Six Nursing Theories and Their Influence in Nursing Care

Several policies, theories and rules guide the nursing profession. The theories are put in place to help nurses understand their patients and give them tailored care that’s unique to everyone. 

Nursing theories center around major concepts such as environment, health, personal care and nursing itself. They guide the profession in various healthcare settings including acute, chronic, and community-based care. This article will discuss six nursing theories, and their influence on modern nursing. 

Six nursing theories influencing nursing across all healthcare settings

Nursing theories give nurses a framework to help them understand and analyze patient care. Several key nursing theories have revolutionized the provision of care in the nursing profession.

Florence Nightingale’s environmental theory

Florence Nightingale believed in environmental hygiene. She believed that one must have clean air, water, basic sanitation, light, and a clean environment to have a healthy home or healthcare setting. These are the five points on which the Florence Nightingale environmental theory is based. 

Florence Nightingale trained as a nurse in 1851. She served as a nursing professional and statistician during the Crimean war. Her observations and experience during the war laid the foundation for her environmental theory, which has now become a cornerstone in nursing practices today. 

During the war, Nightingale noticed that soldiers weren’t just dying from their injuries; they had infections from the unsanitary conditions of the hospitals. Unhygienic water was infecting their wounds, and the surroundings weren’t clean enough to improve their health.  

She believed that health and recovery were about more than medical treatments, and hospitals needed five elements to create a healing environment:

Clean water and fresh air

Having clean water and unpolluted air would prevent infections and promote health. Nightingale insisted on proper ventilation and a pure water supply in hospitals, which was a radical idea at the time. 

Basic sanitation 

Lack of sanitation is a major cause of infection and disease spread, especially in acute and chronic patients. Nightingale encouraged nurses, patients, and medical staff to practice personal hygiene. Her theory also advocated for improved sanitary methods to reduce the rate of infections among the wounded and sick. 

Cleanliness

Nightingales believed that an unclean environment is a perfect breeding ground for dirt and germs. To counter this, she introduced basic cleaning practices in nursing care, including preparing baths for patients, and changing the sheets. These practices are still important in today’s medical care. 

Lights

Bright surroundings are vital in maintaining a cheerful environment. Nightingale also believed that light played a role in disease prevention. She advocated for the presence of natural light in patient recovery areas to help speed up their healing process.

History says that Nightingale’s principles reduced the mortality rates during the Crimean War. Soldiers healed better and nurses became better at their jobs. Her approach combined her observations with statistical evidence, which paved the way for the development of evidence-based medicine today. Her emphasis on creating a healing environment still resonates in the way modern hospitals are designed to reduce hospital-acquired infections.

Virginia Henderson’s need theory

Henderson, often referred to as the Nightingale of modern nursing, was a nurse and theorist in the 20th century, a time when the profession was experiencing a shift. Nurses were transitioning from basic caretakers to taking on more roles within the healthcare system.

At the time, Henderson defined the role in this way: “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.” 

She believed nurses were vital in helping patients recover and gain back a level of independence. Her theory outlined fourteen basic needs:

• breathing normally
• eating and drinking adequately 
• eliminating body waste
• moving and maintaining desirable postures 
• sleeping and resting 
• selecting suitable clothes. 
• maintaining body temperature
• avoiding dangers
• keeping the body clean 
• communicating with others 
• the need for worship according to one’s faith
• having a sense of accomplishment
• playing
• learning, discovering, or satisfying curiosity. 

Henderson’s perspective shifted the focus of nursing from mere medical care practitioners to professionals who provided holistic health support for their patients. In modern nursing, many reputable universities now infuse this knowledge into their teaching programs to educate nurses. These include Wilkes University’s ABSN programs online. It’s a reputable, Commission on Collegiate Nursing Education (CCNE) accredited program, lasting 15 months within four semesters. Registered students have a total of 11 courses, and 48 credit hours. They also have access to two residencies – one online, and another on campus. 

If this interests you, you need a bachelor’s degree with a 3.0 GPA, two letters of recommendation, and your statement of professional goals. Beyond the academic field, Henderson’s theory also influences different nursing care settings.

In acute care settings, like hospitals, Henderson’s theory encourages personalized care plans that address these basic needs. Here, nurses assess patients to determine which of the fourteen needs they can meet independently and where they need help. 

It’s like community-based care, where nurses use the need theory to encourage patients to take an active role in their healthcare. In chronic care, where patients deal with long-term health challenges, Henderson’s theory guides nurses to help patients manage their conditions. The goal of the need theory is to help patients become independent enough to carry out activities to the best of their capabilities.

Dorothea Orem’s self-care deficit theory

Dorothea Orem emphasized the need to prioritize patient independence and self-care. She believed that every individual, patient or not, should be self-reliant and responsible for their care. While medical care was essential, Orem believed that it was equally important for patients to take an active role in their own care. 

She built the self-care deficit theory on the premise that individuals should care for themselves to the extent of their ability. It concludes that nursing becomes necessary when an individual cannot fulfill their own self-care needs due to limitations like illnesses, injuries or lack of knowledge on what to do.

Orem discussed three interrelated theories within this framework: 

• The theory of self-care
• The theory of self-care deficit 
• The theory of nursing systems

The theory of self-care revolves around activities that individuals can perform on their own behalf to maintain their life, health, and well-being. The second theory relates to the self-care deficit which shows up when individuals cannot effectively care for themselves. The last theory – the theory of nursing systems – discusses how nurses can provide care to patients. 

When it comes to chronic care, Orem’s theory emphasizes that nurses should educate patients about their conditions and equip them with the skills they need to manage their health. This will encourage autonomy, which is crucial for dealing with long-term conditions.

Jean Watson’s theory of human caring

Watson started her nursing career in the 1960s when medical procedures and protocols dominated the field. Creating human connection between nurses and their patients was not a norm as patients were just individuals with illnesses. They were not people with stories, fears, or hopes that nurses could connect to and reinforce.

Therefore, Jean Watson envisioned a world where nurses genuinely care and connect with their patients. She describes nursing as a field that focuses on the individual and how they experience health and sickness. In essence, it’s about how nurses understand and care for each patient and their unique health condition.

Her theory highlights three core metaparadigm concepts: the person, their health, and the act of nursing itself. 

Watson believes each person is valuable and should be nurtured, cared for, and assisted. She sees individuals as complex beings and stresses that each person should be seen as a whole, with all aspects of their lives considered.

To her, “health” means more than being free from illnesses. It means having good physical, mental and social health. 

The hustle and bustle of acute care settings can overshadow the individual needs of patients. Watson’s theory reminds nurses to slow down and connect with their patients. This approach can significantly calm patients who are afraid or are in pain – it’s partly the reason for group therapies for cancer patients. 

Watson’s theory is also relevant in chronic care settings as it reminds nurses that their work is about managing symptoms and building relationships with their patients. Nurses who embrace this approach can help their patients develop a sense of normalcy and embrace some form of dignity, even in precarious situations.

Hildegard Peplau’s interpersonal relations theory

Hildegard Peplau’s theory also focuses on the relationship between nurses and patients. Before the development of her theory, nursing was mostly about doing tasks. However, Peplau saw nurses as a vital part of patients’ emotional and mental health. 

She believed that talking with patients, understanding them and empathizing with them is really important in nursing. Peplau’s idea is that patients are more likely to heal and get better when nurses form helpful relationships with them. 

According to Peplau, the nurse-patient relationship has different stages: 

• The first is getting to know each other. This can be their first conversations and recurring hellos during ward visits. 
• The next stage is identifying problems, such as the patient’s condition and what they need to get better.
• The third stage is using the relationship to help the patient. For instance, nurses could engage patients in discussions during medical procedures to help them take their minds off the procedure. 
• The final stage is solving the problem. Each of these stages is vital to helping the patient get better. 

Peplau’s theory plays out differently in different healthcare settings. In hospitals, nurses can use their interpersonal skills to build trust, understand their patients’ needs and give needed support. This skill can help them reduce patient anxiety and encourage them to cooperate. 

The use of interpersonal relations theory can be even more pronounced when nurses are caring for patients in the long term. Their relationship grows over time, and the nurse can truly understand their patient. This insight will help them create personalized care plans throughout their illness.

Madeleine Leininger’s transcultural nursing theory

Madeleine Leininger was a nursing theorist and an anthropologist whose work was largely undertaken between 1956-1995. She introduced the idea of transcultural nursing in the 1950s because she noticed a disparity in care between nurses and patients of different races. 

The lack of attention to cultural differences meant that patients were receiving less care and concern than they should. She proposed that nurses serve every population and should infuse the knowledge of transcultural nursing into their approach. This observation and proposition led to the birth of transcultural nursing theory, also known as the culture care theory.

The core of Leininger’s theory is that different cultures have unique ways of caring for people. She suggested that nurses should learn about these cultural differences to give respectful and sensitive care to their patients. 

Her theory is most relevant in community care where nurses treat people from different cultural backgrounds. Nurses are to respect and adapt to these cultural differences, especially their sentiments about healthcare.

In modern healthcare, cultural competence will help nurses, physicians and other healthcare professionals build trust with their patients. In this way, professionals protect the integrity of Leininger’s idea of nursing action which involved keeping cultural practices (culture care preservation) and adapting care to fit cultural needs (culture care accommodation).

In summary, Leininger believes that culturally competent nurses will always learn about and respect their different patients’ viewpoints and culture with the sole aim of increasing the quality of care.

Conclusion

These nursing theories can be adjusted and used in different ways to match the needs of each patient as well as the challenges of the healthcare setting and its professionals. Nurses now mix these ideas with their practical skills and knowledge to give complete, focused care, regardless of the setting or the patient.