MAHATMA HANS RAJ D.A.

V INSTITUTE OF NURSING
JALANDHAR

SUBJECT: NURSING RESEARCH AND STATISTICS

ASSIGNMENT
ON

VARIOUS NURSING THEORIES AND

MODELS

SUBMITTED BY: SUBMITTED TO:

RESPECTED MRS. JOPHY
ELIZABETH GEORGE
MUSKAN
PROFESSOR
M.SC (N) 1ST YEAR
(Child Health Nursing)
Obstetrics & Gynaecology Nursing
MHR DAV INSTITUTE OF
NURSING, JALANDHAR

ASSOCIATE PROFESSOR
(Community Health Nursing)
MHR DAV INSTITUTE OF
NURSING, JALANDHAR
 INDEX

S No. Content Page No.

1 Introduction 1

2 Importance of nursing theories 2

3 Characteristics and components 3

4 Nursing Metaparadigm 4

5 Levels of nursing theories 5

6 Nightingale’s theory 6-8

7 Peplau’s theory 9-10

8 Henderson’s theory 11

9 Faye Glenn Abdellah’s theory 12

10 Imogene king’s theory 13-15

11 Newmann’s theory 16-18

12 Orem’s theory 19-20

13 Jean Watson theory 21-22

14 Roy’s model 23-25

15 Johnson’s model 25-26

16 Livine’s conservation model 27-28

17 Martha roger’s model 28-29

18 Parse’s model 30-32

19 Conclusion 32

20 Research abstract 33

21 Bibliography 34
 NURSING THEORIES

INTRODUCTION:
A theory is a group of related concepts that propose action that guide practice. A nursing theory
is a set of concepts, definitions, relationships, and assumptions or propositions derived from
nursing models or from other disciplines and project a purposive, systematic view of
phenomena by designing specific inter-relationship among concepts for the purposes of
describing, explaining, predicting and prescribing.
DEFINITION:
Nursing theory is defined as "a creative and conscientious structuring of ideas that project a
tentative, purposeful, and systematic view of phenomena".
-According to Wikipedia
"A nursing theory is a set of concepts, definitions, and propositions that provide a framework
for understanding and explaining nursing phenomena."
-According to American Nurses Association (ANA)
"A nursing theory is a systematic and c way of thinking about and understanding nursing
phenomena, which provides a framework for nursing practice, education, and research."
-According to International Council of Nurses (ICN)
"A theory is a systematic and organized way of thinking about and understanding the
relationships between variables and phenomena."
-According to Afaf Melies

Concepts Proportions Definitions

NURSING
THEORIES

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IMPORTANCE:
Nursing theories play a crucial role in the development and practice of nursing. There are
some of the importance of nursing theories:
1. Guides Nursing Practice: Nursing theories provide a framework for nurses to understand
and address patient needs, making practice more effective and efficient.
2. Improves Patient Outcomes: Theories help nurses identify and address specific patient
needs, leading to better health outcomes.
3. Enhances Critical Thinking: Nursing theories promote critical thinking and problem-
solving skills, enabling nurses to make informed decisions.
4. Curriculum Development: Nursing theories inform the development of nursing curricula,
ensuring that students learn essential concepts and principles.
5. Theoretical Foundation: Theories provide a foundation for nursing education, helping
students understand the underlying principles and concepts of nursing practice.
6. Research and Evidence-Based Practice: Nursing theories guide research and evidence-
based practice, enabling nurses to develop and implement effective interventions.
7. Advances Nursing Knowledge: Nursing theories contribute to the advancement of
nursing knowledge, promoting the development of new theories and frameworks.
8. Promotes Professional Autonomy: Theories empower nurses to take ownership of their
practice, making informed decisions and advocating for patients.
9. Enhances Interdisciplinary Collaboration: Nursing theories facilitate collaboration with
other healthcare professionals, promoting a shared understanding of patient needs and
priorities.
10. Guide clinical decision-making: Nursing theories are the foundation for the clinical
decisions nurses make. They help nurses identify problems, evaluate solutions, and choose
the best option.
11. Shape research: Nursing theories influence nursing research and create conceptual
blueprints.
12. Determine nurse-patient interactions: Nursing theories determine how and why nurses
interact with patients.
13. Help assess patients: Nursing theories can help nurses determine if patients have fully
recovered or still need care.
14. Informs Health Policy: Nursing theories inform health policy, guiding decision-making
and resource allocation.
15. Improves Healthcare Quality: Theories promote high-quality, patient-centred care,
enhancing the overall healthcare system.

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CHARACTERISTICS:

CHARACTERS VIEW
Interrelating Nursing theories are interrelating in such a way as to create a
different way of looking at a particular phenomenon.
Logical Theories have concept and logic that are interrelated to create a
systematic view of nursing phenomena.
Consistent These theories are consistent with other validated theories,
laws and principles.
Assumptions Nursing theories are drawn on assumptions or universal beliefs
that are accepted as truth in nursing practice.
Consistent These are consistent with other validated theories but will
leave open unanswered questions that need to be investigated.
Generalizable They are logical, and they can be used as the basis for
hypotheses that can be tested. Nursing theories also increase
the body of knowledge in nursing through the research that
validates them.
Clear Definition These should have clear definitions for the terms used within
them to ensure consistency and understanding.
Relational Statements Nursing theories have relational statements that defines the
relationships between concepts in logical way.
Simple and concise Nursing theories are simple and concise, avoiding unnecessary
complexity.
Universal application Nursing theories can be applied in various settings and
populations.
Conceptual framework Nursing theories provide a conceptual framework for
understanding and organizing nursing knowledge.
Research-based Theories are developed and refined through research and
evidence-based practice.

CONCEPTS OF NURSING THEORIES:

Nursing theories offer frameworks that give shape to the scope of nursing care and practice.
These consist of concepts, such as collaboration or respect, descriptions of relationships, and
definitions. Nursing theories guide nurses in their practice and give them a foundation to
make clinical decisions.
There are four common concepts in nursing theory that influence & determine nursing
practice are as follows:
1.The person (patient)
2. The environment
3. Health
4. Nursing (goals, roles, functions)

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All of these concepts are usually defined and described by a nursing theorist, often uniquely:
although these concepts are common to all nursing theories. Of the four concepts, the most
important is that of the person. The focus of nursing, regardless of definition or theory, is the
person.
NURSING METAPARADIGM:
Four major concepts are frequently interrelated and fundamental to nursing theory: person,
environment, health, and nursing. These four are collectively referred to as metaparadigm for
nursing.
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
client. 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 nurse's attributes, characteristics, and actions provide care on behalf of or in conjunction
with the client. There are numerous definitions of nursing, though nursing scholars may have
difficulty agreeing on its exact definition. The ultimate goal of nursing theories is to improve
patient care.

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LEVELS OF NURSING THEORIES:
* Meta Theory
* Grand Theory
* Middle Range Theory
* Practice Theory
1. Meta theory - A meta-theory is a high-level theoretical framework that provides a broad
perspective on a particular discipline or field of study. In the context of nursing, a meta-
theory is a general framework that guides the development of more specific nursing theories.
Characteristics of Meta-Theories:
* Abstractness: Meta-theories are highly abstract and provide a broad perspective on a
discipline.
* Comprehensive: Meta-theories encompass a wide range of concepts and phenomena
within a discipline.
* Generalizability: Meta-theories can be applied across different contexts and populations.
2. Grand theory - A grand theory is a comprehensive and abstract theoretical framework that
provides a broad perspective on a particular discipline or field of study. In nursing, grand
theories are considered the highest level of theoretical abstraction and provide a general
framework for understanding nursing phenomena.
Characteristics of Grand Theories:
* Highly abstract: Grand theories are highly abstract and provide a broad perspective on a
discipline.
* Comprehensive: Grand theories encompass a wide range of concepts and phenomena
within a discipline.
* Generalizability: Grand theories can be applied across different contexts and populations.
* Complexity: Grand theories are complex and often require a high level of theoretical
understanding.
3. Middle Range Theory - A middle range theory is a theoretical framework that is more
specific and less abstract than grand theories, but still provides a broad perspective on a
particular phenomenon or concept. Middle range theories are designed to be more applicable
to practice and research than grand theories.
Characteristics of Middle Range Theories:
* Less abstract: Middle range theories are less abstract than grand theories and provide a
more specific framework for understanding a phenomenon.
* More specific: Middle range theories are more specific and focused on a particular concept
or phenomenon.
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* Testable: Middle range theories are designed to be testable and can be evaluated through
research.
* Applicable to practice: Middle range theories are designed to be applicable to practice and
can guide nursing interventions.
4. Practice Theory - A practice theory is a specific, concrete, and practical theoretical
framework that guides nursing practice in a particular context or situation. Practice theories
are designed to be directly applicable to practice and are often developed by practicing
nurses.
Characteristics of Practice Theories:
* Specific: Practice theories are specific and focused on a particular nursing practice or
situation.
* Concrete: Practice theories are concrete and provide clear guidance for nursing practice.
* Practical: Practice theories are practical and designed to be directly applicable to practice.
* Contextual: Practice theories are developed within a specific context or situation.

NIGHTINGALE’S ENVIRONMENTAL THEORY

The core concept most reflective of Nightingale's writings is that of the foundation of
Nightingale's theory that is environment.
The environment is viewed as all the external conditions and influences affecting the life and
development of an organism and capable of preventing, suppressing or contributing to
disease or death.
Her goal was to help the patient retain his own vitality by meeting his basic needs through
control of the environment. At this point it is helpful to think of a patient who has had
surgery, such as an appendectomy, and relate what Nightingale proposes.
Medicine is seen as functioning to remove the diseased part, whereas nursing places the
patient in an environment in which nature can assist postoperative patients to reach their
optimum health conditions. This approach to nursing is as valid today as it was over one
hundred years ago, in spite of the fact that both in home and in hospitals the environment
today is more sophisticated in structure.
Nightingale prescribes following components of positive environment:
* Health of Houses
Badly constructed houses do for the healthy what badly constructed hospitals do for the sick.
Once ensure that the air is stagnant and sickness is certain to follow.
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* Ventilation and Warming
Keep the air he breathes as pure as the external air, without chilling him.
Nightingale believed that the person who breathed his or her own air would become sick or
remain sick. She was very concerned about "noxious air" or "effluvia" and foul odors that
came from excrement She also criticized "fumigations," for she believed that the offensive
source, not the smell, must be removed.
The importance of room temperature was also stressed by Nightingale. The patient should not
be too warm or too cold. The temperature could be controlled by appropriate balance between
burning fires and ventilation from windows.
* Light
Nightingale believed that second to fresh air, the sick needed light. She noted that direct
sunlight was what patients wanted.
* Noise
She stated that patients should never be waked intentionally or accidentally during the first
part of sleep. She asserted that whispered or long conversations about patients are thoughtless
and cruel. She viewed unnecessary noise, including noise from female dress, as cruel and
irritating to the patient.
* Variety
She discussed the need for changes in colour and form, including bringing the patient
brightly coloured flowers or plants. She also advocated rotating 10 or 12 paintings and
engravings each day, week, or month to provide variety for the patient. Nightingale also
advocated reading, needlework, writing, and cleaning as activities to relieve the sick of
boredom.
* Bed and Bedding
Nightingale noted that an adult in health exhales about three pints of moisture through the
lungs and skin in a 24-hour period. This organic matter enters the sheets and stays there
unless the bedding is changed and aired frequently.
* Personal Cleanliness
Just as it is necessary to renew the air round a sick person frequently to carry off morbid
effluvia from the lungs and skin, by maintaining free ventilation, so it is necessary to keep
pores of the skin free from all obstructing excretions.
Every nurse ought to wash her hands very frequently during the day.
* Nutrition and Taking Food
Nightingale noted that individuals desire different foods at different times of the day and that
frequent small servings may be more beneficial to the patient than a large breakfast or dinner.
She urged that no business be done with patients while they are eating because this was
distraction.
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* Chattering Hopes and Advices
Nightingale wrote that to falsely cheer the sick by making light of their illness and its danger
is not helpful. She encouraged the nurse to heed what is being said by visitors, believing that
sick persons should hear good news that would assist them in becoming healthier.
* Social Considerations
Nightingale supported the importance of looking beyond the individual to the social
environment in which he or she lived.

Nightingale’s Environment Conceptual Framework

FOUR MAJOR CONCEPTS OF NIGHTINGALE’S THEORY:

1. Human or Individual
* Person is a human being acted upon by a nurse or affected by the environment.
* Nightingale envisioned the person as comprising physical, intellectual, emotional, social
and spiritual components.
2. Nursing
* Nightingale believed nursing to be a spiritual calling. She saw nursing as the science of
environmental management.
* It aims to provide fresh air, light, warmth, cleanliness, quiet and a proper diet.
3. Environment
It involves those external conditions that affect life and development of the individual. The
focus is on ventilated, warmth, odours, noise & light.
4. Health
Nightingale said health is only maintained by controlling environmental factors.
 HILDEGARD E. PEPLAU’S THEORY OF
INTERPERSONAL RELATIONS

Hildegard Peplau's Interpersonal Relations Theory, published in 1952, focuses on the nurse-
patient relationship and the therapeutic process. The theory emphasizes the importance of
interpersonal relationships in nursing practice.
Peplau's Interpersonal Relations Theory emphasizes the importance of building a therapeutic
relationship between the nurse and patient.
By focusing on interpersonal relationships and using effective communication skills, nurses
can promote positive health outcomes and improve the overall quality of care.
PHASES OF INTERPERSONAL RELATIONSHIP THEORY:
1. Orientation
2. Identification
3. Exploration
4. Resolution
ORIENTATION PHASE
* Problem defining phase.
* Starts when client meets nurse as stranger.
* Defining problem and deciding type of service needed.
* Client seeks assistance, conveys needs, asks questions, shares preconceptions and
expectations of past experiences.
* Nurse responds, explains roles to client, helps to identify problems and to use available
resources and services.
Factors influencing orientation phase:
IDENTIFACTION PHASE
* Selection of appropriate professional assistance.
* Patient begins to have a feeling of belonging and a capability of dealing with the problem
which decreases the feeling of helplessness and hopelessness.
EXPLORATION PHASE
* Use of professional assistance for problem solving alternatives.
* Advantages of services are used is based on the needs and interests of the patients.
* Individual feels as an integral part of the helping environment.
* They may make minor requests or attention getting techniques.
* Patient may fluctuate on independence.
* Nurse must be aware about the various phases of communication.
RESOLUTION PHASE
* Termination of professional relationship
* The patients' needs have already been met by the collaborative effect of patient and nurse
* Now they need to terminate their therapeutic relationship and dissolve the links between
them.
* Sometimes may be difficult for both as psychological dependence persists.
* Patient drifts away and breaks bond with nurse and healthier emotional balance is
demonstrated and both becomes mature individuals.

LIMITATIONS OF PEPLAU’S THEORY

1. Personal space considerations and community social service resources are considered less.
2. Health promotion and maintenance were less emphasized.
3. Cannot be used in a patient who doesn't have a felt need
4. Some areas are not specific enough to generate hypothesis.

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 VIRGINIA HENDERSON’S NEED THEORY

Henderson’s concept of nursing was derived from her practice and education therefore, her
work is inductive.
Virginia define nursing as “assisting individuals to gain independence in relation to the
performance of activities contributing to health or its recovery”.

14 BASIC COMPONENTS OF HENDERSON’S THEORY

The 14 basic needs are as follows:
1. Breath normally
2. Eat and drink adequately
3. Eliminate body waste
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes
7. Maintain body temperature with normal range
8. Keep the body clean and well groomed
9. Avoid dangers in environment and avoid injuring others
10. Communicate with others in expressing emotions, needs, fears and opinion
10. Worship according to one’s faith
12. Work in such a way that there is a sense of accomplishment
13. Participate in various recreation
14. Learn or satisfy the curiosity that leads to normal development
Henderson’s and Nursing Process
* Henderson views the nursing process “really the application of logical approach to the
solution of a problem”.
* Nursing process stresses the science of nursing rather than the mixture of science and art on
which it seems effective health care service of any kind is based.

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 FAYE GLENN ABDELLAH’S THEORY

Faye Glenn Abdellah's Patient-Centred Approach Theory, published in 1960, focuses on the
importance of patient-centred care and the nurse's role in promoting patient autonomy and
self-care.
Faye Glenn Abdellah's nursing theory, also known as the 21 Nursing Problems Theory, is a
patient-centred approach to nursing care that focuses on health promotion and maintenance.

Abdellah's 21 nursing problems are grouped into three categories:

1. Physiological problems (pain, nausea, fatigue)
2. Psychological problems (anxiety, fear, depression)
3. Sociological problems (social isolation, cultural differences)

10 Steps to Identify the Client's Problems:

1. Learn to know the patient.
2. Sort out relevant and significant data.
3. Make generalizations about available data in relation to similar nursing problems presented
by other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and make additional generalizations.
6. Validate the patient's conclusions about his nursing problems.
7. Continue to observe and evaluate the patient over a period of time to identify any attitudes
and clues affecting his behaviour.
8. Explore the patient's and family's reaction to the therapeutic plan and involve them in the
plan.
9. Identify how the nurses feel about the patient's nursing problems.
10. Discuss and develop a comprehensive nursing care plan.
11 Nursing Skills:
1. Observation of health status.
2. Skills of communication.
3. Application of knowledge.
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4. Teaching of patients and families.
5. Planning and organization of work.
6. Use of resource materials.
7. Use of personnel resources.
8. Problem-solving.
9. Direction of work of others.
10. Therapeutic use of the self.
11. Nursing procedures.
The Twenty-one Nursing Problems:
* To maintain good hygiene and physical comfort.
* To promote optimal activity: exercise, rest and sleep
* To promote safety through the prevention of accidents, injury, or other trauma and through
the prevention of the spread of infection.
* To maintain good body mechanics and prevent and correct deformities.

IMOGENE KING : THEORY OF

GOALATTAINMENT

Imogene King's Goal Attainment Theory, published in 1981. King's Theory of Goal
Attainment focuses on the nurse-patient relationship and the mutual goal-setting process. Her
theory emphasizes that nurses and patients should collaborate to establish goals that promote
the patient's well-being and health.

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King’s conceptual framework:
It includes:
* Several basic assumptions
* Three interacting systems
* Several concepts relevant for each system
Basic Assumptions:
* Nursing focus is the care of human being
* Nursing goal is the health care of individuals & groups
* Interacting systems:
 personal system
 Interpersonal system
 Social system
Concepts for Personal System:
* Perception
* Self
* Growth & development
* Body image
* Space
* Time
Concepts for Interpersonal System:
* Interaction
* Communication
* Transaction
* Role
* Stress
Concepts for Social System:
* Organization
* Authority
* Power
* Status
* Decision making
MAJOR COMPONENTS OF KING’S THEORY
1. Human being
Person has ability to:
* Perceive
* Think
* Feel
* Choose
* Set goals
* Select means to achieve goals
2. Health
According to King, health involves dynamic life experiences of a human being, which
implies continuous adjustment to stressors in the internal and external environment through
optimum use of one's resources to achieve maximum potential for daily living
3. Environment
Environment is the background for human interactions. It is of two types:
a) Internal environment: transforms energy to enable person to adjust to continuous
external environmental changes.
b) External environment: involves formal and informal organizations. Nurse is a part of the
patient's environment.
4. Nursing
Nursing: is defined as "A process of action, reaction and interaction by which nurse and client
share information about their perception in nursing situation." and "a process of human
interactions between nurse and client whereby each perceives the other and the situation, and
through communication, they set goals, explore means, and agree on means to achieve goals."
PROPOSITIONS OF KING’S THEORY
* If perceptual interaction accuracy is present in nurse client interactions, transaction will
occur
* If nurse and client make transaction, goal will be attained
* If goals are attained, satisfaction will occur.
* If transactions are made in nurse-client interac- tions, growth & development will be
enhanced
* If role expectations and role performance as perceived by nurse & client are congruent,
transaction will occur.
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 BETTY NEWMANN’S SYSTEM MODEL
THEORY

Betty Neumann's system model provides comprehensive flexible holistic and system based
perspective for nursing.
It focuses attention on the response of the client system to actual or potential environmental
stressors and the use of primary, secondary and tertiary nursing prevention intervention for
retention, attainment, and maintenance of optimal client system wellness.
The theory was published in 1972 as "A Model for Teaching Total Person Approach to Patient
Problems" in Nursing Research.
MAJOR CONCEPTS OF NEWMANN’S THEORY
1. Content
The variables of the person in interaction with the internal and external environment
comprise the whole client system.
2. Basic structure/Central core
Common client survival factors in unique individual characteristics representing basic system
energy resources. The basic structure, or central core, is made up of the basic survival factors
that are common to the species.
The factors include:
Normal temperature. range, genetic structure-response pattern.
3. Degree to reaction
The amount of system instability resulting from stressor invasion of the normal line of
defence.
4. Entropy
A process of energy depletion and disorganization moving the system toward illness or
possible death.
5. Flexible Line of defence
A protective, accordion like mechanism that surrounds and protects the normal line of
defence from invasion by stressors.
6. Normal Line of defence
It represents what the client has become over time, or the usual state of wellness. It is
considered dynamic because it can expand or contract over time.

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7. Lines of resistance
The series of concentric circles that surrounds the basic structure.
8. Input output
The matter, energy, and information exchanged between client and environment that is
entering or leaving the system at any point in time.
9. Negentropy
A process of energy conservation that increase organization and complexity, moving the
system towards stability or a higher degree of wellness.
10. Open system
A system in which there is continuous flow of input and process, output and feedback.
11. Prevention intervention
Interventions modes for nursing action and determinants for entry of both client and nurse in
to health care system.
12. Reconstitution
The return and maintenance of system stability, following treatment for stressor reaction,
which may result in a higher or lower level of wellness.
13. Stability
A state of balance of harmony requiring energy exchanges as the client adequately copes with
stressors to retain, attain, or maintain an optimal level of health thus preserving system
integrity.
14. Stressors
A stressor is any phenomenon that might penetrate both the flexible and normal line of
defence, resulting in either a positive or negative outcome Stressors can be intrapersonal,
interpersonal and extra personal.
Environmental factors, intra (emotion, feeling), inter (role expectation), and extra personal
(job or finance pressure) in nature, that have potential for disrupting system stability.
15. Wellness/Illness
Wellness is the condition in which all system parts and subparts are in harmony with the
whole system of the client. Illness is a state of insufficiency with disrupting needs unsatisfied.
Illness is an excessive expenditure of energy when more energy. is used by the system in its
state of disorganization than is built and stored; the outcome may be death.

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PREVENTION ACCORDING TO THEORY
1. Primary Prevention
* Primary prevention occurs before the system reacts to a stressor. On one hand, it
strengthens the person (primary the flexible Line of defence) to enable him to better deal with
stressors.
* Primary prevention includes health promotion and maintenance of wellness.
2. Secondary Prevention
* Secondary prevention occurs after the system reacts to a stressor and is provided in terms of
existing system.
* It focuses on preventing damage to the central core by strengthening the internal lines of
resistance and/or removing the stressor.

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3. Tertiary Prevention
* Tertiary prevention occurs after the system has been treated through secondary prevention
strategies.
* It offers support to the client and attempts to add energy to the system or reduce energy
needed in order to facilitate reconstitution.

DOROTHEA OREM’S THEORY

It is a nursing theory that suggests that patients are better able to recover when they maintain
some independence over their own self-care. The theory is based on the idea that patients
have the innate ability and responsibility to care for themselves.
Orem’s general theory of nursing has further based on three theories:
1. Theory of selfcare
2. Theory of selfcare deficit
3. Theory of nursing systems

THEORY OF SELFCARE
* Selfcare
Practice of activities that individual initiates and performs on their own behalf in maintaining
life, health and well being
* Selfcare agency
It is a human ability which is "the ability for engaging in self-care"
* Therapeutic selfcare demand
Totality of selfcare actions to be performed for some duration in order to meet selfcare
requisites by using valid methods and related sets of operations and actions.

THEORY OF SELF CARE DEFICIT

* Specifies when nursing is needed
* Nursing is required when an adult is incapable or limited in the provision of continuous
effective selfcare.
Supporting another
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THEORY OF NURSING SYSTEMS
* It describes how the patient's selfcare needs will be met by the nurse, the patient, or both.
* It designs and elements of nursing system define
* Scope of nursing responsibility in health care situations
* General and specific roles of nurses and patients
* Orem recognized that specialized technologies usually developed by members of the health
profession
A technology is systematized information about a process or a method for affecting some
desired result through deliberate practical endeavour.

OREM’S CONCEPTUAL FRAMEWORK

PRORITIES FOR SELF CARE DEFICIT

1. Air 6. Interaction
2. Water 7. Prevention of Hazards
3. Food 8. Promotion of normalcy
4. Elimination 9. Good environment
5. Activity 10. Modify self-image

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 JEAN WATSON’S PHILOSOPHY OF NURSING
THEORY

The Jean Watson theory was published in 1979 in nursing: "The philosophy and science of
caring"
In 1988, her theory was published in "nursing: human science and human care".
* Watson believes that the main focus in nursing is on curative factors. She believes that for
nurses to develop humanistic philosophies and value system, a strong liberal arts background
is necessary.
* This philosophy and value system provide a solid foundation for the science of caring. A
humanistic value system thus under grids her construction of the science of caring.
* She asserts that the caring stance that nursing has always held is being threatened by the
tasks and technology demands of the curative factors.

THE 10 PRIMARY CARATIVE FACTORS OF THEORY

Jean Watson structures ten carative factors which are as follows:
1. The formation of a humanistic- altruistic system of values
* Mediated through one’s own life experiences, the learning one gains and exposure to the
humanities.
* Is perceived as necessary to the nurse's own maturation which then promotes altruistic
behaviour towards others.
2. Faith-hope
* Hope essential for both the carative and the curative processes.
* When modern science has nothing further to offer the person, the nurse can continue to use
faith-hope to provide a sense of well-being through beliefs which are meaningful to the
individual.
3. Cultivation of sensitivity to one's self and to others
* This explores the need of the nurse to begin to feel an emotion as it presents itself.
* Development of one's own feeling is needed to interact genuinely and sensitively with
others.
* Striving to become sensitive, makes the nurse more authentic, which encourages self-
growth and self-actualization, in both the nurse and those with whom the nurse interacts.

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4. Establishing a helping-trust relationship
* She has defined the characteristics needed to develop the helping-trust relationship. They
are: congruence empathy and warmth
* Communication includes verbal, nonverbal and listening in a manner which connotes
empathetic understanding.
5. The expression of feelings, both positive and negative
* According to Watson, "feelings alter thoughts and behaviour, and they need to be
considered and allowed for in a caring relationship".
* According to her such expression improves one's level of awareness.
* Awareness of the feelings helps to understand the behaviour it engenders.
6. The systematic use of the scientific problem- solving method for decision making
* According to Watson, the scientific problem- solving method is the only method that allows
for control and prediction, and that permits self-correction.
* She also values the relative nature of nursing and supports the need to examine and develop
the other methods of knowing to provide a holistic perspective.
7. Promotion of interpersonal teaching-learning
* The caring nurse must focus on the learning process as much as the teaching process.
* Understanding the person's perception of the situation assist the nurse to prepare a cognitive
plan.
8. Provision for a supportive, protective and/ or corrective mental, physical, socio-
cultural and spiritual environment
* Watson divides these into eternal and internal variables, which the nurse manipulates in
order to provide support and protection for the person's mental and physical well-being.
* The external and internal environments are interdependent.
* Watson suggests that the nurse also must provide comfort, privacy and safety as a part of
this carative factor.
9. Assistance with the gratification of human needs
* It is grounded in a hierarchy of need similar to that of the Maslow's.
* She has created a hierarchy which she believes is relevant to the science of caring in
nursing.
* According to her each need is equally important for quality nursing care and the promotion
of optimal health. All the needs deserve to be attended to and valued.

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10. Allowance for existential-phenomenological forces
* Phenomenology is a way of understanding people from the way things appear to them, from
their frame of reference.
* Existential psychology is the study of human existence using phenomenological analysis.
* This factor helps the nurse to reconcile and mediate the incongruity of viewing the person
holistically while at the same time attending to the hierarchical ordering of needs.
* The nurse assists the person to find the strength or courage to confront life or death.

THE ROY’S ADAPTATION MODEL

Sister Callista Roy's Adaptation Theory, published in 1976, focuses on the individual's ability
to adapt to changes in their environment and the nurse's role in promoting adaptation.
* She organized course content according to a view pf person and family as adaptive systems.
* She introduced her ideas about adaptation nursing as the basis for an integrated nursing
curriculum.
The theory describes:
1. Who is the focus of nursing care?
2. What is the target of nursing care?
3. When is nursing care indicated?

INFLUENCING FACTORS OF THEORY

* Family
* Education
* Religious Background
* Mentors
* Clinical Experience
PERSON AS AN ADAPTIVE SYSTEM
1. Input
2. Throughput
3. Output
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INPUT:
* In Roy's system, input is identified as stimuli which can come from the environment or
from within a person.
* Stimuli are classified as focal (immediately confronting the person), contextual (all other
stimuli that are present) or residual (non-specific such as cultural beliefs).
* Input also includes a person's adaptation level
THROUGHPUT:
1. Throughput makes use of a person's processes and effectors.
2. Processes refer to the control mechanisms that a person uses an adaptive system.
3. Effectors refer to the physiologic function, self-concept and role function involved in
adaptation.
OUTPUT:
1. Output is the outcome of the system; when the system is a person. Output refers to the
persons behaviour.
2. In Roy's system, output is categorized as adaptive responses (that promote a person's
integrity) or ineffective responses (those that do not promote goal achievement; for example,
not taking antihypertensive medicines)
3. Adaptive responses are used when a person demonstrates behaviours that achieve the goals
of survival, growth, reproduction and mastery.

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FOUR ADAPTIVE MODELS
1. Physiologic functions
* Involves the body's basic needs and ways to adapt.
* Includes a person's patterns of oxygenation, nutrition, elimination, activity and rest, skin
integrity, senses and endocrine functions.
2. Self-Concept
* Refers to beliefs and feelings about oneself.
* Comprises the physical self (includes sensation
and body image), and moral and ethical self
(includes self-observation and evaluation)
3. Role Function
* Involves behaviour based on a person's positions
in society.
* Is depend on how a person interacts with others
in a given situation.
* It can be classified as primary (age, sex) secondary (husband, wife), or tertiary (temporary
role of a coach)
4. Interdependence
* It involves a person's relationship with significant others and support systems.
* It strikes a balance between dependent behaviours (seeking help, attention and affection)
and independent behaviours (taking initiative and obtaining satisfaction from work)
* Meets a person's needs for love, nurturing and affection.

JOHNSON’S BEHVIOUR SYSTEM MODEL

Dorothy Johnson's Behavioural System Model, published in 1968, focuses on the individual's
behavioural system and the nurse's role in promoting balance and stability within that system.
She also stated that nursing was concerned with man as an integrate threat ed whole and this
is the specific knowledge of order we require.
She defines nursing as “an external regulatory force which acts to preserve the organization
and integration of patient behaviours at an optimum level under those conditions in which
behaviours constitute a threat to the physical and social health.

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CONCEPT
1. Behavioural System: The individual's organized, goal-directed behaviour.
2. Subsystems: Seven subsystems that make up the behavioural system: attachment,
dependency, ingestive, eliminative, sexual, aggressive, and achievement.
3. Drives: Internal forces that motivate behaviour.
4. Set: The individual's preferred pattern of behaviour.
5. Stress: A state of tension or discomfort that occurs when the behavioral system is
disrupted.

THEORY PROPOSITIONS
1. Humans have a unique behavioural system: Each individual's behavioural system is
distinct and influenced by their environment.
2. The nurse's role is to promote balance and stability: Nurses help individuals maintain
balance and stability within their behavioural system.
3. Behavioural system imbalance leads to stress: Imbalance within the behavioural system
can lead to stress and discomfort.

JOHNSON’S BEHAVIOURAL SUBSYSTEMS

* Attachment or Affiliative
Social inclusion intimacy and the formation and attachment of a strong social bond.
* Dependency subsystem
"Approval, attention or recognition and
physical assistance"
* Ingestive subsystem
"The emphasis is on the meaning and
structures of the social events
surrounding the occasion when the food
is eaten"
* Eliminative subsystem
"Human cultures have defined different
socially acceptable behaviours for
excretion of waste, but the existence of
such a pattern remains different from
culture to culture."
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* Sexual subsystem
"Both biological and social factor affect the behaviour in the sexual subsystem"
* Aggressive subsystem
"It relates to the behaviours concerned with protection and self-preservation.

* Achievement subsystem
"Provokes behaviour that attempt to control the environment intellectual, physical, creative,
mechanical and social skills achievement are some of the areas that Johnson recognizes".

LEVINE’S CONSERVATION MODEL

Myra Levine's Conservation Model, published in 1967, focuses on the individual's

conservation of energy, structure, and function. The model aims to help nurses understand the
individual's adaptive responses to environmental changes and provide care that promotes
conservation.
KEY CONCEPTS
1. Conservation: The individual's ability to maintain and conserve energy, structure, and
function.
2. Adaptation: The individual's response to environmental changes.
3. Perception: The individual's interpretation of internal and external stimuli.

FOUR CONSERVATION PRINCIPLES:

1. Conservation of energy
2. Conservation of structural integrity
3. Conservation of personal integrity
4. Conservation of social integrity

Conservation of energy
* Refers to balancing energy input and output to avoid excessive fatigue
* Includes adequate rest, nutrition and exercise.

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Conservation of structural integrity
It refers to maintaining or restoring the structure of body preventing physical breakdown and
promoting healing.
Conservation of personal integrity
It recognizes the individual as one who strives for recognition, respect and self-determination.
Conservation of social integrity
An individual is recognized as someone who resides with in a family, a community, a
religious group, and ethnic group.

MARTHA ROGER’S MODEL OF SCIENCE OF

UNITARY HUMAN BEINGS

Martha Rogers' model, known as the Science of Unitary Human Beings, is a nursing theory
that views humans as indivisible energy fields that are connected to their environment.
Martha Rogers' Science of Unitary Human Beings, published in 1970, is a nursing theory that
views humans as unitary beings, integral with their environment. The theory focuses on the
individual's unique experiences and the nurse's role in promoting harmony and balance.

KEY CONCEPTS:
1. Energy field
* The energy field is the fundamental unit of both the living and non-living
* This energy field "provide a way to perceive people and environment as irreducible wholes"
* The energy fields continuously vary in intensity, density, and extent
2. Openness
* The human field and the environmental field is constantly exchanging their energy
* There are no boundaries or barrier that inhibit energy flow between fields
3. Pattern
* Pattern is defined as the distinguishing characteristic of an energy field perceived as a
single wave.
* Pattern is an abstraction and it gives identity to the field"

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4. Pan dimensionality
* Pan dimensionality is defined as non-linear domain without spatial or temporal attributes"
* The parameters that human use in language to describe events are arbitrary.
* The present is relative; there is no temporal ordering of lives.
5. Unitary Human Being (person)
* A unitary human being is an irreducible, indivisible, pan dimensional (four-dimensional)
energy field identified by pattern and manifesting characteristics that are specific to the whole
and which cannot be predicted from knowledge.
* The people has the capacity to participate knowingly and probabilistically in the process of
change.

ROGERIAN THEORIES
1. The Theory of Accelerating Evolution
Theory postulates that evolutionary change is speeding up and that the range of diversity of
life process is widening. Rogers explained that higher wave frequencies are associated with
accelerating human development.
2. Theory of Paranormal Phenomena
* This theory focuses on explanation precognition, déjàvu, clairvoyance, telepathy, and
therapeutic touch.
* Clairvoyance is rational in a four-dimensional human field in continuous mutual,
simultaneous interaction with a four-dimensional world; there is no linear time nor any
separation of human and the environmental fields.
3. Theory of Rhythmicity
* Focus on the human field rhythms (these rhythms are different from the biological,
psychological rhythm)
* This theory deals with the manifestations of the whole unitary man as changes in human
sleep wake patterns, indices of human field motion, perception of time passing, and other
rhythmic development.

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 PARSE’S HUMAN BECOMING THEORY

Rosemarie Parse's Human Becoming Theory, published in 1981, is a nursing theory that
focuses on the individual's experiences, meanings, and values. The theory views humans as
unique, open systems who are constantly becoming.
* Parse's Human Becoming Theory guides the practice of nurses to focus on quality of life as
it is described and lived.
* Parse's model rates quality of life from each person's own perspective as the goal of the
practice of nursing. Rosemarie Rizzo Parse first published the theory in 1981 as the "Man-
living-health" theory, and the name was changed to the "human becoming theory" in 1992.
* The model makes assumptions about man and becoming, as well as three major
assumptions about human becoming.

This theory makes following assumptions about man:

1. The human is coexistent while co-constituting rhythmical patterns with the universe.
2. The human is open, freely choosing meaning in a situation, as well as bearing
responsibility for decisions made.
3. The human is unitary, continuously co-constituting patterns of relating.
4. The human is transcending multi-dimensionally with the possibles.

The Human Becoming Theory makes the following assumptions about becoming:
1. Becoming is unitary with human-living-health.
2. Becoming is a rhythmically co-constituting the human-universe process.
3. Becoming is the human's patterns of relating value priorities.
4. Becoming is an inter-subjective process of transcending with the possibles.
5. Becoming is the unitary human's emerging.
Parse's theory includes a symbol with three elements:
1. The black and white colours represent the opposite paradox significant to ontology of
human becoming, while green represents hope.
2. The joining in the centre of the symbol represents the co-created mutual human universe
process at the ontological level, and the nurse-patient process.
3. The green and black swirls intertwining represent the human-universe co-creation as an
ongoing process of becoming.
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MAJOR DIMENSIONS OF THEORY
1. Function of professional nursing - organizing principle
2. Presenting behaviour - problematic situation
3. Immediate reaction - internal response
4. Nursing process discipline - investigation
5. Improvement - resolution

Functions of Professional Nursing - Organizing Principle

* Finding out and meeting the patient’s immediate needs for help.
* Nursing is responsive to individuals who suffer or anticipate a sense of helplessness, it is
focused on the process of care in an immediate experience.
* The purpose of nursing is to supply the help a patient requires for his needs to be met.
* If the patient has an immediate need for help and the nurse finds out and meets that need
the function of professional nursing is achieved.
Presenting Behaviour - Problematic Situation
* To find out the immediate need for help, the nurse must first recognize the situation as
problematic.
* The presenting behaviour of the patient, regardless of the form in which it appears, may
represent a plea for help.
* The presenting behaviour of the patient, the stimulus, causes an automatic internal response
in the nurse, and the nurses behaviour causes a response in the patient.
Immediate Reaction-Internal Response
* Person perceives with any one of his five sense organs an object or objects.
* The perceptions stimulate automatic thought.
* Each thought stimulates an automatic feeling.
* The first three items taken together are defined as the person's immediate reaction.
* Reflects how the nurse experiences her or his participation in the nurse patient situation.
Nursing Process Discipline – Investigation
* Any observation shared and explored with the patient is immediately useful in ascertaining
and meeting his need or finding out that he is not in need at that time.
* The nurse does not assume that any aspect of her reaction to the patient is correct, helpful or
appropriate until she checks the validity of it in exploration with the patient.
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* The nurse initiates a process of exploration to ascertain how the patient is affected by what
she says or does.
* Automatic reactions are not effective because the nurses action is decided upon for reasons
other than the meaning of the patients behaviour or the patients immediate need for help.
* When the nurse does not explore with the patient her reaction it seems reasonably certain
that clear communication between them stops.
Improvement – Resolution
* It is not the nurses' activity that is evaluated but rather its result: whether the activity serves
to help the patient communicate her or his need for help and how it is met.
* In each contact the nurse repeats a process of learning how to help the individual patient.
* Her own individuality and that of the patient requires that she go through this each time she
is called upon to render service to those who need her.

CONCLUSION
Nursing theories illuminate the multifaceted nature of nursing practice. They serve as guides,
empowering nurses to provide compassionate care, make informed decisions and adapt to the
ever-changing healthcare landscape. These theories, whether focused on the environment,
human relationships, self-care, or cultural sensitivity, collectively shape the essence of
nursing – an art that intertwines with science to promote health, alleviate suffering and
enhance the quality of life. In essence, nursing theories provide a structured framework for
nurses to approach patient care in a systematic and thoughtful manner. By incorporating these
theories into their practice, nurses can provide care that is not only based on scientific
knowledge but also takes into account the unique needs and circumstances of each patient,
fostering a patient-centred approach that is at the core of the nursing profession.

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 RESEARCH ABSTRACT

Abstract-I
Imogene King, a renowned nursing theorist, introduced the Theory of Goal Attainment,
which revolutionized the nursing profession. This theory emphasizes the importance of nurse-
patient collaboration, focusing on mutual goal setting and achievement. By embracing this
theory, nurses can create therapeutic relationships, enhance patient outcomes and contribute
significantly to the overall well-being of individuals in their care. At the heart of King’s
Theory of Goal Attainment lies the dynamic interpersonal relationship between the nurse and
the patient. King posited that nurses and patients work together to establish health-related
goals. The theory comprises three interacting systems: personal, interpersonal and social. The
personal system represents the individual's perception and understanding of their health and
wellbeing. The interpersonal system involves the nurse and patient, with both parties
contributing to the establishment of goals. The social system encompasses the broader
healthcare environment and the resources available to support goal achievement.
By - Rebecca Heron
Department of Community Medicine and Rehabilitation
University of Kentucky College of Nursing
Lexington, KY, USA
Abstract-II
A study on the effect of COVID-19 on children shows that once we pay special attention to
the psychological aspect of youngsters, the worst effect occurs, although less sensitive to
COVID-19. There’s also evidence that nursing care supported by Betty Newman's model
helps prevent 94% of patients with psychiatric cases within the medical care unit.
Objectives: To evaluate the efficacy of modified Betty Newman’s Nursing Theory to develop
an evidence-based pandemic care pathway for preadolescents between the experimental and
control groups and associate the post-test score of preadolescents with their demographic
variables.
Methodology: Preadolescent students will be recruited for the Superiority trial. the standard
and modified Betty Newman theory will be applied to the control and experimental group.
The pre and post-test of both groups will be evaluated for their effectiveness.
Expected Outcomes: The newly developed pandemic care approach will effectively reduce
the psychological impact of pandemics in Preadolescent children.
Conclusions: Generation of pandemic care pathway for preadolescents and Reduction of the
psychological impact of the pandemic among preadolescents.
Keywords: Psychological impact, pandemic, preadolescents, Betty Neumann’s theory,
pandemic care pathway.
By - Jayant Vaga
Jawaharlal Nehru Medical College, HP
 BIBLIOGRAPHY

1. Basheer S. Advanced Nursing Practice.3rded. EMMESS: Medical Publishers. (P) Ltd.

2022, PP-361-500.
2. Kaur N. Textbook of Advanced Nursing Practice.2nd ed. Jaypee Publishers New Delhi (P)
Ltd. 2020, PP-563-600.

Additional Websites
1. https://pmc.ncbi.nlm.nih.gov/articles/PMC10098484/
2. https://nursology.net/nurse-theories/

3. https://nurseslabs.com/jean-watsons-philosophy-theory-transpersonal-caring/