1. Nursing Theory
What is it?
Deanna B Hiott MSN,RN

2. Nursing Domain
A domain is a specific area of expert knowledge.
Thedomain of nursing describes the profession’s
subject, concepts, values, and beliefs.
Nursing’s domain is the profession itself, past, present,
future…

3. The Nursing Paradigm…
A paradigm is a model. It describes the domain
using science, philosophy and theory. Nursing’s
paradigm involves person, health, environment
and nursing.
Environment – setting affecting client, family,
community
Health – dynamic, changing, individual
Nursing Care – treatment of human responses to
illness
Person – recipient of care, individual, family,
community

4. Nursing Theories
Are composed of concepts, definitions and
proposals to explain phenomenon.
A phenomenon is an aspect of life that people
experience
Nursing theories provide the lens through which
nursing care and interventions are viewed
Different theories emphasize different areas of
care or concern

5. Nursing Theories can be
described as…
Descriptive: First level, describe phenomena
Prescriptive: Address nursing interventions
Mid-Range: Limited, less abstract, reflect a wide
variety of nursing situations
Grand: Broad, complex, addresses nursing
framework not specific interventions

6. Common Nursing Theories
Nightingale (1860) fresh air, light, cleanliness, quiet
and proper nutrition
Peplau (1952) Interpersonal Relations Theory,
mutual goal setting
Virginia Avenal Henderson (1955) 14 basic human
needs.
Martha Rogers Science of Unitary Human Beings
(1970)
Betty Neuman (1972) Systems Theory

7. Common Nursing Theories
Orem’s Self Care Deficit Theory (1971)
Leininger’s Culture Care Theory (1991)
Sister Calista Roy’s Adaptation Theory focuses
on helping the client adapt to health changes
Watson’s Theory of Human Caring 1979
(Potter & Perry, 2009)

8. Nurses also use
interdisciplinary theories...
Maslow’s Hierarchy of Needs –
Helps prioritize care
Developmental theories – Piaget, Erikson…
Helps anticipate care
Psychosocial theories - grief, culture, learning,
family
Helps predict care

9. What’s the point?
Over the years nurses have attempted to define
nursing. From these efforts, numerous theories
have emerged. Many might consider these
theories rather dry material, and in all honesty,
this was probably my first conclusion as well. As I
studied nursing theorists, I felt confused by the
language. I was at a loss to see the purpose.
However, for any students grappling with these
same feelings, I would like to encourage you.
The more you study them, the more you
appreciate these nurses who spent a great deal
of time and effort defining our profession, for
ultimately this is what delineates a science.

10. Assessing Nursing
Theories
Theory relevance can be assessed by applying
the theory to a patient care situation
The nursing paradigm of environment, health,
nursing care and person are examined

11. An example of a theorist’s paradigm.
Definitions of person, nurse, health and
environment
 According to Myra Estrine Levine (Conservation Theory) :
 "From the moment of birth until the instant of death,
every individual cherishes and defends his wholeness.
"(Schaefer, Pond 1991, p. 17)
 Health represents the "unity and integrity of the
patient." (George,p.185)
 "Nursing is a human interaction" based on the goal of
promoting wholeness for that individual. (Schaefer,
Pond, 1991,p. 23)
 A patient's environment is internal and external.

12. Nursing Interventions based on a
nursing theory
 Myra Estrine Levine’s Conservation Theory views
nursing care through the lens of conservation…
 1) The conservation of energy
 2) The conservation of structural integrity
 3) The conservation of personal integrity
 4) The conservation of social integrity
(George, 1990)

13. Research can test the application of
Nursing Theory
 Levine's theory has been tested in several different nursing
situations:
 to mitigate fatigue in cancer patients
 to wean patients off the ventilator
 to preserve and protect the infant and the family in the
neonatal intensive care unit (NICU).

14. ENVIRONMENTAL
INFLUENCES ON PRETERM INFANT
 Development of a healthy fetus should occur in an intrauterine environment, when this
process is interrupted the neonate must conform to environmental factors including:
 Perceptual Environment:
Instead of the dark, quiet fluid-filled
environment, the neonate must adjust
to the NICU's complex sensory stimuli,
such as light, noise, people and
equipment.
 Operational Environment:
The neonate has been removed from
the protection of the uterus, placing
the infant at risk for infection, and a
reduced muscle mass
 Conceptual Environment:
CNS competence depends on the
gestational age at delivery. Neonates
must quickly learn how perform oral
feedings and interact with family.

15. HEALTH (WHOLENESS)
INFLUENCES ON PRETERM INFANTS
 Physiologic immaturity: Neonates must use energy adapt to
underdeveloped respiratory, gastrointestinal, and central
nervous systems.
 Structural immaturity: Neonates must confront increased
risks of infections, toxic effects of oxygen administration,
retinal detachment, GI disorders, brain injury,
musculoskeletal abnormalities.
 Neurologic Immaturity: Sense of identity can be affected.
 Disruption in Family System: Challenges include grieving
the loss of the healthy infant, disruption of bonding, parenting
a special needs child, social identity.
(Mefford, 2004)

16. NURSING INFLUENCES
PRETERM INFANTS
Conservation of Energy:
 oxygen, ventilation, airway integrity,
breathing assessments
 provide calm environment, promote
rest, pain control, temperature
regulation
 provide nutrition: parenterally, g-tube,
orally

17. NURSING INFLUENCES
PRETERM INFANTS
 Conservation of Structural Integrity:
 Promote optimal oxygenation while minimizing need for
supplemental o2
 Stabilize blood pressure; calm environment, comfort
 Prevent infections; hand hygiene, aseptic technique, maintain
skin integrity
 Monitor internal feedings for tolerance
 Promote flexed posture
(Mefford, 2004)

18. NURSING INFLUENCES
PRETERM INFANTS
 Conservation of Personal Identity:
 Interpret physiologic cues (vs, labs, physical
assessment findings)
 Effectively communicate with the neonate, by
recognizing the response: read the message
 Minimize signs of stress
 Promote self-regulating behavior
(Levine, 1973)(Mefford, 2004)

19. NURSING INTERVENTIONS
PRETERM INFANTS
 Conservation of Social Integrity:
 Modifying NICU to welcome families and promote
parental comfort
 Assist parents through grief of loss of having a
healthy infant
 Provide support to family to cope with NICU
experience
 Foster parent-infant attachment
 Facilitate parent performance of infant care
 Ensure infant and family's readiness for discharge
from the NICU
(Mefford, 2004)

20. Links to Nursing Theory
http://nursingclass2.wikispaces.com/Nursing+Th
eorists
http://currentnursing.com/nursing_theory/introduc
tion.html
http://nursing-theory.org/

21. Bibliography
Alligood, Martha; Ann Marriner-Tomey. (1997). Nursing Theory Utilization and Application. St. Louis: Mosby.
Ann Marriner Tomey, Martha Raile Alligood. (1998). Nursing Theorists and Their Work (4th ed.). (L. Wilson, Ed.) St Louis:
Mosby.
Delmore, B. A. (2006). Levine's Framework in Long-Term Ventilated Patients During the Weaning Course. Nursing
Science Quarterly , 19 (3), 247-258.
George, J. B. (Ed.). (1990). Nursing Theories: The Base for Professional Nursing Practice (3rd ed.). Norwalk, Connecticut:
Appleton and Lange.
Kathleen Sitzman, Lisa Wright Eichelberger. (2004). Understanding the Work of Nurse Theorists : A Creative Beginning.
Sudbury, Massachusetts: Jones and Bartlett Publishers, Inc.
Mefford, L. (2004). A Theory of Health Promotion for Preterm Infants Based on Levine's Conservation Model of Nursing.
Nursing Science Quarterly , 17 (3), 260-266.
Melanie McEwen, Evelyn M. Wills. (2007). Theoretical Basis for Nursing (2nd ed.). (H. Kogut, E. Kors, & M. Zuccarini,
Eds.) Philadelpia, PA: Lippincott Williams & Wilkins.
Myra Levine, Jacqueline Fawcett. (1991). Levine's Conservation Model: A Framework for nursing Practice. (K. M.
Schaefer, & J. B. Pond, Eds.) Philadelphia: F.A.Davis Company.
Victoria Mock, Christine St, Ours, Amy Bositis, Miriam Tillery, Anne Belcher, Sharon Krumm and Ruth McCorkle. (2007).
Using a conceptual model in nursing research - mitigating fatigue in cancer patients. Journal of Advanced Nursing , 58 (5),
503-512.