another much dreaded, seemingly forgettable part of the nursing education experience. You memorize the theorists, try to memorize what they stand for and hope to replay it successfully on nursing school exams. And the whole time, if you are like me, you wonder, "what am I going to do with this when I graduate? What I really need to know is how to put in an IV!"
Well, a few years into practice I started to realize that the work I do– the care I provide — is all based on my theory of what is right for my area of nursing — and my theory (ugh, there's that word) is hardly original. In fact, my personal philosophy for my job, my work ethic, my behavior and treatment of my patients all fall into the realms of a few specific nursing theorists I was forced to study in school. It seems they built my framework for being a careful, conscientious, caring RN.
There are many different theories of nursing, but let's take a look at some of the most prominent, and the nurses who developed them:
- Virginia Henderson: Often called "the Nightingale of Modern Nursing," Henderson was a noted nursing educator and author. Her "Need Theory" was based in practice and her education. She emphasized the importance of increasing a client's independence to promote their continued healing progress after hospitalization. Her definition of nursing was one of the first to mark the difference between nursing and medicine. "The unique function of the nurse is 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. And to do this in such a way as to help him gain independence as rapidly as possible. She must in a sense, get inside the skin of each of her patients in order to know what he needs."
- Martha Rogers: Rogers honed her theory through many years of education. She was not only a diploma nurse, she held a Master's of Public Health from Johns Hopkins University and completed her Doctorate of Nursing there as well. She saw nursing as both a science and an art. Rogers' theory is known as that of the Unitary Human Beings. Nursing seeks to promote symphonic interaction between the environment and the person, to strengthen the coherence and integrity of the human beings, and to direct and redirect patterns of interaction between the person and the environment for the realization of maximum health potential. Her development of this abstract system was strongly influenced by an early grounding in arts and background of science along with her keen interest in space.
- Dorothea E. Orem: Known as the Self-Care Theory, Orem's vision of health is a state characterized by wholeness of developed human structures and of bodily and mental functioning. It includes physical, psychological, interpersonal and social aspects. Her major assumptions included that people should be self-reliant and responsible for their own care and the care of others in their family. She said that a person's knowledge of potential health problems is necessary for promoting self-care behaviors. Orem defined nursing as an art, a helping service and a technology.
- Betty Neuman: The System Model, developed by Neuman, focuses on the response of the client system to actual or potential environmental stressors and the use of several levels of nursing prevention intervention for attaining, retaining and maintaining optimal client system wellness. Neuman defines the concern of nursing is preventing stress invasion. If stress is not prevented then the nurse should protect the client's basic structure and obtain or maintain a maximum level of wellness. Nurses provide care through primary, secondary and tertiary prevention modes.
- Hildegard Peplau: Four phases define Peplau's Interpersonal Theory or nursing. She defines the nurse/patient relationship evolving through orientation, identification, exploitation and resolution. She views nursing as a maturing force that is realized as the personality develops through educational, therapeutic, and interpersonal processes. Nurses enter into a personal relationship with an individual when a felt need is present. Peplau's model is still very popular with clinicians working with individuals who have psychological problems.
- Madeleine Leininger: One of the newer nursing theories, Transcultural Nursing first appeared in 1978. According to Leininger, the goal of nursing is to provide care congruent with cultural values, beliefs, and practices. Leininger states that care is the essence of nursing and the dominant, distinctive and unifying feature. She says there can be no cure without caring, but that there may be caring with curing. Health care personnel should work towards an understanding of care and the values, health beliefs, and life-styles of different cultures, which will form the basis for providing culture-specific care.
- Patricia Benner: From Novice to Expert is probably the simplest nursing theory to understand. Benner describes five levels of nursing experience: novice, advanced beginner, competent, proficient and expert. The levels reflect a movement from reliance on abstract principles to the use of past concrete experience. She proposes that a nurse could gain knowledge and skills without ever learning the theory. Each step builds on the previous one as the learner gains clinical expertise. Simply put, Benner says experience is a prerequisite for becoming an expert. Benner published her "Novice to Expert Theory" in 1982.
What Theory Suits You?
As I review these very different theories I see where my own practice comes from. Certainly Benner applies, I knew nothing, I learned, I grew in confidence and in an area or two I may even be an expert. Simple enough. And, having worked in some major medical centers in the U.S. that attract clients from all over the world, I believe strongly in Leininger's Transcultural Care Theory. As a nurse it is imperative to recognize the differences between cultures, the different views on health care, life and death and work within those frameworks to provide the most respectful care for your patients.
Just as nursing theory embraces many different viewpoints, we, as nurses can embrace some or all of each theory. Why all this theory study is important as a nursing student is because it helps you understand the career you have chosen, its vibrancy, its motivation, its fluidity. With this input you can form your own concept of what it means to be a nurse and how you will use that concept to provide the best, the safest, the most respectful patient care.
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